Pelvic inflamatory disease

(PID)
Oleh:
Dr.T.M.Ichsan,SpOG
Bagian Obstetri dan Ginekologi FK.USU.

PID
Merupakan komplikasi dari
sexually transmitted disease
(STDs) pada wanita.
USA, 1 jt kasus akut pid
pertahun.

Definition
Pid adalah infeksi klinik drpd satu
atau lebih dari struktur berikut ini:
Cervix (cervisitis)
Endometrium (endometritis)
Fallopian tube (salpingitis)
Ovary (oophoritis)
Uterin wall (myometritis)
Uterin serosa & broad ligaments
(parametritis)
Pelvic peritoneum (peritonitis)

PID
Acute pid (acute salpingitis)
refers the acute clinical
syndrom of ascending infection.
Chronic pid refers to the longterm sequelae of such as
adhesions and hydrosalpinges.

Etiology
Pid is the result of polymicrobial
infection ascending from the
bacterial flora of the vagina and
cervix.
Chlamydia trachomatis and / or
neisseria gonorrhoeae > 50%.
15% of cases follow a surgical
procedure (endometrial byopsi,
intrauterine device (IUD) placement)

Risk factors

Sexually active women

Young age at first intercourse
Multiple partners
Frequency of intercourse
Incidence 75% < 25 years old
Desease of menstruating women
Increased risk IUD, decreased risk
barrier contraception
Previous pid (25%).

Symptoms and signs

90%, pain in the lower abdomen and pelvis.
75%, mucopurulent cervical discharge.
40%, abnormal vaginal bleeding,
metrorrhagia.
33%, fever > 100,4 F.
Nausea and vomiting.
5%, Fitz-Hugh-Curtis syndrome

(perihepatic inflammation and

adhesions)

= pleuritic upper quadrant pain

# pneumonia or acute cholecystitis.

Diagnosis
Pid is a clinical diagnosis.
1/3 misdiagnosed : acute
appendicitis, endometriosis and
rupture of and adnexal mass.
Endocervical cultures for chlamydia
and GO.
USG (abscess), purulent fluid on
culdocentesis, ^ erythrocyte
sediment rate.
Laparoscopy.

Treatment of acute pid

AB treatment should be started as
soon as possible.
75% can be managed as outpatients.
TOA (tuboovarian abscess) drained
immediately.
Male partners.
Education for the prevention of
reinfection.

Surgical
Laparotomy

~ ruptured TOA

~ not respond to

conservative therapy
Bilateral salpingo-oophorectomy
With hysterectomy.

Long-term sequelae of
PID

25% long-term sequelae

20% infertility
Ectopic pregnancy
Chronic PID, pelvic adhesions,
hydrosalpinges.

Rare causes of PID

Actinomycosis

~ actinomyces israelii

~ high-dose parenteral

penicillin + oral doxycyclin

for 6 weeks.
Pelvic tuberculosis

~ chronic PID and infertility

~ mycobacterium tuberculosis

~ multiple antituberculosis.

Sequelae of pid
Ectopic gestation
Tubal infertility
Recurrent infections and
chronic pain

Rationale for prevention

of pid
Prevention of primary infection,
education, especially of young girls
and boys
Eradication of std reservoir and
reduction of std exposure
Selective use of iud
Care of instrumentatio
Treatment of asymtomatic std in
lower genital tract