Abstract
This seminar work entitled pelvic inflammatory disease/disorder is an
infection of the upper part of the female reproductive system namely the
uterus, fallopian tubes, ovaries , and inside of the pelvis. The main causes
are Infections by Neisseria gonorrhea and
Chlamydia trachomatis. Its has signs and symptoms that include lower abdominal
pain, vaginal discharge, fever, burning with urination, pain with sex, or irregular
menstruation. Long term complications including infertility, ectopic pregnancy,
chronic pelvic pain and cancer when untreated. Preventions include not having
sex or having few sexual partners and using condoms. Screening women at risk
for Chlamydial infection followed by treatment decreases the risk of PID.
infection of the upper part of the female reproductive system namely the
uterus, fallopian tubes, ovaries , and inside of the pelvis. The main causes
are Infections by Neisseria gonorrhea and
Chlamydia trachomatis. Its has signs and symptoms that include lower abdominal
pain, vaginal discharge, fever, burning with urination, pain with sex, or irregular
menstruation. Long term complications including infertility, ectopic pregnancy,
chronic pelvic pain and cancer when untreated. Preventions include not having
sex or having few sexual partners and using condoms. Screening women at risk
for Chlamydial infection followed by treatment decreases the risk of PID.
treatment
for mild pelvic inflammatory disease includes a single injection of
theantibiotic ceftriaxone along with two weeks of doxycycline and possibly
metronidazole by mouth is recommended. In cases that do not improve after three
days intravenous antibiotics should be used. Intravenous antibiotics like
Gentamicin loading dose IV or IM (1mg/kg), followed by a maintenance dose (1.5
mg/kg) every 8 hours. Single daily dosing (3–5 mg/kg) can be substituted. Doxycycline
100 mg orally or IV every 12 hours, Cefotetan 2 g IV every 12 hours. After PID
is cured there may be permanent effect like damage to the reproductive system,
Formation of scar tissue due to one or episodes of PID can lead to tubal
blockage, increasing the risk of the inability to get pregnant and long-term
pelvic/abdominal pain.
Introduction
Pelvic inflammatory disease or pelvic inflammatory disorder (PID ) is an
infection of the upper part of the female reproductive system namely the
uterus, fallopian tubes, ovaries , and inside of the pelvis. Often there may be
no symptoms. Signs and symptoms, when present
may include lower abdominal pain, vaginal discharge, fever, burning with
urination, pain with sex, or irregular menstruation. Untreated PID can result
in long term complications including infertility, ectopic pregnancy, chronic
pelvic pain and cancer.
infection of the upper part of the female reproductive system namely the
uterus, fallopian tubes, ovaries , and inside of the pelvis. Often there may be
no symptoms. Signs and symptoms, when present
may include lower abdominal pain, vaginal discharge, fever, burning with
urination, pain with sex, or irregular menstruation. Untreated PID can result
in long term complications including infertility, ectopic pregnancy, chronic
pelvic pain and cancer.
Disease is caused by bacteria that spread from the vagina and
cervix. Infections by Neisseria
gonorrhoeae or Chlamydia trachomatis are present in 75 to 90 percent of cases.
Often multiple different bacteria are involved. Without treatment about 10
percent of those with a chlamydial infection and 40 percent of those with a gonorrhea
infection will develop PID. Risk factors
are similar to those of sexually transmitted infections generally and include a
high number of sexual partners and drug use. Vaginal douching may also increase
the risk. The diagnosis is typically
based on the presenting signs and symptoms.
It is recommended that the disease be considered in all women of
childbearing age who have lower abdominal pain.
cervix. Infections by Neisseria
gonorrhoeae or Chlamydia trachomatis are present in 75 to 90 percent of cases.
Often multiple different bacteria are involved. Without treatment about 10
percent of those with a chlamydial infection and 40 percent of those with a gonorrhea
infection will develop PID. Risk factors
are similar to those of sexually transmitted infections generally and include a
high number of sexual partners and drug use. Vaginal douching may also increase
the risk. The diagnosis is typically
based on the presenting signs and symptoms.
It is recommended that the disease be considered in all women of
childbearing age who have lower abdominal pain.
Preventions include not having sex or having few sexual partners and
using condoms. Screening women at risk
for chlamydial infection followed by treatment decreases the risk of PID. If the diagnosis is suspected, treatment is
typically advised. Treating a woman’s
sexual partners should also occur. In
those with mild or moderate symptoms a single injection of the antibiotic
ceftriaxone along with two weeks of doxycycline and possibly metronidazole by
mouth is recommended.
using condoms. Screening women at risk
for chlamydial infection followed by treatment decreases the risk of PID. If the diagnosis is suspected, treatment is
typically advised. Treating a woman’s
sexual partners should also occur. In
those with mild or moderate symptoms a single injection of the antibiotic
ceftriaxone along with two weeks of doxycycline and possibly metronidazole by
mouth is recommended.
For those who do not improve after three days or who have severe disease
intravenous antibiotics should be used. Globally about 106 million cases of
chlamydia and 106 million cases of gonorrhea occurred in 2008. The number of cases of PID however, is not
clear. It is estimated to affect about
1.5 percent of young women yearly. In
the United States PID is estimated to affect about one million people yearly.
intravenous antibiotics should be used. Globally about 106 million cases of
chlamydia and 106 million cases of gonorrhea occurred in 2008. The number of cases of PID however, is not
clear. It is estimated to affect about
1.5 percent of young women yearly. In
the United States PID is estimated to affect about one million people yearly.
Signs and symptoms
Symptoms in PID range from none to severe. If there are symptoms, then
fever, cervical motion tenderness, lower abdominal pain , new or different
discharge, painful intercourse , uterine tenderness, adnexal tenderness, or irregular
menstruation may be noted.
fever, cervical motion tenderness, lower abdominal pain , new or different
discharge, painful intercourse , uterine tenderness, adnexal tenderness, or irregular
menstruation may be noted.
Other complications include endometritis, salpingitis, tubo-ovarian
abscess, pelvic peritonitis, periappendicitis, and perihepatitis.
abscess, pelvic peritonitis, periappendicitis, and perihepatitis.
Causes
Chlamydia trachomatis and Neisseria gonorrhoeae are usually the main
cause of PID. Other bacteria involved may include
cause of PID. Other bacteria involved may include
Bacteria involved
·
Chlamydiatrachomatis
Chlamydiatrachomatis
·
Neisseriagonorrhoea
Neisseriagonorrhoea
·
Prevotellaspp.
Prevotellaspp.
·
Streptococcuspyogenes
Streptococcuspyogenes
·
Prevotellabivia
Prevotellabivia
·
Prevotelladisiens
Prevotelladisiens
·
Bacteroidesspp.
Bacteroidesspp.
·
Peptostreptococcusasaccharolyticus
Peptostreptococcusasaccharolyticus
·
Peptostreptococcusanaerobius
Peptostreptococcusanaerobius
·
Gardnerellavaginalis
Gardnerellavaginalis
·
Escherichia coli
Escherichia coli
·
GroupBstreptococcus
GroupBstreptococcus
·
α-hemolyticstreptococcus
α-hemolyticstreptococcus
·
Coagulase-negativestaphylococcus
Coagulase-negativestaphylococcus
·
Atopobiumvaginae
Atopobiumvaginae
·
Acinetobacterspp.
Acinetobacterspp.
·
Dialisterspp.
Dialisterspp.
·
Fusobacteriumgonidiaformans
Fusobacteriumgonidiaformans
·
Gemellaspp.
Gemellaspp.
·
Leptotrichiaspp.
Leptotrichiaspp.
·
Mogibacteriumspp.
Mogibacteriumspp.
·
Porphyromonasspp.
Porphyromonasspp.
·
Propionibacteriumacnes
Propionibacteriumacnes
·
Sphingomonasspp.
Sphingomonasspp.
·
Veillonellaspp.
Veillonellaspp.
·
Mycoplasmagenitalium
Mycoplasmagenitalium
·
Mycoplasmahominis
Mycoplasmahominis
·
Urea plasmaspp.
Urea plasmaspp.
Chlamydia trachomatis
Chlamydia trachomatis commonly known as chlamydia, is one of four bacterial species in the genus
Chlamydia . Chlamydia is a genus of pathogenic bacteria that are obligate
intracellular parasites.
Chlamydia . Chlamydia is a genus of pathogenic bacteria that are obligate
intracellular parasites.
C. trachomatis is a Gram-negative bacterium . It is ovoid in shape and
nonmotile. The bacteria are non spore -forming, but the elementary bodies act
like spores when released into the host. The inclusion bodies of C. trachomatis
were first described in 1907 by Stanislaus von Prowazek and Ludwig
Halberstädter during research on trachoma. C. trachomatis agent was first
cultured in the yolk sacs of eggs by Professor Tang Fei-fan , et al. in 1957. Disorders
caused by C. trachomatis include chlamydia, trachoma , lymphogranulomavenereum
, nongonococcal urethritis, cervicitis, salpingitis, pelvic inflammatory
disease , and pneumonia .
nonmotile. The bacteria are non spore -forming, but the elementary bodies act
like spores when released into the host. The inclusion bodies of C. trachomatis
were first described in 1907 by Stanislaus von Prowazek and Ludwig
Halberstädter during research on trachoma. C. trachomatis agent was first
cultured in the yolk sacs of eggs by Professor Tang Fei-fan , et al. in 1957. Disorders
caused by C. trachomatis include chlamydia, trachoma , lymphogranulomavenereum
, nongonococcal urethritis, cervicitis, salpingitis, pelvic inflammatory
disease , and pneumonia .
Identification
Chlamydia species are readily identified and distinguished from other
Chlamydia species using DNA-based tests. Most strains of C. trachomatis are
recognized by monoclonal antibodies (mAbs) to epitopes in the VS4 region of
MOMP. [10] However, these mAbs may also cross-react with two other Chlamydia
species, C. suis and C.muridarum .
Chlamydia species using DNA-based tests. Most strains of C. trachomatis are
recognized by monoclonal antibodies (mAbs) to epitopes in the VS4 region of
MOMP. [10] However, these mAbs may also cross-react with two other Chlamydia
species, C. suis and C.muridarum .
Treatment
Treatment depends on the infection site, age of the patient, and whether
another infection is present. Having a C. trachomatis and one or more other
sexually transmitted infections at the same time is possible. Treatment is
often done with both partners simultaneously to prevent reinfection. C.
trachomatis may be treated with several antibiotic medications, including
azithromycin , erythromycin , or ofloxacin .
another infection is present. Having a C. trachomatis and one or more other
sexually transmitted infections at the same time is possible. Treatment is
often done with both partners simultaneously to prevent reinfection. C.
trachomatis may be treated with several antibiotic medications, including
azithromycin , erythromycin , or ofloxacin .
Neisseria gonorrhea
Neisseria gonorrhea, also known as gonococci (plural), or gonococcus
(singular), is a species of Gram-negative coffee bean-shaped diplococci
bacteria responsible for thesexually transmitted infection gonorrhea
(singular), is a species of Gram-negative coffee bean-shaped diplococci
bacteria responsible for thesexually transmitted infection gonorrhea
Transmission
N. gonorrhoeae is transmitted from person to person during sexual
relations. Traditionally, the bacteria was thought to move attached to
spermatozoon, but this hypothesis did not explain female to male transmission
of the disease. A recent study suggests that rather than “surf” on wiggling
sperm, N.gonorrhoeae bacteria uses hairlike structures called pili to anchor
onto proteins in the sperm and move through coital liquid. It can also be
transmitted to the fetus in utero and afterward become apparent as a neonatal infection
.
relations. Traditionally, the bacteria was thought to move attached to
spermatozoon, but this hypothesis did not explain female to male transmission
of the disease. A recent study suggests that rather than “surf” on wiggling
sperm, N.gonorrhoeae bacteria uses hairlike structures called pili to anchor
onto proteins in the sperm and move through coital liquid. It can also be
transmitted to the fetus in utero and afterward become apparent as a neonatal infection
.
The anatomical structure of the internal organs and tissues of the
female reproductive tract provides a pathway for pathogens to ascend from the
vagina to the pelvic cavity through the infundibulum.
female reproductive tract provides a pathway for pathogens to ascend from the
vagina to the pelvic cavity through the infundibulum.
Diagnosis
Upon a pelvic examination, cervical motion, uterine, or adnexal tenderness
will be experienced. Mucopurulent cervicitis
and or urethritis may be observed. In severe cases more testing may be required
such as laparoscopy, intra-abdominal bacteria sampling and culturing, or tissue
biopsy. Laparoscopy can visualize “violin-string” adhesions, characteristic
of Fitz-Hugh–Curtis perihepatitis and other abscesses that may be present.
will be experienced. Mucopurulent cervicitis
and or urethritis may be observed. In severe cases more testing may be required
such as laparoscopy, intra-abdominal bacteria sampling and culturing, or tissue
biopsy. Laparoscopy can visualize “violin-string” adhesions, characteristic
of Fitz-Hugh–Curtis perihepatitis and other abscesses that may be present.
Other imaging methods, such as ultrasonography, computed tomography
(CT), and magnetic imaging (MRI), can aid in diagnosis. Blood tests can also help identify the presence
of infection: the erythrocyte sedimentation rate (ESR), the C-reactive protein
(CRP) level, and chlamydial and gonococcal DNA probes
(CT), and magnetic imaging (MRI), can aid in diagnosis. Blood tests can also help identify the presence
of infection: the erythrocyte sedimentation rate (ESR), the C-reactive protein
(CRP) level, and chlamydial and gonococcal DNA probes
Prevention
Regular testing for sexually transmitted infections is encouraged for
prevention. The risk of contracting pelvic
inflammatory disease can be reduced by the following:
prevention. The risk of contracting pelvic
inflammatory disease can be reduced by the following:
·
Using
barrier methods such as condoms; see human sexual behavior for other listings.
Using
barrier methods such as condoms; see human sexual behavior for other listings.
·
Seeking
medical attention if you are experiencing symptoms of PID.
Seeking
medical attention if you are experiencing symptoms of PID.
·
Using
hormonal combined contraceptive pills also helps in reducing the chances of PID
by thickening the cervical mucosal plug & hence preventing the ascent of causative
organisms from the lower genital tract.
Using
hormonal combined contraceptive pills also helps in reducing the chances of PID
by thickening the cervical mucosal plug & hence preventing the ascent of causative
organisms from the lower genital tract.
·
Seeking
medical attention after learning that a current or former sex partner has, or
might have had a sexually transmitted infection.
Seeking
medical attention after learning that a current or former sex partner has, or
might have had a sexually transmitted infection.
·
Getting a
STI history from your current partner and strongly encouraging they be tested
and treated before intercourse.
Getting a
STI history from your current partner and strongly encouraging they be tested
and treated before intercourse.
·
Diligence
in avoiding vaginal activity, particularly intercourse, after the end of a
pregnancy (delivery, miscarriage, or abortion) or certain gynecological procedures,
to ensure that the cervix closes.
Diligence
in avoiding vaginal activity, particularly intercourse, after the end of a
pregnancy (delivery, miscarriage, or abortion) or certain gynecological procedures,
to ensure that the cervix closes.
·
Reducing
the number of sexual partners sexual monogamy that restricts sexual activities
to two ‘virgins’ or partners remaining sexually exclusive with each other and
having no outside sex partners.
Reducing
the number of sexual partners sexual monogamy that restricts sexual activities
to two ‘virgins’ or partners remaining sexually exclusive with each other and
having no outside sex partners.
·
Abstinence
Abstinence
Treatment
Treatment is often started without confirmation of infection because of
the serious complications that may result from delayed treatment. Treatment
depends on the infectious agent and generally involves the use of antibiotic
therapy. If there is no improvement within two to three days, the patient is
typically advised to seek further medical attention. Hospitalization sometimes
becomes necessary if there are other complications.
the serious complications that may result from delayed treatment. Treatment
depends on the infectious agent and generally involves the use of antibiotic
therapy. If there is no improvement within two to three days, the patient is
typically advised to seek further medical attention. Hospitalization sometimes
becomes necessary if there are other complications.
Treating sexual partners for possible STIs can help in treatment and
prevention. For women with PID of mild
to moderate severity, parenteral and oral therapies appear to be effective. It does not matter to their short- or
long-term outcome whether antibiotics are administered to them as inpatients or
outpatients. Typical regimens include
cefoxitin or cefotetan plus doxycycline, and clindamycin plus gentamicin . An
alternative parenteral regimen is ampicillin /sulbactam plus doxycycline.
Erythromycin –based medications can also be used. Another alternative is to use a parenteral
regimen with ceftriaxone or cefoxitin plus doxycycline. Clinical experience
guides decisions regarding transition from parenteral to oral therapy, which usually
can be initiated within 24–48 hours of clinical improvement. Intravenous antibiotics
like Gentamicin loading dose IV or IM (1mg/kg), followed by a maintenance dose
(1.5 mg/kg) every 8 hours. Singledaily dosing (3–5 mg/kg) can be
substituted.Doxycycline 100 mg orally or IV every 12 hours,Cefotetan 2 g IV
every 12 hours.
prevention. For women with PID of mild
to moderate severity, parenteral and oral therapies appear to be effective. It does not matter to their short- or
long-term outcome whether antibiotics are administered to them as inpatients or
outpatients. Typical regimens include
cefoxitin or cefotetan plus doxycycline, and clindamycin plus gentamicin . An
alternative parenteral regimen is ampicillin /sulbactam plus doxycycline.
Erythromycin –based medications can also be used. Another alternative is to use a parenteral
regimen with ceftriaxone or cefoxitin plus doxycycline. Clinical experience
guides decisions regarding transition from parenteral to oral therapy, which usually
can be initiated within 24–48 hours of clinical improvement. Intravenous antibiotics
like Gentamicin loading dose IV or IM (1mg/kg), followed by a maintenance dose
(1.5 mg/kg) every 8 hours. Singledaily dosing (3–5 mg/kg) can be
substituted.Doxycycline 100 mg orally or IV every 12 hours,Cefotetan 2 g IV
every 12 hours.
Prognosis
Even when the PID infection is cured, effects of the infection may be
permanent. This makes early identification essential. Treatment resulting in
cure is very important in the prevention of damage to the reproductive system. Formation
of scar tissue due to one or episodes of PID can lead to tubal blockage,
increasing the risk of the inability to get pregnant and long-term
pelvic/abdominal pain. Certain occurrences such as a post pelvic operation, the
period of time immediately after childbirth (postpartum), miscarriage or
abortion increase the risk of acquiring another infection leading to PID.
permanent. This makes early identification essential. Treatment resulting in
cure is very important in the prevention of damage to the reproductive system. Formation
of scar tissue due to one or episodes of PID can lead to tubal blockage,
increasing the risk of the inability to get pregnant and long-term
pelvic/abdominal pain. Certain occurrences such as a post pelvic operation, the
period of time immediately after childbirth (postpartum), miscarriage or
abortion increase the risk of acquiring another infection leading to PID.
Complications
PID can cause scarring inside the reproductive system, which can later
cause serious complications, including chronic pelvic pain, infertility ,
ectopic pregnancy (the leading cause of pregnancy-related deaths in adult females),
and other complications of pregnancy. Occasionally, the infection can spread to
in the peritoneum causing inflammation and the formation of scar tissue on the
external surface of the liver (Fitz-Hugh–Curtis syndrome).
cause serious complications, including chronic pelvic pain, infertility ,
ectopic pregnancy (the leading cause of pregnancy-related deaths in adult females),
and other complications of pregnancy. Occasionally, the infection can spread to
in the peritoneum causing inflammation and the formation of scar tissue on the
external surface of the liver (Fitz-Hugh–Curtis syndrome).
Epidemiology
Globally about 106 million cases of chlamydia
and 106 million cases of gonorrhea occurred in 2008. The number of cases of PID; however, is not
clear. It is estimated to affect about
1.5 percent of young women yearly. In
the United States PID is estimated to affect about one million people yearly. Rates are highest with teenagers and first
time mothers. PID causes over 100,000 women to become infertile in the US each
year.
and 106 million cases of gonorrhea occurred in 2008. The number of cases of PID; however, is not
clear. It is estimated to affect about
1.5 percent of young women yearly. In
the United States PID is estimated to affect about one million people yearly. Rates are highest with teenagers and first
time mothers. PID causes over 100,000 women to become infertile in the US each
year.
In Nigeria Abuja — It has been estimated that more than 1 million women experience
an episode of acute Pelvic Inflammatory Diseases (PID) each year and the rate
is higher in teenagers and first time mothers. More than 100,000 women become
infertile each year as a result of PID, and a large proportion of the ectopic pregnancies
occurring every year are due to the consequences of PID. Annually more than 150
women die from PID or its complications
an episode of acute Pelvic Inflammatory Diseases (PID) each year and the rate
is higher in teenagers and first time mothers. More than 100,000 women become
infertile each year as a result of PID, and a large proportion of the ectopic pregnancies
occurring every year are due to the consequences of PID. Annually more than 150
women die from PID or its complications
Conclusion
Pelvic inflammatory disease is an infection of the upper part of the
female reproductive system, namely; the uterus, fallopian tube, ovaries and
inside the pelvis. The main causes include infections by Neisseria Gonorrhoea, and Chlamydia
Trachomatis. The signs and symptoms include lower abdominal pain, vagina
discharge, fever, burning with urination, pain during sex and irregular
menstruation. Long term complications may include infertility, etopic
pregnancy, chronic pelvic pain and cancer when untreated. Prevention include
not having sex or having few sexual partners or using condom. Treatment for PID
include using antibiotics like Gentamicin IV or IM (1mg/kg) Cefotetan 2g IV
every 12 hours and Doxycyline 100mg orally.
female reproductive system, namely; the uterus, fallopian tube, ovaries and
inside the pelvis. The main causes include infections by Neisseria Gonorrhoea, and Chlamydia
Trachomatis. The signs and symptoms include lower abdominal pain, vagina
discharge, fever, burning with urination, pain during sex and irregular
menstruation. Long term complications may include infertility, etopic
pregnancy, chronic pelvic pain and cancer when untreated. Prevention include
not having sex or having few sexual partners or using condom. Treatment for PID
include using antibiotics like Gentamicin IV or IM (1mg/kg) Cefotetan 2g IV
every 12 hours and Doxycyline 100mg orally.
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