Pelvic inflammatory disease (PID)

Generality

Pelvic inflammatory disease is an acute or chronic inflammatory process that affects the female reproductive organs and adjacent structures. The sites most commonly affected are the fallopian tubes and to a lesser extent the uterus, ovaries and pelvic peritoneum.

Pelvic inflammatory disease is mostly caused by sexually transmitted infectious agents (Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis...) or from other microorganisms present in the "female genital area. The infection, therefore, is transmitted mainly ascending, while in less than 1% of cases it is due to an extragenital (often appendicular) focus that reaches the "reproductive system by blood, lymphatic or contiguity.

Symptoms

For further information: Symptoms of pelvic inflammatory disease

The most evident manifestation of pelvic inflammatory disease is pain, even of strong intensity, localized in the lower abdomen and pelvis. Acute episodes are often associated with other characteristic symptoms, such as:

• dyspareunia (pain during sexual intercourse)
• leucoxantorrhea (vaginal discharge of bad smell)
• spotting (intermenstrual bleeding)
• hypermenorrhea (particularly heavy menstrual flow)
• low back pain (lower back pain)
• low-grade fever or mild fever
• weakness
• diarrhea
• He retched
• urinary symptoms.

However, the clinical presentation of pelvic inflammatory disease is highly variable. In some cases, for example - especially when it is sustained by the Chlamydia trachomatis infection - the inflammation occurs almost asymptomatically. disease and because it can severely damage a woman's reproductive organs.

Therefore, when the symptoms listed above appear even in a rather subtle way, it is important to stop sexual activity and to bring them to medical attention as soon as possible. An early intervention can in fact avoid the risk that a common sexually transmitted disease, treatable with a very short oral antibiotic therapy, evolves into pelvic inflammatory disease and its terrible consequences.

Causes and Risk Factors

The main risk factors for the development of pelvic inflammatory disease are represented by: multiple sexual partners, early onset of sexual activity (biological defenses not yet fully formed), failure to use barrier methods of contraception (condoms), sex tourism, intercourse paid and prostitution, IUD (recent insertion of intrauterine devices), drug addiction, history of pelvic inflammatory disease or any venereal disease, poor or excessive personal hygiene (vaginal douches, for example, upset the normal balance of the vaginal bacterial flora and can mask the symptoms that normally lead to a medical consultation). The age group most affected is that between 20 and 25. Overall, pelvic inflammatory disease affects 1-2% of the sexually active female population.

The use of the contraceptive pill does not in any way limit the chances of contracting sexually transmitted diseases, but it can decrease the risk of pelvic inflammatory disease by increasing the density of the cervical mucus; this viscous liquid, in fact, represents a natural obstacle to the ascent of bacteria in the upper genital tract. On the contrary, voluntary termination of pregnancy, childbirth or an endometrial biopsy favor the penetration of bacteria into the reproductive organs.

The most common infectious agents involved in pelvic inflammatory disease are Chlamydia trachomatis and Neisseria gonorrhoeae, although culture shows a polymicrobial infection very often. In non-EU individuals, tuberculous etiology must also be considered.

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Complications

When pelvic inflammatory disease, favored by the patient's neglect or by the subclinical course, lasts for a long time, it tends to become chronic. In this case, the repercussions on the woman's health are quite serious and the possibility of complications such as infertility, sterility, ectopic pregnancy, recurrent episodes of pelvic pain, pain during sexual intercourse and recurrent genital infections increases.

As shown in the figure, in the absence of adequate treatment, pelvic inflammatory disease leads to the formation of scar tissue, adhesions and abscesses inside the fallopian tubes.

For this reason, PID represents the main cause of ectopic pregnancy, in which the fertilized oocyte - unable to reach the uterus - implants itself in the fallopian tubes. These, however, have too narrow a lumen to accommodate the gestational sac and inevitably abortion or tubal rupture occurs; this last event is particularly dangerous and endangers the very survival of the woman.

Diagnosis

The diagnosis of pelvic inflammatory disease can make use of numerous clinical and instrumental tests. Among these we remember the "culture examination of the cervico-vaginal secretion, the urethral swab of the partner, the endometrial biopsy (removal of a small sample of the endometrium, tissue that lines the uterine cavity internally), laparoscopy (exploration through a microtelecamera inserted through a very small cut in the abdomen) and pelvic ultrasound (less invasive than the previous ones, allows to reconstruct the image of the pelvic organs using ultrasound). As regards the blood chemistry tests, there is an increase in the ESR (non-specific index of inflammation), in the CRP and sometimes neutrophilic leukocytosis.

Treatment

For further information: Drugs for the treatment of Pelvic Inflammatory Disease

The treatment of acute, uncomplicated pelvic inflammatory disease is essentially antibiotic (possibly associated with painkillers). Considering the generally polymicrobial origin and the poor reliability of the examination of cervico-vaginal secretions (the pathogens detected are not necessarily the same ones present in the upper genital tracts), it is necessary to administer drugs with differentiated action on the pathogens most frequently involved in the etiology of The essential is the evaluation, and eventual treatment, of the partner, as well as the abstention from sexual intercourse for the entire duration of the treatment.

Only in the most serious cases and in emergencies, pelvic inflammatory disease requires hospitalization to undergo intravenous antibiotic therapy or a specific surgery.