|
|
| (36 intermediate revisions by 11 users not shown) |
| Line 1: |
Line 1: |
| {{DiseaseDisorder infobox | | | __NOTOC__ |
| Name = Pelvic Inflammatory Disease |
| | {{Pelvic inflammatory disease}} |
| ICD10 = {{ICD10|N|70||n|70}}-{{ICD10|N|77||n|70}}|
| |
| ICD9 = {{ICD9|614}}-{{ICD9|616}} |
| |
| ICDO = |
| |
| Image = |
| |
| Caption = |
| |
| OMIM = |
| |
| MedlinePlus = |
| |
| eMedicineSubj = emerg |
| |
| eMedicineTopic = 410 |
| |
| DiseasesDB = 9748 |
| |
| }}
| |
| {{Search infobox}}
| |
| {{CMG}}
| |
|
| |
|
| {{Editor Help}} | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
|
| |
|
| ==Overview==
| | {{CMG}}; {{AE}} {{MehdiP}} |
| '''Pelvic inflammatory disease''' (or '''disorder''') ('''PID''') is a generic term for [[infection]] of the female [[uterus]], [[fallopian tubes]], and/or [[ovaries]] as it progresses to scar formation with [[Adhesion (medicine)|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 had PID <ref name="titleSTD Facts - Pelvic inflammatory disease (PID)">{{cite web |url=http://www.cdc.gov/std/PID/STDFact-PID.htm |title=STD Facts - Pelvic inflammatory disease (PID) |accessdate=2007-11-23 |format= |work=}}</ref> (Cecil's 5th ed). 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 [[sexually transmitted disease|STD]] is often the cause, other routes are possible, including lymphatic, postpartum, postabortal (either miscarriage or abortion) or [[Intrauterine device|intrauterine device (IUD)]] related, and [[blood|hematogenous]] spread.
| |
|
| |
|
| == Etiology == | | {{SK}} PID |
| *[[Bacteroides]]
| | ==[[Pelvic inflammatory disease overview|Overview]]== |
| *[[Chlamydia trachomatis]]
| |
| *[[Enterococci]]
| |
| *[[Mycoplasma]]
| |
| *[[Neisseria gonorrhoeae]]
| |
| *[[Staphylococci]]
| |
| *[[Streptococci]]
| |
|
| |
|
| ==[[Epidemiology]]== | | ==[[Pelvic inflammatory disease historical perspective|Historical Perspective]]== |
| In the [[United States]], more than one million women are affected by PID each year, and the rate is highest with teenagers. Approximately 50,000 women become [[infertile]] in the US each year from PID [1]. [[gonorrhea|N. gonorrhoea]] is isolated in only 40-60% of women with acute salpingitis <ref name="isbn0-8385-1401-4">{{cite book |author=Lauren Nathan; DeCherney, Alan H.; Pernoll, Martin L. |title=Current obstetric & gynecologic diagnosis & treatment |publisher=Lange Medical Books/McGraw-Hill |location=New York |year=2003 |pages= |isbn=0-8385-1401-4 |oclc= |doi=}}</ref> . [[chlamydia|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 [[N. gonorrhoea|Neisseria gonorrhoeae]] <ref name="isbn0-8385-1401-4"> </ref> <ref name="isbn0-8385-1401-4">{{cite book |author=Lauren Nathan; DeCherney, Alan H.; Pernoll, Martin L. |title=Current obstetric & gynecologic diagnosis & treatment |publisher=Lange Medical Books/McGraw-Hill |location=New York |year=2003 |pages= |isbn=0-8385-1401-4 |oclc= |doi=}}</ref> 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. <ref name="isbn0-7216-8179-4"> </ref>. PID is the leading cause of infertility. "A single episode of PID results in infertility in 13% of women." <ref name="isbn0-7216-8179-4"> </ref> This rate of infertility increases with each infection.
| |
|
| |
|
| ==Diagnosis== | | ==[[Pelvic inflammatory disease pathophysiology|Pathophysiology]]== |
| There may be no actual symptoms of PID. If there are symptoms then [[fever]], [[cervix|cervical]] motion tenderness, lower [[abdominal pain]], new or different discharge, [[Pain and nociception|painful]] [[sexual intercourse|intercourse]], or irregular [[Menstrual cycle|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 (current obgyn 9th ed 2003). Regular [[Sexually Transmitted Disease|Sexually transmitted disease (STD)]] testing is important for prevention. Treatment is usually started [[empirical|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 <ref name="isbn0-7216-8179-4"> </ref>
| |
|
| |
|
| ===Differential diagnosis=== | | ==[[Pelvic inflammatory disease causes|Causes]]== |
|
| |
|
| *[[Appendicitis]]
| | ==[[Pelvic inflammatory disease differential diagnosis|Differentiating Pelvic Inflammatory Disease from other Diseases]]== |
| *[[Ectopic pregnancy]]
| |
| *Hemorrhagic [[ovarian cyst]]
| |
| *ruptured [[ovarian cysts]]
| |
| *[[Myoma]]
| |
| *[[Ovarian torsion]]
| |
| *[[Ovarian tumor]]
| |
| *[[Septic]] [[abortion]]
| |
| *[[Urinary Tract Infection]]
| |
| *twisted [[ovarian cyst]]
| |
| *degeneration of a [[myoma]]
| |
| *acute [[enteritis]]
| |
| *[[Urinary Tract Infection]] <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
| |
|
| |
|
| 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. | | ==[[Pelvic inflammatory disease epidemiology and demographics|Epidemiology and Demographics]]== |
|
| |
|
| 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 inflammatory disease risk factors|Risk Factors]]== |
|
| |
|
| 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. | | ==[[Pelvic inflammatory disease natural history|Natural History, Complications and Prognosis]]== |
|
| |
|
| 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 [[Centers for Disease Control and Prevention|CDC]] diagnostic criteria from 83% to 95%. However, even the modified 2002 CDC criteria does not identify women with subclinical disease. <ref name="pmid17343812">{{cite journal |author=Blenning CE, Muench J, Judkins DZ, Roberts KT |title=Clinical inquiries. Which tests are most useful for diagnosing PID? |journal=J Fam Pract |volume=56 |issue=3 |pages=216–20 |year=2007 |pmid=17343812 |doi=}}</ref>
| | ==[[Pelvic inflammatory disease diagnosis|Diagnosis]]== |
| | | [[Pelvic inflammatory disease diagnostic criteria|Diagnostic Criteria]] | [[Pelvic inflammatory disease history and symptoms|History and Symptoms]] | [[Pelvic inflammatory disease physical examination|Physical Examination]] | [[Pelvic inflammatory disease laboratory findings|Laboratory Findings]] | [[Pelvic inflammatory disease CT|CT]] | [[Pelvic inflammatory disease MRI|MRI]] | [[Pelvic inflammatory disease echocardiography or ultrasound|Ultrasound]] | [[Pelvic inflammatory disease other imaging findings|Other Imaging Findings]] | [[Pelvic inflammatory disease other diagnostic studies|Other Diagnostic Studies]] |
| ==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. | |
| | |
| 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 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.
| |
|
| |
|
| ==Treatment== | | ==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 to increase the effectiveness of antibiotic treatment. Hospitalization may be necessary if Tubo-ovarian abscess, very ill, immunodeficient, pregnancy, incompetence, or because this or something else life threatening can not be ruled out. Treating partners for STD's 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.
| | [[Pelvic inflammatory disease medical therapy|Medical Therapy]] | [[Pelvic inflammatory disease surgery|Surgery]] | [[Pelvic inflammatory disease primary prevention|Primary Prevention]] | [[Pelvic inflammatory disease secondary prevention|Secondary Prevention]] | [[Pelvic inflammatory disease cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Pelvic inflammatory disease future or investigational therapies|Future or Investigational Therapies]] |
|
| |
|
| A systematic review of the literature related to PID treatment was performed prior to the 2006 [[Centers for Disease Control and Prevention|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. <ref name="pmid17342664">{{cite journal |author=Walker CK, Wiesenfeld HC |title=Antibiotic therapy for acute pelvic inflammatory disease: the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines |journal=Clin. Infect. Dis. |volume=44 Suppl 3 |issue= |pages=S111–22 |year=2007 |pmid=17342664 |doi=10.1086/511424}}</ref>
| | ==Case Studies== |
| | [[Pelvic inflammatory disease case study one|Case #1]] |
|
| |
|
| ==Prevention==
| | ==External Links== |
| *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 disease]]s appear, or after learning that a current or former sex partner has, or might have had a sexually transmitted disease.
| |
| * Getting regular [[Gynecology|gynecological]] (pelvic) exams with [[STD]] testing to screen for symptomless PID. <ref name="pmid17888100">{{cite journal |author=Smith KJ, Cook RL, Roberts MS |title=Time from sexually transmitted infection acquisition to pelvic inflammatory disease development: influence on the cost-effectiveness of different screening intervals |journal=Value Health |volume=10 |issue=5 |pages=358–66 |year=2007 |pmid=17888100 |doi=10.1111/j.1524-4733.2007.00189.x}}</ref>
| |
| * 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 so you don't become reinfected or they do not infect another.
| |
| | |
| ==Other diseases that can lead to or be involved in PID==
| |
| # [[Salpingitis]], any infection of the fallopian tubes.
| |
| # Tubo-ovarian abscess an [[abscess]] of the fallopian tube or ovary.
| |
| # [[Endometritis]]
| |
| # Pelvic [[peritonitis]]
| |
| # The [[Dalkon Shield]] (withdrawn from the market in 1975 for this reason)
| |
| # [[Bacterial Vaginosis]]
| |
| | |
| ==References==
| |
| {{Reflist|2}}
| |
| | |
| ==External links== | |
| * [http://www.nlm.nih.gov/medlineplus/pelvicinflammatorydisease.html#diagnosissymptoms NIH/Medline] | | * [http://www.nlm.nih.gov/medlineplus/pelvicinflammatorydisease.html#diagnosissymptoms NIH/Medline] |
| * [http://www.cdc.gov/std/PID/STDFact-PID.htm CDC] | | * [http://www.cdc.gov/std/PID/STDFact-PID.htm CDC] |
| * [http://www.health.am/gyneco/more/pelvic_inflammatory_disease_pid_salpingitis_endometritis/ Pelvic Inflammatory Disease (PID; Salpingitis, Endometritis)]
| |
|
| |
| ==Additional Resources==
| |
| * Current Obstetric & Gynecologic Diagnosis Treatment. Alan Decherney and Lauren Nathan. 9th Ed. 2003: pgs 729-731. ISBN 0-8385-1401-4
| |
| * Carpenter, Griggs, Loscalzo. Cecil's essentials of medicine 5th ed. 2001: pages 623-625. ISBN 0-7216-8179-4
| |
| * Harrison's Principles of Internal Medicine 15th ed. ISBN 0-07-007272-8
| |
| <br>
| |
|
| |
|
| {{Diseases of the pelvis, genitals and breasts}} | | {{Diseases of the pelvis, genitals and breasts}} |
|
| |
| [[nl:Eileiderontsteking]] | | [[nl:Eileiderontsteking]] |
| [[pt:Doença inflamatória pélvica]] | | [[pt:Doença inflamatória pélvica]] |
| | {{WikiDoc Help Menu}} |
| | {{WikiDoc Sources}} |
|
| |
|
| {{SIB}}
| | [[Category:Disease]] |
| | |
| [[Category:Infectious disease]] | |
| [[Category:Gynecology]] | | [[Category:Gynecology]] |
| [[Category:Abdominal pain]] | | [[Category:Abdominal pain]] |
| | | [[Category:Sexually transmitted diseases]] |
| {{WikiDoc Help Menu}}
| | [[Category:Emergency mdicine]] |
| {{WikiDoc Sources}}
| | [[Category:Up-To-Date]] |
| | [[Category:Infectious disease]] |