In this video-lesson we will get to know more closely a disease that we have often mentioned among the possible complications of some neglected or not properly treated sexually transmitted infections. I am talking about pelvic inflammatory disease, more simply known as PID.
Pelvic inflammatory disease is inflammation that affects the woman's upper genital tract and adjacent tissues. Often, therefore, it affects the fallopian tubes, the uterus, the ovaries, the uterine cervix and the surrounding peritoneum. In the presence of pelvic inflammatory disease, all of these tissues become inflamed, irritated and swollen. In the long run, the persistence of the inflammatory process can seriously damage the reproductive organs, even being responsible for the woman's infertility. For this reason, immediate medical intervention is essential at the first suspicion. Otherwise, that is, if the pelvic inflammatory disease is left untreated, the further complications can be very serious.
Most cases of pelvic inflammatory disease are the consequence of an ascending infection. In practice, the infection extends from the vagina upwards, crossing the cervix and reaching the pelvic organs. Factors that can contribute to the development of pelvic inflammatory disease are numerous. These include, for example, sexual promiscuity, the presence of bacterial vaginosis or a sexually transmitted disease, termination of pregnancy and the insertion of an intrauterine device, such as a contraceptive coil. Many infectious agents can play a role in determining the onset of pelvic inflammatory disease. However, most cases are caused by the bacteria responsible for 2 of the most common sexually transmitted infections. These bacteria are there Chlamydia trachomatis and the Neisseria gonorrhoeae. It must also be considered that the epithelial damage caused during the initial stages of the infection in turn favors the addition of further infections, sustained by opportunistic pathogens such as Mycoplasma, bacteria of intestinal origin, anaerobes, streptococci and staphylococci. Finally, for completeness, it is necessary remember that - albeit very rarely - pelvic inflammatory disease can also be the result of a process that does not originate in the genitals, but reaches the reproductive system by blood, lymphatic or contiguity from nearby organs.
As for the symptoms, pelvic inflammatory disease can be symptomatic or asymptomatic, also in relation to the stages in which it is located. Furthermore, even when they are present, the clinical manifestations can be so nonspecific that it is difficult to formulate the diagnosis. However, the most common symptom of pelvic inflammatory disease is abdominal pain, often constant and of strong intensity. Characteristic features of pelvic inflammatory disease also include lower back pain, painful sexual intercourse, abnormal vaginal discharge in color, texture or smell, heavy or irregular menstrual bleeding, fever, weakness, nausea, and urinary symptoms.
When pelvic inflammatory disease lasts for a long time, it tends to become chronic. In this case, the complications can be very serious and increase the chances of chronic pelvic pain, recurrent genital infections and infertility from tubal occlusion. As you can see from the figure, if adequate treatment is not used, pelvic inflammatory disease leads to the formation of scar tissue, adhesions and abscesses within the fallopian tubes. As a result, there is an obstruction or deformation of the fallopian tubes. For this reason, pelvic inflammatory disease is the leading cause of ectopic pregnancy. In fact, due to the obstruction we have mentioned, the fertilized egg cell, unable to reach the uterus, implants itself at the level of the tubes. Naturally, the structure of the fallopian tubes is not suitable to accommodate the gestational sac; therefore, in the presence of ectopic pregnancy, abortion or tubal rupture will inevitably occur; the latter is particularly dangerous and can endanger the patient's life. Another complication of pelvic inflammatory disease is the extent of the infection This leads to inflammation called Fitz-Hugh-Curtis syndrome, characterized by the formation of scar tissue on the outer surface of the liver.
Let's now turn to the diagnosis. In this regard, pelvic inflammatory disease can be diagnosed starting from the pelvic examination.During the visit, the gynecologist will check for abnormal secretions in the vagina or cervix. In addition, it will investigate the possible causes of pelvic, tubal and neck pain associated with uterine movements. Culture examination of cervico-vaginal secretion and urethral swab allows to determine the infectious agents responsible, and, above all, to confirm or exclude the presence of Chlamydia trachomatis and of Neisseria gonorrhoeae. Laparoscopy is considered the best diagnostic test, but it is clearly a rather invasive procedure, so it is not recommended as a routine examination. In making a diagnosis, ultrasound and endometrial biopsy can also help. The latter, in particular, consists in taking a small sample of the endometrium, that is, the tissue that lines the uterine cavity internally. As for blood tests, in the presence of pelvic inflammatory disease there is an increase in the white blood cell count and some non-specific indexes of inflammation, such as erythrocyte sedimentation rate (ESR) and C-reactive protein.
Pelvic inflammatory disease can be treated with antibiotics, possibly combined with pain relievers. To reduce inflammation, on the other hand, anti-inflammatory drugs, such as cortisone and derivatives, can be prescribed. In severe cases, hospitalization and the use of intravenous antibiotics may be necessary. Fundamental is the evaluation and possible treatment of the partner, as well as the abstention from sexual intercourse for the entire duration of the therapy. In even more serious cases, for example when the infection spreads deeper into the abdomen or forms an abscess, surgery may be required. Before concluding, from the point of view of prevention, the possibility of contracting pelvic inflammatory disease can be reduced by avoiding risky sexual behaviors. In particular, to reduce the risks it is recommended to use a condom during sexual intercourse, to limit the number of partners and to undergo regular screening tests, especially to rule out chlamydia and gonorrhea.
