Pelvic Inflammatory Treatment

Pelvic Inflammatory Disease: Not Just a Sexually Transmitted Disease
When sexually transmitted disease or STD is heard, individuals automatically assume or think the disease is only contracted through sexual contact. There are a few exceptions to this thought process, one of which is pelvic inflammatory disease (PID). Statistically, more than 750,000 women in the United States experiences an acute PID episode each year (Pelvic Inflammatory Disease (PID) - CDC Fact Sheet, 2011) and 8% of all United States women will have been diagnosed with PID at least once in their lifetime (Haggerty & Ness, 2008). PID is labeled as a STD and many individuals have never heard of it or do not know exactly what it is. The following will illustrate pelvic inflammatory
disease’s definition, causes, symptoms, treatments, and possible complications.
Definition
PID is defined in different ways. According to the CDC it is a spectrum of inflammatory disorders of the upper female genital tract. (Monif, MD, 2001) The International Infectious Disease Society for Obstetrics and Gynecology-USA defines PID as an inflammatory process of infectious etiology which shares a common epidemiological profile [sexual risk factors], which specifically involves at the least the uterine and/or fallopian tube sites, and which may result in relatively comparable long-term squeal; and diseases due to bacteria not meeting these requirements will be termed upper female genital tract infection and the designation of specific etiology cited. (Monif, MD, 2001) Essentially pelvic inflammatory disease is an inflammation of pelvic organs, that is usually caused by a bacterial infection, that travels from the vagina, to the cervix, to the uterus, to the fallopian tubes, to the ovaries, and finally into the abdomen.
Originally pelvic inflammatory disease was defined as an upper female genital tract infection caused primarily by the Neisseria gonorrhoeae bacterial infection. Then the definition evolved to an upper female genital tract infection that is caused by any one of a large number of bacterium. Because of PID’s broad definition, in November 1999 the International Infectious Disease Society for Obstetrics and Gynecology-USA formed a 7 member panel, which moved to stop using PID as the term to fit its current definition and instead use the term upper genital tract infection. The panel set criteria, that in order to use the term PID the disease must involve at least the endometrium and fallopian tubes and is restricted to a disease in which initial causative agents are major sexually transmitted disease (STD) pathogens that share common demographic features and consequences. (Monif, MD, 2001)
Causes/Risks. Although PID is not always contracted through sexually contact one fourth of all cases are caused by chlamydia or gonorrhea. PID can be indicative of an ill functioning immune system. (NHS Greater Glasgow and Clyde) Women under the age of 25 are most at risk, it is thought to be because that age group’s cervix is still immature which makes them more susceptible to the STDs that can cause PID. Early treatment of a STD, aids in preventing an episode of pelvic inflammatory disease. PID can occur after an abortion or a miscarriage but rarely occurs when an individual is pregnant. Due to damage to the reproductive organs that may occur during an initial PID episode, an individual has an increased risk of experiencing repeated episodes. Women who douche are at risk for experiencing PID because douching can push vaginal bacteria into the upper reproductive organs and it also harmfully changes the body’s natural vaginal flora. (Pelvic Inflammatory Disease (PID) - CDC Fact Sheet, 2011) A study conducted by researchers from the Centers for Disease Control in Atlanta, Georgia on a group of hospitalized women showed a large correlation between smokers, rather past or present, and PID. (Hale, 1990) This study proved former smokers are at a higher risk than current smokers but both have a substantial heightened risk for developing PID. Ironically, the study stated the number of cigarettes smoked each day has no consistent effect on the PID risk factor. This particular study has limited data conclusions but it indicates further research is needed because of the substantial numbers indicating the correlated risk.
Treatment.
Pelvic inflammatory disease is usually treated with at least two antibiotics that work on a broad range of bacteria because of the difficulty in identifying the bacteria that is the cause and it is possible for multiple types of bacteria to be the current cause. A broad spectrum antibiotic with at least a two week regimen is a typical course of treatment. Antibiotics are administered by mouth, intravenous, and injection and usually are very effective as treatment for PID. Individuals may be hospitalized if they are pregnant, unable to take pills or tablets, are not improving after having started antibiotic treatment at home, an abscess has developed, or if diagnosis of PID is questionable. A surgical operation may need to be conducted if an abscess has occurred and antibiotic treatment has not aided in the abscess resolution. Once treatment has been completed the individual must follow-up with their health care provider, in ordered to ensure the treatment was successful. Sexual contact can resume once all partners have been tested and treatment has been completed. The use of condoms can aid in preventing another PID episode, through its STD prevention
factor.
Diagnosis. Diagnosing PID can be very difficult because its symptoms and signs can be relatable to other things or diseases, sometimes are absent, and vary in severity. The most common symptoms and signs are: smelly or unusual vaginal discharge, lower abdominal pain, deep internal pain during sexual intercourse, bleeding after or during sex, fever, dysuria, irregular menstrual bleeding, upper right abdominal pain, white blood cells in vaginal secretions, elevated erythrocyte sedimentation rate (ESR), elevated C-reactive protein, and pelvic organ tenderness. During a silent episode of PID, even though there may be evidence of endometritis or salpingitis, the individual may experience mild if any pelvic pain at all. (Haggerty & Ness, 2008) When PID is experienced due to a chlamydial infection, the individual likely may only experience mild symptoms even though serious reproductive organ damage has occurred and possibly no symptoms if the fallopian tubes have been infected. After gathering the signs and symptoms from the individual the provider must conduct an examination and possibly test vaginal and cervical swabs for the detection of chlamydia and/or gonorrhea and cervical inflammation, conduct an ultrasound, and /or conduct a laparoscopy surgery.
Complications. PID itself can be a very serious complication of contracting a STD. If the episode of PID is very severe or if treatment has been delayed, the bacteria can transform the normal organ tissue into scar tissue, which is the cause of complications long after the disease has been treated. These complications are chronic pelvic pain, ectopic pregnancy, infertility, and sometimes abscess formation. Complications become more likely if the individual has experienced recurrent episodes of pelvic pain, after an episode of PID. As many as 10-15% of all affected individuals each year experience infertility as a result of PID. (Pelvic Inflammatory Disease (PID) - CDC Fact Sheet, 2011) The damage the reproductive organs sustain during a PID episode cannot be reversed through antibiotic treatment. Chronic pelvic pain and tissue scarring can be very difficult to treat, but sometimes these complications may show some improvement with surgery.
Conclusion.
Pelvic inflammatory disease is considered a sexually transmitted disease because of the bacteria that cause it, but it is also important to remember PID can also be caused by bacteria that are a part of the body’s natural vaginal flora. The rule of thumb is early and appropriate treatment of PID can aid in preventing any lifelong complications. The treatments and causes of PID are currently not completely certain but studies are underway in order to increase knowledge that will in turn aid in prevention of PID’s many complications. The exact goal is to gain microbe-specific and optimized PID treatment, which should preserve fertility and prevent recurrent and persistent infection, ectopic emergency and chronic pain, and improve the long-term prognosis of women diagnosed with PID. (Haggerty & Ness, 2008) After becoming informed about what PID is, its causes, its symptoms, treatments, and complications, it should be slightly easier to aid in preventing either the disease itself or the disease’s complications.
References
Haggerty, C. L., & Ness, R. B. (2008). Diagnosis and Treatment of Pelvic Inflammatory Disease. Medscape Nurses, 1-12.
Hale, M. (1990). Pelvic Inflammatory Disease: Another Reason Not to Smoke. American Journal of Nursing.
Monif, MD, G. R. (2001). Pelvic Inflammatory Disease Redefined. Medscape Nurses, 1-2.
NHS Greater Glasgow and Clyde. (n.d.). Pelvic Inflammatory Disease (PID). Retrieved from Sandyford: http://www.sandyford.org/do-you-want-informatin-on-sexually-transmitted-infections-/pelvic-inflammatory/disease-(pid).aspx
Pelvic Inflammatory Disease (PID) - CDC Fact Sheet. (2011, September 28). Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/std/pid/stdfact-pid.htm