Pelvic inflammatory Disease

Describes acute, sub-acute or chronic infection of

reproductive pelvic organs

Endometritis Parametritis Salpingitis Oophoritis

Causative organisms Sexually transmitted infections (80%) Chlamydia, Gonorrhoea Other bacterial infections E. coli, Streptococcus, Staphylococcus, Anaerobic bacteria

Symptoms
Fever
Lower abdominal pain Foul smelling vaginal discharge

Anorexia and nausea

Lethargy, malaise Sometimes associated with UTI dysuria, frequency

Signs
General Increased temperature Increased PR
Abdomen Localized lower abdominal tenderness Lower abdominal rigidity with associated peritonitis Abdominal distension if complicated with paralytic ileus Vaginal examination Purulent vaginal discharge Inflammatory changes of cervix reddened cervix Tender adenexial masses when tubes or ovaries are involved

Complications
Abscess formation, tubo-ovarian mass formation
Peritonitis Adynamic ileus intestinal obstruction

Intestinal adhesions intestinal obstruction

Infertility Ectopic pregnancy Chronic pelvic pain due to visceral adhesions

Investigations
High vaginal swab for culture & ABST
FBC ESR and CRP

UFR and Urine culture if urinary symptoms present

Blood culture in severe cases USS to detect tubo-ovarian masses (abscesses) and

to exclude other causes of pelvic pain

Management Acute pelvic infection

Can be managed as an out-patient or an in-ward patient

depending on severity of symptoms Mild disease

Oral empirical antibiotics after obtaining a high vaginal swab

(usually Amoxycillin and Metronidazole)

Severe infection IV antibiotics (eg: Ampicillin, Cephalosporins, Gentamicin, Metronidazole) IV fluids to correct dehydration and acidosis Monitor PR, RR, BP May need exploratory laparotomy if rupture of abcess is suspected

Management chronic pelvic infection

Oral antibiotic therapy Ampicillin, Cephalosporins,

Tetracycline for 3 to 4 weeks Symptomatic relief with analgesics If causative agent present (eg: IUCD) should be removed Surgical treatment
Salpingo-oophorectomy to remove a tubo-ovarian mass

Salpingostomy to evacuate a pyosalpinx

Abdominal hysterectomy and B/L sapingo-

oophorectomy in advanced disease (as a last resort)

Thank you!