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{{Pelvic inflammatory disease}}
{{Pelvic inflammatory disease}}
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{{CMG}}; {{AE}} {{MehdiP}}
==Overview==
The overall prognosis of PID is good. Timely, appropriate treatment often prevents serious complications such as [[ectopic pregnancy]], [[infertility]], [[hydrosalpinx]], and [[chronic pelvic pain]].


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==Natural history==
If left untreated, PID may lead to [[infertility]] in approximately 16% of affected women.<ref name="pmid1411832">{{cite journal |vauthors=Weström L, Joesoef R, Reynolds G, Hagdu A, Thompson SE |title=Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results |journal=Sex Transm Dis |volume=19 |issue=4 |pages=185–92 |year=1992 |pmid=1411832 |doi= |url=}}</ref> It may progress to adjacent organ involvement or even [[peritonitis]].


==Overview==
==Prognosis==
PID 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. 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.
The overall prognosis of PID is good if patients are treated within 3 days of the onset of symptoms onset, though clinical improvement cannot guarantee protection against [[infertility]].<ref name="pmid15652102">{{cite journal |vauthors=Ross J |title=Pelvic inflammatory disease |journal=Clin Evid |volume= |issue=11 |pages=2121–7 |year=2004 |pmid=15652102 |doi= |url=}}</ref>
 
Factors that predict poor prognosis include:<ref name="pmid24118399">{{cite journal |vauthors=Terao M, Koga K, Fujimoto A, Wada-Hiraike O, Osuga Y, Yano T, Kozuma S |title=Factors that predict poor clinical course among patients hospitalized with pelvic inflammatory disease |journal=J. Obstet. Gynaecol. Res. |volume=40 |issue=2 |pages=495–500 |year=2014 |pmid=24118399 |doi=10.1111/jog.12189 |url=}}</ref>
*Advanced age
*History of previous open [[gynecological surgery]]
*Any [[cystic]] [[lesion]] identified by [[ultrasonography]]
*High [[CRP]] levels


==Complications==
==Complications==
PID can cause [[scarring]] inside the [[reproductive system|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. 


Infertile women may wish to see a specialist, because there may be a possibility in restoring fertility after scarring. Traditionally [[tuboplasty|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.
 
===Chronic pelvic pain===
*[[Chronic pelvic pain]] is defined as [[lower abdominal pain]] that lasts for at least 6 months and causes functional disability. Approximately 1 in 3 of women affected by [[PID]] will experience chronic pelvic pain.<ref name="pmid12015517">{{cite journal |vauthors=Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Songer T, Lave JR, Hillier SL, Bass DC, Kelsey SF |title=Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial |journal=Am. J. Obstet. Gynecol. |volume=186 |issue=5 |pages=929–37 |year=2002 |pmid=12015517 |doi= |url=}}</ref>
*Recurrent PID is the strongest predictor for the development of [[chronic pelvic pain]] due to the [[scars]] and [[adhesions]] that result from repeated [[inflammation]].<ref name="pmid15849530">{{cite journal |vauthors=Haggerty CL, Peipert JF, Weitzen S, Hendrix SL, Holley RL, Nelson DB, Randall H, Soper DE, Wiesenfeld HC, Ness RB |title=Predictors of chronic pelvic pain in an urban population of women with symptoms and signs of pelvic inflammatory disease |journal=Sex Transm Dis |volume=32 |issue=5 |pages=293–9 |year=2005 |pmid=15849530 |doi= |url=}}</ref>
 
===Infertility===
*PID may cause permanent damages to the [[fallopian tubes]], this damages include loss of ciliary action, [[fibrosis]], and occlusion that may result in [[infertility]].<ref name="pmid8362945">{{cite journal |vauthors=Cates W, Joesoef MR, Goldman MB |title=Atypical pelvic inflammatory disease: can we identify clinical predictors? |journal=Am. J. Obstet. Gynecol. |volume=169 |issue=2 Pt 1 |pages=341–6 |year=1993 |pmid=8362945 |doi= |url=}}</ref>
*Risk factors for infertility include:
*#[[Chlamydial]] infection<ref name="pmid17548070">{{cite journal |vauthors=Svenstrup HF, Fedder J, Kristoffersen SE, Trolle B, Birkelund S, Christiansen G |title=Mycoplasma genitalium, Chlamydia trachomatis, and tubal factor infertility--a prospective study |journal=Fertil. Steril. |volume=90 |issue=3 |pages=513–20 |year=2008 |pmid=17548070 |doi=10.1016/j.fertnstert.2006.12.056 |url=}}</ref>
*#Delayed PID treatment<ref name="pmid8498436">{{cite journal |vauthors=Hillis SD, Joesoef R, Marchbanks PA, Wasserheit JN, Cates W, Westrom L |title=Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility |journal=Am. J. Obstet. Gynecol. |volume=168 |issue=5 |pages=1503–9 |year=1993 |pmid=8498436 |doi= |url=}}</ref>
*#Frequent PIDs<ref name="pmid7008604">{{cite journal |vauthors=Weström L |title=Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries |journal=Am. J. Obstet. Gynecol. |volume=138 |issue=7 Pt 2 |pages=880–92 |year=1980 |pmid=7008604 |doi= |url=}}</ref>
*#Severity of infection<ref name="pmid9609570">{{cite journal |vauthors=Lepine LA, Hillis SD, Marchbanks PA, Joesoef MR, Peterson HB, Westrom L |title=Severity of pelvic inflammatory disease as a predictor of the probability of live birth |journal=Am. J. Obstet. Gynecol. |volume=178 |issue=5 |pages=977–81 |year=1998 |pmid=9609570 |doi= |url=}}</ref>
 
===Ectopic pregnancy===
*[[Fallopian tubes|Tubal]] damage due to PID may result in anatomical distortion, which can predispose the patient to [[ectopic pregnancy]].<ref name="pmid1411832">{{cite journal |vauthors=Weström L, Joesoef R, Reynolds G, Hagdu A, Thompson SE |title=Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results |journal=Sex Transm Dis |volume=19 |issue=4 |pages=185–92 |year=1992 |pmid=1411832 |doi= |url=}}</ref>
 
===Hydrosalpinx===
*Tubal damage may lead to tubal blockade, sterile fluid accumulation, and/or [[fallopian tube]] enlargement, which may cause pain or [[infertility]].<ref name="pmid23812461">{{cite journal |vauthors=Kawwass JF, Crawford S, Kissin DM, Session DR, Boulet S, Jamieson DJ |title=Tubal factor infertility and perinatal risk after assisted reproductive technology |journal=Obstet Gynecol |volume=121 |issue=6 |pages=1263–71 |year=2013 |pmid=23812461 |pmc=4292839 |doi=10.1097/AOG.0b013e31829006d9 |url=}}</ref>
 
===Fitz Hugh Curtis syndrome===
*[[Inflammation]] and adhesion formation in the liver capsule ([[perihepatitis]]) may cause [[Right upper quadrant abdominal pain resident survival guide|right upper quadrant abdominal pain]] and [[tenderness]].<ref name="pmid25992748">{{cite journal |vauthors=Brunham RC, Gottlieb SL, Paavonen J |title=Pelvic inflammatory disease |journal=N. Engl. J. Med. |volume=372 |issue=21 |pages=2039–48 |year=2015 |pmid=25992748 |doi=10.1056/NEJMra1411426 |url=}}</ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Needs content]]
[[Category:Disease]]
[[Category:Infectious disease]]
[[Category:Gynecology]]
[[Category:Abdominal pain]]
[[Category:Sexually transmitted diseases]]
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Latest revision as of 15:17, 4 May 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

The overall prognosis of PID is good. Timely, appropriate treatment often prevents serious complications such as ectopic pregnancy, infertility, hydrosalpinx, and chronic pelvic pain.

Natural history

If left untreated, PID may lead to infertility in approximately 16% of affected women.[1] It may progress to adjacent organ involvement or even peritonitis.

Prognosis

The overall prognosis of PID is good if patients are treated within 3 days of the onset of symptoms onset, though clinical improvement cannot guarantee protection against infertility.[2]

Factors that predict poor prognosis include:[3]

Complications

Chronic pelvic pain

Infertility

Ectopic pregnancy

Hydrosalpinx

Fitz Hugh Curtis syndrome

References

  1. ↑ 1.0 1.1 Weström L, Joesoef R, Reynolds G, Hagdu A, Thompson SE (1992). "Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results". Sex Transm Dis. 19 (4): 185–92. PMID 1411832.
  2. ↑ Ross J (2004). "Pelvic inflammatory disease". Clin Evid (11): 2121–7. PMID 15652102.
  3. ↑ Terao M, Koga K, Fujimoto A, Wada-Hiraike O, Osuga Y, Yano T, Kozuma S (2014). "Factors that predict poor clinical course among patients hospitalized with pelvic inflammatory disease". J. Obstet. Gynaecol. Res. 40 (2): 495–500. doi:10.1111/jog.12189. PMID 24118399.
  4. ↑ Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Songer T, Lave JR, Hillier SL, Bass DC, Kelsey SF (2002). "Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial". Am. J. Obstet. Gynecol. 186 (5): 929–37. PMID 12015517.
  5. ↑ Haggerty CL, Peipert JF, Weitzen S, Hendrix SL, Holley RL, Nelson DB, Randall H, Soper DE, Wiesenfeld HC, Ness RB (2005). "Predictors of chronic pelvic pain in an urban population of women with symptoms and signs of pelvic inflammatory disease". Sex Transm Dis. 32 (5): 293–9. PMID 15849530.
  6. ↑ Cates W, Joesoef MR, Goldman MB (1993). "Atypical pelvic inflammatory disease: can we identify clinical predictors?". Am. J. Obstet. Gynecol. 169 (2 Pt 1): 341–6. PMID 8362945.
  7. ↑ Svenstrup HF, Fedder J, Kristoffersen SE, Trolle B, Birkelund S, Christiansen G (2008). "Mycoplasma genitalium, Chlamydia trachomatis, and tubal factor infertility--a prospective study". Fertil. Steril. 90 (3): 513–20. doi:10.1016/j.fertnstert.2006.12.056. PMID 17548070.
  8. ↑ Hillis SD, Joesoef R, Marchbanks PA, Wasserheit JN, Cates W, Westrom L (1993). "Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility". Am. J. Obstet. Gynecol. 168 (5): 1503–9. PMID 8498436.
  9. ↑ Weström L (1980). "Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries". Am. J. Obstet. Gynecol. 138 (7 Pt 2): 880–92. PMID 7008604.
  10. ↑ Lepine LA, Hillis SD, Marchbanks PA, Joesoef MR, Peterson HB, Westrom L (1998). "Severity of pelvic inflammatory disease as a predictor of the probability of live birth". Am. J. Obstet. Gynecol. 178 (5): 977–81. PMID 9609570.
  11. ↑ Kawwass JF, Crawford S, Kissin DM, Session DR, Boulet S, Jamieson DJ (2013). "Tubal factor infertility and perinatal risk after assisted reproductive technology". Obstet Gynecol. 121 (6): 1263–71. doi:10.1097/AOG.0b013e31829006d9. PMC 4292839. PMID 23812461.
  12. ↑ Brunham RC, Gottlieb SL, Paavonen J (2015). "Pelvic inflammatory disease". N. Engl. J. Med. 372 (21): 2039–48. doi:10.1056/NEJMra1411426. PMID 25992748.

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