Pelvic inflammatory disease (or disorder) (PID) is a generic term for inflammation of the female uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to tissue necrosis with/or without abscess formation. Pus can be released into the peritoneum. Two thirds of patients with laparoscopic evidence of previous PID were not aware they had PID.^[1] PID is often associated with sexually transmitted diseases, as it is a common result of such infections. PID is a vague term and can refer to viral, fungal, parasitic, though most often bacterial infections. PID should be classified by affected organs, the stage of the infection, and the organism(s) causing it. Although an STD is often the cause, other routes are possible, including lymphatic, postpartum, postabortal (either miscarriage or abortion) or intrauterine device (IUD) related, and hematogenous spread. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // N00-N39 - Diseases of the genitourinary system: urinary system (N00-N08) Glomerular diseases Prefixes: .2 Diffuse membranous glomerulonephritis (N00) Acute nephritic syndrome (N01) Rapidly progressive nephritic syndrome (N02) Recurrent and persistent haematuria (N03) Chronic nephritic syndrome (N04) Nephrotic syndrome Lipoid nephrosis (N05) Unspecified nephritic syndrome (N06) Isolated proteinuria with specified... // N00-N39 - Diseases of the genitourinary system: urinary system (N00-N08) Glomerular diseases Prefixes: .2 Diffuse membranous glomerulonephritis (N00) Acute nephritic syndrome (N01) Rapidly progressive nephritic syndrome (N02) Recurrent and persistent haematuria (N03) Chronic nephritic syndrome (N04) Nephrotic syndrome Lipoid nephrosis (N05) Unspecified nephritic syndrome (N06) Isolated proteinuria with specified... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... This article is about female reproductive anatomy. ... Female internal reproductive anatomy The Fallopian tubes or oviducts are two very fine tubes leading from the ovaries of female mammals into the uterus. ... Human female internal reproductive anatomy Ovaries are a part of a female organism that produces eggs. ... An adhesion is a fibrous band of scar tissue that binds together normally separate anatomical structures. ... Necrosis (in Greek Νεκρός = Dead) is the name given to accidental death of cells and living tissue. ... For the death metal band, see Abscess (band). ... For other uses, see Pus (disambiguation). ... Laparoscopic surgery, also called keyhole surgery (when natural body openings are not used), bandaid surgery, or minimally invasive surgery (MIS), is a surgical technique. ... Sexually-transmitted infections (STIs), also known as sexually-transmitted diseases (STDs), are diseases that are commonly transmitted between partners through some form of sexual activity, most commonly vaginal intercourse, oral sex, or anal sex. ... A sexually transmitted disease (STD), a. ... This article is about non-hormonally-based intrauterine contraceptives. ... For other uses, see Blood (disambiguation). ...

Epidemiology

In the United States, more than one million women are affected by PID each year, and the rate is highest with teenagers. Over 100,000 women become infertile in the US each year from PID.^[2] N. gonorrhoea is isolated in only 40-60% of women with acute salpingitis.^[3] C. trachomatis was estimated by current obgyn 9th ed to be the cause in about 60% of cases of salpingitis, which may lead to PID. It is unsure how much is due to a single organism and how much is due to multiple organisms; many other pathogens that are in normal vaginal flora become involved in PID. 10% of women in one study had asymptomatic Chlamydia trachomatis infection and 65% had asymptomatic infection with Neisseria gonorrhoeae.^[3] It was noted in one study that 10-40% of untreated women with N. gonorrhoea develop PID and 20-40% of women infected with C. trachomitis developed PID.^[1] PID is the leading cause of infertility. "A single episode of PID results in infertility in 13% of women."^[1] This rate of infertility increases with each infection. Fertility is the ability of people or animals to produce healthy offspring in abundance. ... The clap redirects here. ... Chlamydia is a common term for Chlamydiae. ... Female internal reproductive anatomy The Fallopian tubes, also known as oviducts and uterine tubes, are two very fine tubes leading from the ovaries of female mammals into the uterus. ... lactobacilli and a vaginal squamous cell. ... Binomial name Chlamydia trachomatis Busacca, 1935 Chlamydia trachomatis is a species of the chlamydiae, a group of obligately intracellular bacteria. ... Binomial name Neisseria gonorrhoeae Zopf, 1885 Neisseria gonorrhoeae is a species of Gram-negative bacteria responsible for the disease gonorrhoea. ...

Diagnosis

There may be no actual symptoms of PID. If there are symptoms then fever, cervical motion tenderness, lower abdominal pain, new or different discharge, painful intercourse, or irregular menstrual bleeding may be noted. It is important to note that PID can occur and cause serious harm without causing any noticeable symptoms. Laparoscopic identification is helpful in diagnosing tubal disease, 65-90% positive predictive value in patients with presumed PID.^[3] Regular Sexually transmitted disease (STD) testing is important for prevention. Treatment is usually started empirically because of the terrible complications. Definitive criteria include: histopathologic evidence of endometritis, thickened filled fallopian tubes, or laparoscopic findings. Gram-stain/smear becomes important in identification of rare and possibly more serious organisms.^[1] An analogue medical thermometer showing the temperature of 38. ... The cervix (from Latin neck) is the lower, narrow portion of the uterus where it joins with the top end of the vagina. ... Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. ... Dyspareunia is painful sexual intercourse, due to medical or psychological causes. ... Menstrual cycle In the female reproductive system, the menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive age females of several mammals, including human beings and other apes. ... The positive predictive value is the proportion of patients with positive test results who are correctly diagnosed. ... A sexually transmitted disease (STD), a. ... A central concept in science and the scientific method is that all evidence must be empirical, or empirically based, that is, dependent on evidence or consequences that are observable by the senses. ... Histopathology is a field of pathology which specialises in the histologic study of diseased tissue. ... Endometritis refers to inflammation of the endometrium, the inner lining of the uterus. ...

Differential diagnosis

Appendicitis, ectopic pregnancy, septic abortion, hemorrhagic or ruptured ovarian cysts or tumors, twisted ovarian cyst, degeneration of a myoma, and acute enteritis must be considered. Pelvic inflammatory disease is more likely to occur when there is a history of pelvic inflammatory disease, recent sexual contact, recent onset of menses, or an IUD in place or if the partner has a sexually transmitted disease. Appendicitis (or epityphlitis) is a condition characterized by inflammation of the appendix. ... Tumor (American English) or tumour (British English) originally means swelling, and is sometimes still used with that meaning. ... A myoma is a benigne tumor and non-cancerous that grows in the uterous muscular tissue or myometrium. ... Enteritis is the inflammation of the small intestine (inflammation of the large intestine is termed colitis). ...

Acute pelvic inflammatory disease is highly unlikely when recent intercourse has not taken place or an IUD is not being used. A sensitive serum pregnancy test should be obtained to rule out ectopic pregnancy. Culdocentesis will differentiate hemoperitoneum (ruptured ectopic pregnancy or hemorrhagic cyst) from pelvic sepsis (salpingitis, ruptured pelvic abscess, or ruptured appendix).

Pelvic and vaginal ultrasounds are helpful in the differential diagnosis of ectopic pregnancy of over six weeks. Laparoscopy is often utilized to diagnose pelvic inflammatory disease, and it is imperative if the diagnosis is not certain or if the patient has not responded to antibiotic therapy after 48 hours.

No single test has adequate sensitivity and specificity to diagnose pelvic inflammatory disease. A large mulitsite U.S. study found that cervical motion tenderness as a minimum clinical criterion increases the sensitivity of the CDC diagnostic criteria from 83% to 95%. However, even the modified 2002 CDC criteria does not identify women with subclinical disease.^[4] The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ...

Prognosis

Although the PID infection itself may be cured, effects of the infection may be permanent. This makes early identification by someone who can prescribe appropriate curative treatment so important in the prevention of damage to the reproductive system. Since early gonococcal infection may be asymptomatic, regular screening of individuals at risk for common agents (history of multiple partners, history of any unprotected sex, or people with symptoms) or because of certain procedures (post pelvic operation, postpartum, miscarriage or abortion). Prevention is also very important in maintaining viable reproduction capabilities. A pictorial illustration of the human female reproductive system. ... Postnatal (Latin for after birth) is the period beginning immediately after the birth of a child and extending for about six weeks. ... Miscarriage or spontaneous abortion is the natural or spontaneous end of a pregnancy at a stage where the embryo or the fetus is incapable of surviving, generally defined in humans at a gestation of prior to 20 weeks. ...

If the initial infection is mostly in the lower tract, after treatment the person may have few difficulties. If the infection is in the fallopian tubes or ovaries, more serious complications are more likely to occur.

Complications

PID can cause scarring inside the reproductive organs, which can later cause serious complications, including chronic pelvic pain, infertility (difficulty becoming pregnant), ectopic pregnancy (the leading cause of pregnancy-related deaths in adult females), and other dangerous complications of pregnancy. Multiple infections and infections that are treated later are more likely to result in complications. A scar results from the biologic process of wound repair in the skin and other tissues of the body. ... A pictorial illustration of the human female reproductive system. ... Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. ... A pregnant woman Pregnancy is the process by which a mammalian female carries a live offspring from conception until it develops to the point where the offspring is capable of living outside the womb. ...

Infertile women may wish to see a specialist, because there may be a possibility in restoring fertility after scarring. Traditionally tuboplastic surgery was the main approach to correct tubal obstruction or adhesion formation, however success rates tended to be very limited. In vitro fertilization (IVF) was developed to bypass tubal problems and has become the main treatment for patients who want to become pregnant. A tuboplasty is a surgical operation to correct an obstruction or adhesion of a fallopian tube to achieve a pregnancy in women with tubal infertility. ... In vitro fertilization (IVF) is a technique in which egg cells are fertilized outside the mothers body in cases where conception is difficult or impossible through normal intercourse. ...

Treatment

Treatment depends on the cause and generally involves use of antibiotic therapy. If the patient has not improved within two to three days after beginning treatment with the antibiotics, they should return to the hospital for further treatment. Drugs should also be given orally and/or intravaneously to the patient while in the hospital to begin treatment immediately, and to increase the effectiveness of antibiotic treatment. Hospitalization may be necessary if the patient has Tubo-ovarian abscesses; is very ill, immunodeficient, pregnant, or incompetent; or because a life-threatening condition cannot be ruled out. Treating partners for STDs is a very important part of treatment and prevention. Anyone with PID and partners of patients with PID since six months prior to diagnosis should be treated to prevent reinfection. Psychotherapy is highly recommended to women diagnosed with PID as the fear of redeveloping the disease after being cured may exist. It is important for a patient to communicate any issues and/or uncertainties they may have to a doctor, especially a specialist such as a gynecologist, and in doing so, to seek follow-up care. Staphylococcus aureus - Antibiotics test plate. ...

A systematic review of the literature related to PID treatment was performed prior to the 2006 CDC sexually transmitted diseases treatment guidelines. Strong evidence suggests that neither site nor route of antibiotic administration affects the short or long-term major outcome of women with mild or moderate disease. Data on women with severe disease was inadequate to influence the results of the study.^[5] The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ...

Prevention

• Risk reduction against sexually transmitted diseases through abstinence or barrier methods such as condoms; see human sexual behavior for other listings.
• Going to the doctor immediately if symptoms of PID, sexually transmitted diseases appear, or after learning that a current or former sex partner has, or might have had a sexually transmitted disease.
• Getting regular gynecological (pelvic) exams with STD testing to screen for symptomless PID.^[6]
• Discussing sexual history with a trusted physician in order to get properly screened for sexually transmitted diseases.
• Regularly scheduling STD testing with a physician and discussing which tests will be performed that session.
• Getting a STD history from your current partner and insisting they be tested and treated before intercourse.
• Understanding when a partner says that they have been STD tested they usually mean chlamydia and gonorrhea in the US, but that those are not all of the sexually transmissible diseases.
• Treating partners to prevent reinfection or spreading the infection to other people.

This article is about the practice of abstinence in general. ... A standard latex condom still rolled up This article is about the contraceptive device. ... This article is about sexual practices (i. ... A sexually transmitted disease (STD), a. ... The shamefulness associated with the examination of female genitalia has long inhibited the science of gynaecology. ... Chlamydia is a common term for Chlamydiae. ... The clap redirects here. ...

Other diseases that can lead to or be involved in PID

1. Salpingitis, any infection of the fallopian tubes.
2. Tubo-ovarian abscess an abscess of the fallopian tube or ovary.
3. Endometritis
4. Pelvic peritonitis
5. The Dalkon Shield (withdrawn from the market in 1975 for this reason)
6. Bacterial Vaginosis

Female internal reproductive anatomy The Fallopian tubes, also known as oviducts and uterine tubes, are two very fine tubes leading from the ovaries of female mammals into the uterus. ... For the death metal band, see Abscess (band). ... Endometritis refers to inflammation of the endometrium, the inner lining of the uterus. ... Dalkon Shield was the name of a contraceptive intrauterine device (IUD) introduced by the Dalkon Corporation. ... Bacterial vaginosis (BV) is the most common cause of vaginal infection (vaginitis). ...

References

Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 327th day of the year (328th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links

• NIH/Medline
• CDC
• Pelvic Inflammatory Disease (PID; Salpingitis, Endometritis)