Gynecology Nursing Care in Managing Pelvic Inflammatory Disease
(PID)
Introduction
Pelvic inflammatory disease (PID) is an ascending infection of the upper
female reproductive tract, including the uterus, fallopian tubes, ovaries, and
surrounding tissues. It is often caused by sexually transmitted infections
(STIs), primarily Chlamydia trachomatis and Neisseria gonorrhoeae, but may
also involve polymicrobial infections (Workowski et al., 2021). Early
recognition and treatment are critical to prevent complications such as
infertility, chronic pelvic pain, and ectopic pregnancy. Gynecology nurses are
central to assessment, diagnosis support, education, treatment, and
prevention.
Pathophysiology
PID develops when pathogens ascend from the lower genital tract, triggering:
Inflammation and tissue damage.
Fallopian tube scarring and adhesions.
Tubal occlusion, leading to infertility or ectopic pregnancy risk.
Peritonitis or abscess formation in severe cases.
Early treatment can limit reproductive damage.
Causes and Risk Factors
Untreated STIs (chlamydia, gonorrhea).
Multiple sexual partners.
Unprotected sexual activity.
Douching (which disrupts normal vaginal flora).
Previous PID episode.
Recent IUD insertion (rare, mainly within first weeks).
Adolescents (increased cervical ectopy and susceptibility).
Clinical Presentation
Women with PID may present with:
Bilateral lower abdominal pain.
Abnormal vaginal discharge.
Fever and chills.
Pain during intercourse (dyspareunia).
Dysuria.
Irregular vaginal bleeding or postcoital bleeding.
Cervical motion tenderness on pelvic exam ("chandelier sign").
Nurses are often the first point of contact when women report these
symptoms in clinics or emergency settings.
Nursing Assessment
Nurses conduct thorough assessments that include:
Complete sexual history (including partner STI status).
Menstrual and contraceptive history.
Pain characteristics and associated symptoms.
Medication allergies and pregnancy status.
Screening for emotional distress and support needs.
Sensitive, nonjudgmental communication fosters honest disclosure.
Diagnostic Evaluation
There is no single definitive test for PID; diagnosis is largely clinical. Nurses
assist with and explain:
Pelvic examination (bimanual and speculum).
Cervical and vaginal cultures for chlamydia, gonorrhea, and other
pathogens.
Urinalysis and pregnancy testing.
Complete blood count (CBC) for infection markers.
Pelvic ultrasound to evaluate for tubo-ovarian abscess or other
complications.
HIV and syphilis testing as part of comprehensive STI screening.
Prompt diagnosis minimizes complications and preserves fertility.
Nursing Interventions
Patient Education:
Nurses educate patients on:
The infectious nature of PID.
The importance of early treatment to prevent long-term reproductive
damage.
Partner notification and treatment to prevent reinfection.
The need for complete adherence to antibiotic therapy.
Medical Management:
Antibiotic Regimens (Outpatient):
o Ceftriaxone IM (single dose) plus doxycycline and metronidazole
for 14 days.
Inpatient Treatment (for severe cases):
o IV cefoxitin or cefotetan plus doxycycline, followed by oral
doxycycline.
Pain Management:
o NSAIDs for pelvic pain relief.
Nurses ensure patients understand dosing schedules, side effects, and the
importance of full course completion.
Monitoring and Follow-Up:
Symptom improvement should begin within 48–72 hours.
Nurses schedule follow-up visits to assess response.
Encourage retesting for STIs in 3 months to monitor reinfection risk.
Sexual Health Counseling:
Abstinence during treatment until both partners complete therapy.
Consistent condom use for ongoing STI protection.
Screening and education for sexual partners.
Discussion of long-acting reversible contraceptives (LARC) when
appropriate.
Emotional and Psychosocial Support:
PID can be associated with:
o Anxiety, shame, or guilt.
o Fear of infertility.
o Partner conflict or intimate partner violence.
Nurses offer:
o Emotional reassurance.
o Counseling referrals.
o Partner education and communication support.
Prevention and Health Promotion
Nurses promote prevention through:
Routine STI screening in sexually active women under 25.
Early treatment of STIs.
Safe sex counseling.
Avoidance of douching.
Preconception counseling for women desiring pregnancy post-PID.
Challenges in Nursing Practice
Delayed Care: Many women delay seeking care due to
embarrassment or lack of knowledge.
Recurrent Infections: Nurses must emphasize partner treatment and
preventive behaviors.
Fertility Concerns: Patients require counseling on potential fertility
impacts.
Multidisciplinary Collaboration
Optimal PID care involves collaboration with:
Gynecologists.
Infectious disease specialists.
Sexual health counselors.
Mental health professionals.
Fertility specialists for long-term reproductive care.
Nurses serve as educators, advocates, and coordinators for comprehensive
care.
Conclusion
Pelvic inflammatory disease can have lifelong reproductive consequences if
not addressed early and effectively. Gynecology nurses play a vital role in
early recognition, comprehensive education, medication adherence support,
emotional care, and prevention counseling. Their compassionate, patient-
centered approach helps women not only recover from infection but also
protect their reproductive health long-term.
References
Workowski, K. A., et al. (2021). Sexually transmitted infections
treatment guidelines, 2021. MMWR Recommendations and Reports,
70(4), 1-187.
Haggerty, C. L., & Ness, R. B. (2008). Diagnosis and treatment of pelvic
inflammatory disease. Women's Health, 4(4), 383-397.
