Pelvic Inflammatory Disease
Disease Details
Family Health Simplified
- Description
- Pelvic inflammatory disease (PID) is an infection of the female reproductive organs, typically caused by sexually transmitted bacteria.
- Type
- Pelvic inflammatory disease (PID) is an infection and inflammation of the female reproductive organs. It is not a genetic condition and therefore does not have a type of genetic transmission. PID is typically caused by sexually transmitted bacteria, most commonly Neisseria gonorrhoeae and Chlamydia trachomatis.
- Signs And Symptoms
- Symptoms in PID range from none to severe. If there are symptoms, 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.
- Prognosis
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Early diagnosis and immediate treatment are vital in reducing the chances of later complications from PID. Delaying treatment for even a few days could greatly increase the chances of further complications. Even when the PID infection is cured, effects of the infection may be permanent, or long lasting. This makes early identification essential.
A limitation of this is that diagnostic tests are not included in routine check-ups, and cannot be done using signs and symptoms alone; the required diagnostic tests are more invasive than that. Treatment resulting in cure is very important in the prevention of damage to the reproductive system. Around 20 percent of cis-gendered women with PID develop infertility. Even women who do not experience intense symptoms or are asymptomatic can become infertile. This can be caused by the formation of scar tissue due to one or more episodes of PID, and can lead to tubal blockage. Both of these increase the risk of the inability to get pregnant, and 1% results in an ectopic pregnancy. Chronic pelvic/abdominal pain develops post PID 40% of the time.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. - Onset
- Pelvic inflammatory disease (PID) often has a gradual onset, with symptoms typically developing over several days to weeks. Common symptoms include lower abdominal pain, fever, unusual vaginal discharge, painful intercourse, painful urination, and irregular menstrual bleeding.
- Prevalence
- The prevalence of pelvic inflammatory disease (PID) varies widely, but it is estimated that about 1 in 8 women with a history of PID experience difficulties getting pregnant. PID is most common among sexually active women aged 15-24. The precise prevalence can be challenging to determine due to underreporting and misdiagnosis.
- 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.This is largely due to diagnostic tests being invasive and not included in routine check-ups, despite PID being the most common reason for individuals to admit themselves under gynecological care. 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.
- Intractability
- Pelvic inflammatory disease (PID) is not inherently intractable. It can often be effectively treated with antibiotics if diagnosed early. However, complications can arise if treatment is delayed or if the infection is severe. Chronic or recurrent cases may be more difficult to manage. Early diagnosis and adherence to treatment are key to successful management.
- Disease Severity
- Pelvic Inflammatory Disease (PID) severity can range from mild to severe. Mild cases may present with slight pelvic pain and discomfort, while severe cases can result in intense abdominal pain, high fever, and significant complications such as infertility, ectopic pregnancy, and chronic pelvic pain. Prompt treatment is essential to prevent long-term damage.
- Healthcare Professionals
- Disease Ontology ID - DOID:1003
- Pathophysiology
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Pelvic inflammatory disease (PID) is an infection and inflammation of the female reproductive organs, including the uterus, fallopian tubes, and ovaries. The pathophysiology of PID typically involves the ascending spread of microorganisms from the vagina or cervix to the upper genital tract. The most common causative agents are sexually transmitted bacteria, such as **Neisseria gonorrhoeae** and **Chlamydia trachomatis**, although other bacteria can also be involved.
The process begins when these pathogens breach the cervical barrier, leading to an inflammatory response. The infection can cause damage to the epithelial lining of the fallopian tubes, resulting in scarring and adhesions, which may lead to complications such as chronic pelvic pain, infertility, and an increased risk of ectopic pregnancy.
Inflammatory mediators such as cytokines and chemokines are released, attracting immune cells to the site of infection, further contributing to tissue damage. The body's attempt to fight off the infection can lead to the formation of abscesses or pus-filled pockets within the pelvic cavity.
The severity and progression of PID can vary depending on the virulence of the organisms involved, the host's immune response, and the timeliness and effectiveness of treatment. - Carrier Status
- Pelvic inflammatory disease (PID) is an infection of the female reproductive organs and is usually caused by sexually transmitted bacteria from conditions such as chlamydia or gonorrhea. Carrier status is not applicable to PID, as it is not a genetic condition but rather an infection.
- Mechanism
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Pelvic Inflammatory Disease (PID) is an infection of the female reproductive organs, including the uterus, fallopian tubes, and ovaries. It’s primarily caused by bacteria, most commonly sexually transmitted bacteria like **Chlamydia trachomatis** and **Neisseria gonorrhoeae**.
### Mechanism
PID typically begins when bacteria ascend from the vagina or cervix into the upper genital tract. This can occur following sexual intercourse, childbirth, miscarriage, abortion, or insertion of an intrauterine device (IUD).
### Molecular Mechanisms
1. **Bacterial Adhesion and Invasion**:
- Pathogens adhere to and invade epithelial cells lining the reproductive tract. For instance, **C. trachomatis** uses adhesion molecules to attach to host cells and enters them through endocytosis.
2. **Immune Response**:
- The host's immune system responds to the infection by releasing cytokines and chemokines, which recruit neutrophils and macrophages to the site of infection. This acute inflammatory response is aimed at controlling the spread of bacteria but can also cause tissue damage.
3. **Evasion of Host Defenses**:
- Some pathogens have evolved mechanisms to evade the host's immune response. **N. gonorrhoeae**, for example, can alter its surface proteins to avoid detection and destruction by the immune system.
4. **Tissue Damage and Scarring**:
- Ongoing infection and inflammation can lead to the destruction of epithelial cells and subepithelial tissues. Chronic inflammation can result in scarring and fibrosis of the affected reproductive organs, leading to complications such as infertility, ectopic pregnancy, and chronic pelvic pain.
5. **Biofilm Formation**:
- Certain bacteria can form biofilms, complex structures that protect them from immune responses and antibiotic treatments, contributing to the chronicity and recurrence of PID.
Understanding these mechanisms is crucial for developing targeted treatments and interventions to prevent and manage PID effectively. - Treatment
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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 although there is no clear evidence of which antibiotic regimen is more effective and safe in the management of PID. 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. There should be no wait for STI results to start treatment. Treatment should not be avoided for longer than 2-3 days due to increasing the risk of infertility.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. A single study suggests superiority of azithromycin over doxycycline. 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.
When PID is caught early there are treatments that can be utilized, however these treatments will not undo any damage PID may has caused.
If previously having a PID diagnosis and were to be exposed to another STI the risk of having PID reoccur is higher
Early treatment can not prevent the following:
chronic abdominal pain.
infertility and or ectopic pregnancies.
scar tissue within or outside the fallopian tubes. - Compassionate Use Treatment
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For pelvic inflammatory disease (PID), compassionate use treatments or off-label/experimental treatments are not commonly the focus as standard antibiotic therapy is generally effective. However, in some severe or refractory cases, healthcare providers might consider alternative or adjunctive therapies.
1. **Compassionate Use Treatments:**
- **Severe Cases:** In severe, life-threatening cases of PID where standard treatments fail, healthcare providers may consider the use of intravenous immunoglobulin (IVIG) as a last resort under compassionate use. This treatment aims to modulate the immune response and reduce inflammation.
2. **Off-Label or Experimental Treatments:**
- **Antibiotics:** Some antibiotics might be used off-label, especially if the pathogen is resistant to standard therapy. This includes antibiotics like ertapenem or fosfomycin, which are not first-line treatments for PID.
- **Anti-inflammatory Agents:** Non-steroidal anti-inflammatory drugs (NSAIDs) might be used off-label to reduce pelvic pain and inflammation, although they do not cure the infection.
- **Biologics:** There is emerging research on the use of biologics targeting specific inflammatory pathways, though this is experimental and not currently a standard practice for PID.
It's essential for these treatments to be considered on an individual patient basis and typically within a clinical trial or under strict medical supervision. Always consult a healthcare professional for personalized medical advice. - Lifestyle Recommendations
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Pelvic Inflammatory Disease (PID) can be managed and prevented with various lifestyle recommendations:
1. **Practice Safe Sex**: Use condoms consistently and correctly to reduce the risk of sexually transmitted infections (STIs), which are a common cause of PID.
2. **Regular Medical Check-Ups**: Schedule regular gynecological exams and screenings for STIs to detect and treat infections early.
3. **Limit Number of Sexual Partners**: Having fewer sexual partners reduces the risk of contracting STIs.
4. **Prompt Treatment of STIs**: Seek immediate treatment if diagnosed with an STI to prevent it from progressing to PID.
5. **Complete Antibiotic Courses**: If prescribed antibiotics for PID or any STI, complete the full course of medication even if symptoms improve early.
6. **Avoid Douching**: Douching can disrupt the normal vaginal flora and may increase the risk of infections.
7. **Personal Hygiene**: Maintain good personal hygiene, especially in the genital area, to reduce the risk of infection.
Adopting these lifestyle practices can help manage and reduce the risk of developing PID. - Medication
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Pelvic inflammatory disease (PID) is commonly treated with a combination of antibiotics. The specific regimen may vary, but typical combinations include:
1. **Ceftriaxone** (a single intramuscular injection)
2. **Doxycycline** (oral, taken twice daily for 14 days)
3. **Metronidazole** (oral, taken twice daily for 14 days)
It is important to complete the full course of antibiotics even if symptoms improve. Always consult a healthcare provider for an appropriate diagnosis and treatment plan. - Repurposable Drugs
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Information about repurposable drugs for specific ailments like pelvic inflammatory disease (PID) typically derives from clinical trials and medical research. As of recent research:
1. **Metronidazole**: Often used for bacterial infections and might be utilized for PID due to its effectiveness against anaerobic bacteria.
2. **Doxycycline**: An antibiotic initially indicated for various bacterial infections, including respiratory tract infections and certain sexually transmitted infections, which can be repurposed for PID treatment.
3. **Azithromycin**: Originally used for respiratory infections and certain sexually transmitted infections, it can be a potential alternative in PID treatment regimes.
Research is ongoing, and new findings may provide additional options. Always consult healthcare professionals for current and personalized medical advice. - Metabolites
- Pelvic Inflammatory Disease (PID) primarily affects the female reproductive organs. Since it is an infection-based condition, specific metabolites related to PID are not well-defined in the literature. The focus is generally on the bacterial pathogens causing the infection and the inflammatory response rather than distinct metabolites. Diagnosis and management are usually based on clinical symptoms, microbiological testing, and imaging rather than metabolite profiling.
- Nutraceuticals
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Nutraceuticals are products derived from food sources that provide both nutritional and medicinal benefits. They can potentially help manage pelvic inflammatory disease (PID) by supporting the immune system and reducing inflammation. Some nutraceuticals that may be beneficial include:
1. Probiotics: These can help maintain a healthy vaginal and gut flora, potentially preventing bacterial infections that can lead to PID.
2. Omega-3 fatty acids: Found in fish oil, they have anti-inflammatory properties that may help reduce inflammation associated with PID.
3. Vitamin D: Adequate levels of vitamin D can strengthen the immune system, which might help in managing infections.
4. Antioxidants: Vitamins C and E, as well as selenium, can help reduce oxidative stress and support immune function.
Always consult a healthcare provider before starting any nutraceutical regimen for PID. - Peptides
- Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. It often occurs when sexually transmitted bacteria spread from the vagina to the uterus, fallopian tubes, or ovaries. The role of peptides in PID is an area of ongoing research. Antimicrobial peptides, for example, could potentially play a role in modulating immune responses and combating infection. Nanotechnology, including the use of nanoparticles, is also being explored as a means to deliver targeted therapies for PID, improving the effectiveness of antibiotics or anti-inflammatory agents. However, these applications are still largely in the research and development stages.