Harvey's Garden

Pelvic inflammatory disease

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  • A bacterial infection that spreads beyond the cervix to infect the upper female reproductive tract, i.e., the:
    • Endometrium (endometritis)
    • Fallopian tubes (salpingitis, pyosalpinx, tubo-ovarian abscess)
    • Ovaries (oophoritis, tubo-ovarian abscess)
    • Surrounding pelvic structures (parametritis)
    • Pelvic peritoneum (peritonitis)

Epidemiology

Etiology

  • Pathogens
    • Most common: Chlamydia trachomatis, Neisseria gonorrhoeae
  • Risk factors
    • Multiple sexual partners, unprotected sex
    • History of prior STIs and/or adnexitis
    • Intrauterine devices
      • Patients with long-term intrauterine devices (IUDs) are at increased risk for developing an active Actinomyces infection, as evidenced by this patient’s culture that reveals acute-angle branching, gram-positive bacilli.

Pathophysiology

Clinical features

  • Lower abdominal pain (generally bilateral), which may progress to acute abdomen
  • Nausea, vomiting
  • Fever
  • Dysuria, urinary urgency
  • Menorrhagia, metrorrhagia
  • Dyspareunia
  • Abnormal vaginal discharge (yellow/green color)

Diagnostics

Treatment

  • Broad-spectrum antibiotic regimen, similar to Treatment

Complications

  • Long-term complications
    • Pathophysiology: inflammation (e.g., salpingitis) →
      • Tubal scarring
      • Adhesions of the fallopian tubes and ovaries
      • Hydrosalpinx: the accumulation of fluid in the fallopian tubes
    • Manifestations
      • Tubal infertility (related to loss of tubal ciliary function)
      • Ectopic pregnancy
      • Chronic pelvic pain

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