PELVIC

INFLAMMATORY
DISEASE (PID)
Pelvic Inflammatory Disease (PID) is an infection of the female
reproductive organs, often caused by sexually transmitted bacteria.
It can lead to severe complications like infertility, chronic pain, and
ectopic pregnancy if untreated. Early diagnosis and treatment are
crucial.

Presented by Dr.Habiba Osaf

Definition and Causes of Pelvic
Inflammatory Disease (PID)
Pelvic Inflammatory Disease (PID) is a significant health concern affecting the female reproductive organs. It
is mainly caused by sexually transmitted infections but can also result from medical procedures.
Understanding its causes and risks is essential for prevention and early treatment.

Definition of PID Common Causes Non-STI Causes

Pelvic Inflammatory Disease is PID is primarily caused by Rarely, PID can result from
an infection of the upper female sexually transmitted infections procedures like childbirth,
genital tract, including the abortion, or IUD insertion, which
Symptoms and Signs of Pelvic
Inflammatory Disease (PID)
1 Acute Symptoms 2 Chronic 3 Silent PID
Acute PID often presents Manifestations Some cases are
with lower abdominal pain, Chronic PID may cause
asymptomatic or present
fever, and abnormal vaginal persistent pelvic pain,
with mild, nonspecific
discharge. The pain may dysmenorrhea (painful
symptoms, making
worsen during intercourse periods), and infertility due
diagnosis challenging.
or menstruation. Some to scarring of the
Silent PID is often detected
Diagnosis Methods
The diagnosis of pelvic inflammatory disease (PID) involves a combination of clinical evaluation, laboratory
tests, and imaging techniques to accurately identify the condition and rule out other potential diagnoses.

Laboratory Tests
Tests include STI screenings
(NAAT for Chlamydia/gonorrhea),
CBC (elevated WBCs), and
ESR/CRP (markers of
inflammation). Vaginal or cervical
Clinical Evaluation
cultures may identify specific
Diagnosis begins with a pathogens. Urinalysis can rule
detailed medical history and out UTIs, while pregnancy tests
pelvic exam to identify
2
exclude ectopic pregnancy, a
tenderness, cervical motion common differential diagnosis.
pain, or abnormal discharge.
1
Clinicians use the CDC
criteria (e.g., uterine/adnexal
Imaging Techniques
Complications of PID

10-15% 50% varies

Infertility Ectopic Pregnancy Chronic Pelvic Pain
PID-induced scarring can block Scarred tubes increase the risk of Adhesions and nerve irritation
fallopian tubes, preventing egg- ectopic implantation, a life- from inflammation can cause long-
sperm meeting. About 10-15% of threatening condition. PID term pain, affecting quality of life.
women develop infertility after one accounts for ~50% of ectopic Pain management may require
episode, rising to 50% after three. pregnancies, which require NSAIDs, physical therapy, or even
Early treatment reduces this risk, emergency intervention. Regular surgery (e.g., adhesiolysis) in
but some damage may be monitoring in high-risk patients is severe cases.
irreversible, necessitating IVF for vital to prevent complications.
conception.
Risk Factors for PID
While rare, IUD insertion can
IUD Use/Surgical
introduce procedures
bacteria within the first
3 weeks. Prophylactic antibiotics
are recommended for high-risk
patients. Long-term IUD use
Sexual Behavior
2 doesn’t increase PID risk if STIs
Unprotected sex, multiple are absent. Surgical
partners, or a history of STIs procedures like endometrial
in self or in partner,h/o biopsy,curretage and
sexual abuse, elevate PID hysteroscopy
1
risk. Young age (15-25) is
another factor due to cervical
Douching
ectropion, which increases
bacterial susceptibility. This practice disrupts vaginal
3
Partner treatment is essential flora, facilitating bacterial ascent.
to prevent reinfection. Health education should
discourage douching and
promote safer hygiene practices
Treatment Options

Antibiotic Therapy Surgical Intervention Partner Management

Abscess drainage or Sexual partners must be
First-line treatment includes
salpingectomy may be needed tested/treated to avoid
dual therapy (e.g., ceftriaxone
for ruptured abscesses or reinfection. Abstinence is
+ doxycycline + metronidazole)
severe adhesions. Laparoscopic advised until both parties
to cover polymicrobial
surgery minimizes recovery complete therapy. Public health
infections. Oral regimens suffice
time and preserves fertility measures like contact tracing
for mild cases, while severe PID
when possible. Delayed surgery help curb STI spread.
requires IV antibiotics and
risks sepsis or peritonitis.
hospitalization. Compliance is
Prevention Strategies
Health Education
Awareness campaigns should
target adolescents and
healthcare providers to
emphasize early symptom
Safe Sex Practices
2 recognition. Schools and clinics
Consistent condom use can distribute informational
reduces STI transmission. materials on PID and STI
Monogamous relationships 1 prevention.
and regular STI screenings
are key for high-risk groups.
Vaccination (e.g., HPV Routine Screenings
vaccine) indirectly lowers PID
risk by preventing cervical Annual STI testing for sexually
3
infections. active women under 25 or with
risk factors ensures early
detection. Asymptomatic
screenings are vital, especially in
PID and Pregnancy

Impact on Pregnancy Management During Postpartum PID

PID-related scarring increases Pregnancy Post-delivery infections (e.g.,
miscarriage, preterm birth, and
PID in pregnancy is rare but endometritis) may mimic PID.
stillbirth risks. Preconception
serious, often requiring Timely treatment prevents
counseling should address
hospitalization. Antibiotics must chronic complications and
fertility options, including tubal
be pregnancy-safe (e.g., preserves future fertility.
surgery or IVF for women with
erythromycin). Close fetal
tubal damage.
monitoring is essential due to
sepsis risks.
Differential Diagnoses
Endometriosis

Chronic pain and dysmenorrhea

Appendicitis
overlap, but endometriosis lacks
Right-sided pain and fever can infection markers. Laparoscopy
Ovarian Cysts
mimic PID. Imaging (CT/MRI) confirms diagnosis.
Ruptured cysts cause sudden
helps differentiate. A history of
pain but usually lack fever or
gastrointestinal symptoms may
discharge. Ultrasound aids
point to appendicitis.
differentiation.

1 3
Epidemiology of Pelvic Inflammatory
Disease (PID)
1-2% billions

Global Prevalence Economic Burden

PID affects ~1-2% of young women annually, with
PID costs billions yearly due to infertility treatments
higher rates in regions lacking STI screening.
and chronic pain management. Public health
Chlamydia-linked PID is most common in developed
investments in prevention offset long-term expenses.
countries.
Histopathology
Acute Inflammation
Neutrophil infiltration and edema are hallmarks. Tubal samples
show purulent exudate in severe cases.

Chronic Changes
Fibrosis and adhesions dominate, with plasmacytosis indicating
persistent infection. Histology helps distinguish PID from
malignancies.
Pediatric PID
Pediatric PID is a rare but serious condition in prepubertal children,
often caused by infections such as streptococci, and requires
careful consideration of potential sexual abuse in atypical cases.
Treatment involves precise pediatric dosing and necessitates a
multidisciplinary approach involving both pediatrics and
gynecology for comprehensive care.

1 Rare but Serious

Prepubertal PID often stems from infections like streptococci.
Sexual abuse must be ruled out in atypical cases.

2 Treatment Challenges
Pediatric dosing requires careful calculation. Multidisciplinary
care (pediatrics, gynecology) is essential.
Antibiotic Resistance
Antibiotic resistance is a growing concern in healthcare, with emerging threats like gonorrhea resistance
complicating treatments such as PID. Effective stewardship, including the prudent use of antibiotics and
adherence to guidelines, is essential to curb resistance, alongside ongoing research into new therapeutic
agents.

Stewardship
Emerging Threats
Gonorrhea resistance to Avoiding unnecessary
cephalosporins complicates 1 2 antibiotics and adhering to
PID treatment. Culture- guidelines curbs resistance.
guided therapy is ideal where Research into new agents is
available. critical.
Follow-Up Care
Post-Treatment Evaluation Long-Term Monitoring
Repeat STI tests at 3 months ensure eradication.
Annual pelvic exams and fertility counseling help
Assess for residual pain or fertility concerns
manage chronic sequelae. Mental health support
promptly.
may be needed for quality of life.
Case Studies
Two distinct cases highlighting different aspects of PID diagnosis and treatment.

Case 1: Silent PID Case 2: Severe PID with

Diagnosis Abscess
A 22-year-old diagnosed 1 2
Required laparoscopy.
during infertility workup.
Demonstrates surgical
Highlights need for proactive
indications and outcomes.
screening.
Public Health Policies for PID Prevention
Effective public health policies, such as screening programs and vaccination advocacy, play a crucial role in
reducing the incidence of Pelvic Inflammatory Disease (PID). These measures ensure early detection and
prevention of STIs, which are major contributors to PID.

Screening Programs Vaccination Advocacy

HPV and future gonorrhea vaccines could
Research Frontiers
Research Frontiers include microbiome studies exploring the role of vaginal flora in PID for new probiotics or
diagnostics, and novel therapies such as immunomodulators and targeted antibiotics to reduce tissue
damage.

Microbiome Studies Novel Therapies

1 Immunomodulators and
Investigating vaginal flora’s
2 targeted antibiotics are
role in PID may yield new
under study to reduce tissue
probiotics or diagnostics.
damage.
Conclusion
PID is a preventable cause of infertility with significant personal and societal costs. Multidisciplinary care,
education, and policy changes are vital to curb its impact. Early intervention remains the cornerstone of
management.

Summary Multidisciplinary Care Early Intervention

PID is a preventable cause of Multidisciplinary care, Early intervention remains the
infertility with significant education, and policy changes cornerstone of management.
personal and societal costs. are vital to curb its impact.
Q&A: PID Myths and Treatment
Treatment Expectations
Explain what patients can
expect during and after
Address Common Myths treatment Resources for Learning
Clarify misconceptions (e.g.,
Provide credible sources for
'PID only affects promiscuous
further education on PID
women')

1 3
Closing & Questions
1 Thank You 2 Q&A Session
We appreciate your time Please feel free to ask
and engagement today any remaining questions

3 Follow-Up 4 Key Takeaways

[email protected] Recap of essential points
from the session

5 Feedback Welcome 6 Stay Informed

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