Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) refers to an infection and inflammation of the female pelvic organs, including the uterus, fallopian tubes, ovaries, and surrounding peritoneum. It is typically caused by an ascending infection from the endocervix.

Clinical Features

1. Lower Abdominal Pain: Persistent or intermittent pain in the lower abdomen or pelvis.
2. Fever: Elevated body temperature indicating infection.
3. Deep Dyspareunia: Painful sexual intercourse.
4. Dysuria: Painful urination and potential menstrual irregularities.
5. Vaginal or Cervical Discharge: Often indicative of infection.
6. Cervical Excitation: Tenderness when the cervix is moved during a pelvic exam.
7. Abnormal Vaginal Bleeding: Including post-coital bleeding.

Risk Factors

. Age under 25
. Use of intrauterine devices (IUDs)
. Multiple sexual partners
. History of sexually transmitted infections (STIs)
. Recent uterine instrumentation (e.g., surgical termination of pregnancy)

Investigations

i. Screening for STIs: Vaginal swab for Chlamydia and Gonorrhoea are essential to diagnose and manage PID.
ii. Pelvic Ultrasound: Can be used to assess the extent of the infection and any complications.

Management

Chlamydial Infection

ii. First Line: Doxycycline 100 mg twice daily for 7 days.
ii. Alternative: Azithromycin 1 gram orally followed by 500 mg once daily for 2 days.

Neisseria Gonorrhoeae Infection
Option 1: Ceftriaxone 1 gram intramuscularly (single dose).
Option 2: Ciprofloxacin 500 mg orally (single dose).

General Treatment:
i. Broad-spectrum antibiotics to cover potential pathogens.
ii. Hospitalization may be necessary for severe cases or if the patient is pregnant.