Pelvic inflammatory disease


Pelvic inflammatory disease (PID) infection

    • endometritis
    • Salpingitis
    • Oophoritis
    • Myometritis
    • Pelvioperitonitis.


    • 1-2% of sexually active women
    • In Russia every year, more than half of the women who go to antenatal clinics are diagnosed with PID; 50% of them will need hospital treatment. The predominant age is 16-25 years. Etiology
    • Sexually transmitted diseases
    • Intra-uterine devices (IUD)
    • PID – polymicrobial infections
    • Neisseria gonorrhoeae
    • Chlamydia trachomatis
    • Endogenous aerobic bacteria: Escherichia coli, Proteus, Klebsiella, Streptococcus
    • Endogenous anaerobic bacteria: Bacteroides, Peptostreptococcus, Peptococcus
    • Mycoplasma hominis and Ureaplasma urealyticum
    • Actinomyces israelii
    • Granulomatous salpingitis
    • Tuberculous salpingitis – 10-11% of patients with PID
    • Leprosy salpingitis
    • Actinomycosis develops secondary to acute appendicitis, gastrointestinal disease, or IUD use.
    • Salpingitis due to the presence of a foreign body (use of a hydrophobic contrast agent for hysterosalpingography; introduction of starch, talc, mineral oil into the vagina)
    • Non-granulomatous salpingitis occurs secondary to any other bacterial infection of the abdominal cavity: acute appendicitis, diverticulitis, Crohn’s disease, cholecystitis.


    • PID is traditionally preceded by colonization of the vagina and cervix by opportunistic flora
    • Asymptomatic carriage can last for months or years
    • Under the influence of a provoking factor, bacteria penetrate through the uterine cavity into the lumen of the fallopian tubes.
    • The process is traditionally two-sided. Provoking factors
    • Menstruation. Blood and rejected endometrium are a good nutrient medium. 60% of cases of acute PID begin immediately after menstruation
    • Sexual intercourse. Contractions of the myometrium contribute to the development of ascending infection
    • Yat-rogenic causes (medical abortion, dilation of the cervical canal and curettage, insertion of an IUD, hysterosalpingography, introduction of radioactive substances into the uterine cavity for therapeutic purposes). Pathomorphology
    • Endosalpingitis
    • Hyperemia, edema, microcirculation disorders with subsequent destruction of the cells of the mucous membrane of the fallopian tubes and their fringes by bacterial toxins
    • The process is traditionally bilateral, although it is likely that the fallopian tube is affected only on one side.
    • Inflammation extends to the muscular and serosa
    • Possible penetration of infection into the abdominal cavity through the abdominal end of the fallopian tube and damage to the integumentary epithelium of the ovaries and adjacent peritoneum
    • Oophoritis
    • Development of the process on the plane of the ovaries
    • Subsequent infection of the granular membranes of the follicles with the formation of microabscesses inside the ovaries
    • Pelvioperitonitis develops when the infectious process spreads throughout the abdominal cavity, either by direct or lymphogenous routes.
    • Perihepatitis with adhesions in the right upper quadrant of the abdomen (Fitz Hugh-Curtis syndrome)
    • Tuberculous lesion
    • Macroscopically: the fallopian tube is in the form of a pouch, enlarged, dilated, the uterine end is closed, the fringes are edematous and enlarged
    • Microscopically: epithelioid reaction in tuberculous tubercles, productive inflammation with presence of giant cells, scarring
    • Leprosy: Langerhans giant cells, epithelioid cells
    • Actinomycosis
    • Macroscopically: inflammation, necrosis of the appendages
    • Microscopically: actinomycosis sulfur granules, radial club-shaped filaments with a thickening at the end (actinomycetes), monocyte infiltration, giant cells
    • Shistosomiasis
    • Macroscopically: nonspecific inflammation of the tubes, testicles


    • Microscopically: granulomatous formations, giant cells.

Clinical picture

    • The symptoms of PID are relatively nonspecific, which often leads to misdiagnosis.
    • Symptoms often worsen during or immediately after menstruation
    • Pain in the lower abdomen
    • Pain in the appendages
    • Fever
    • Nausea and vomiting
    • Dysuria
    • Vaginal discharge with an unpleasant odor
    • Tumor-like formations in the area of ​​the uterine appendages.
    • With tuberculous salpingitis
    • History of pulmonary tuberculosis
    • Cases of tuberculosis in the family
    • Intense pain in the lower abdomen
    • Infertility
    • Amenorrhea
    • Seals in the cervical, vaginal and uterine areas.

Laboratory research

    • In 50% of women with acute PID, the number of leukocytes exceeds 10×109/l
    • ESR is elevated in 75% of women with a confirmed diagnosis of PID. Special Studies
    • Coloring smear of cervical mucus according to Grom
    • In case of a torpid or chronic course of the disease, they resort to provocation with the subsequent taking of smears from all alleged foci after 24, 48 and 72 hours (see Gonococcal Infection)
    • Ultrasound helps in the diagnosis of adnexal masses, normal or ectopic pregnancy
    • Determination of the concentration of the p-subunit of chorionic gonadotropin helps to exclude ectopic pregnancy (low content in the early periods)
    • Culdocentesis
    • Laparoscopy.

Differential Diagnosis

    • Ectopic pregnancy
    • Rupture of an ovarian cyst
    • Acute appendicitis
    • endometriosis
    • Inflammatory Bowel Disease
    • Fibromyoma necrosis
    • Spontaneous abortion
    • Diverticulitis.


Indications for hospitalization

    • Doubts about the diagnosis
    • The need to exclude acute surgical pathology
    • Severe condition of the patient (vomiting, dehydration, hyperthermia or signs of peritonitis)
    • Pregnancy
    • Failure of outpatient treatment.

Ambulatory treatment. Antibacterial therapy, taking into account the sensitivity of the microflora. The most commonly used products are:

    • Benzylpenicillin sodium salt 4800000 IU intravenously and twice
    • Ampicillin nbsp;3.5 r/day IM
    • Probenecid 1 g orally, then ampicillin or tetracycline 500 mg 4 times a day orally for 7 days. Hospital treatment
    • At the initial stages – conservative therapy.
    • Antibiotics in high doses
    • Doxycycline hydrochloride 100 mg IV drip 2 r / day
    • Cefoxitin 2 g IV 4 times a day
    • Clindamycin 600 mg IV drip 4 times a day
    • Gentamicin 2.0 mg/kg/day IV
    • Metronidazole – 1.0 g IV 2 r / day.
    • With clinical improvement, maintenance therapy with gentamicin (1.5 mg/kg IV 3 times a day).
    • Treatment is continued until the symptoms disappear (within 7-14 days).
    • The criterion for the cure of gonorrhea is the absence of gonococci in smears after a complex provocation during 3 menstrual cycles.
    • Treatment of tuberculous salpingitis – see Tuberculosis.
    • Surgical treatment is indicated for the ineffectiveness of antibiotic therapy within 48-72 hours. 
    • Colpotomy followed by drainage of pelvic abscesses
    • Laparotomy with unilateral salpingo-oophorectomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy and drainage of the pelvic cavity.

Complications occur in 25% of women with acute PID

    • hydrosalpinx
    • Pyosalpinx
    • Partial obstruction of the fallopian tubes
    • Complete obstruction of the fallopian tubes and infertility
    • Ectopic pregnancy
    • Peritubal and periovarian adhesions
    • Tubal-ovarian abscesses
    • Ruptured abscesses leading to peritonitis and sepsis.


    • Mortality is low
    • In advanced cases, septic shock can develop with a fatal outcome.
    • With tuberculosis, the prognosis is favorable, but very often infertility begins. Prevention
    • Oral contraceptives protect against PID for the following reasons:
    • Reduce blood loss during menstruation
    • Change in the characteristics of the cervical mucus, preventing the penetration of bacteria
    • Barrier methods of contraception (diaphragm, condom, sponge)
    • Spermicides are bactericidal
    • IUDs increase the risk of developing PID (5.21 cases per 100 women per year).


    • PID is an inflammatory disease of the pelvic organs.

See also Gonococcal Infection, ICD Tuberculosis. N70-N77 Inflammatory diseases of female pelvic organs

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