Pelvic inflammatory disease

Inflammation of the uterus, fallopian tubes, ovaries, and adjacent structures that occurs unrelated to surgical procedures is called pelvic inflammatory disease. It usually occurs as a complication of sexually transmitted diseases such as chlamydia or gonorrhea. The consequences of this entity can be serious and therein lies its importance.

Being a complication of sexually transmitted diseases, sexually active women with more than one partner have a higher risk of contracting it.

Causes

The most common cause of pelvic inflammatory disease is a bacterial infection that begins in the vagina and cervix and spreads to the uterus, fallopian tubes, and ovaries. The bacteria that most frequently produce it are Chlamydia trachomatis and Neisseria Gonorrhoeae, but on some occasions it is caused by an infection by more than one microorganism at the same time, that is, they are polymicrobial. On more rare occasions, the infection can arrive through infected adjacent organs such as the appendix or through the bloodstream.

To a lesser extent, the origin may be due to the complication of a medical-surgical procedure such as the placement of an IUD, a spontaneous or elective abortion, or an endometrial biopsy.

Symptoms

Symptoms can be highly variable and nonspecific but usually present some of the following:

• Bilateral lower abdominal pain
• Increased vaginal discharge
• pain with urination
• pain with intercourse
• Fever
• nausea and vomiting

Sometimes pelvic inflammatory disease does not present any symptoms and is diagnosed by complications.

Diagnosis

On many occasions it is difficult to make the diagnosis since the symptoms are usually very unspecific and there is no specific test for the diagnosis. The physical examination is very important in the diagnosis, the abdominal palpation and the vaginal examination usually help to orient the case.

Ultrasound gives information on whether there is any abscess of the tubes or ovaries, but it cannot indicate inflammation.

blood tests will also indicate if there is a possible infection in any organ of the body. Cultures from the vagina and cervix help us determine the presence of bacteria in these organs. They are collected with a small cotton ball at the end of a stick, which, sent to the laboratory, will indicate if there is the growth of any microorganism. It is a test whose result will take a few days, so it can help but sometimes late.

The possible chronic consequences of pelvic inflammatory disease are so important that their suspicion, without having the test results already indicate the start of treatment. Laparoscopy is a surgical procedure that can be performed in very specific cases in which the diagnosis is not clear and the start of treatment may have some complication.

Treatment

As it is a disease of infectious origin and bacteria, the treatment must be antibiotic. In mild cases, outpatient treatment can be performed and the patient can take medication at home, but in the rest of cases, treatment should include hospital admission and medication administered intravenously. antibiotic regimens usually consist of a combination of two antibiotics administered simultaneously. It is very important that the treatment is carried out as many days as indicated even though the symptoms usually disappear in a few days. It should also be understood that antibiotic treatment does not repair damage that has already been done to the genital organs but prevents possible complications that have not yet occurred.

In the event of an abscess of the tubes or ovaries, laparoscopic surgery or open surgery may be necessary for drainage.

Complications

The importance of pelvic inflammatory disease lies in its complications. Upon reaching the fallopian tubes, the infection transforms normal tissue into scar tissue. This fibrous tissue can block the tubes in such a way that it does not allow the passage of sperm to the ovum and therefore produces sterility due to tubal occlusion. This occurs in 10-12% of women in their first episode of pelvic inflammatory disease. IF the clinical picture is repeated, the risk also increases.

In some cases, the tissue does not completely plug the tubes but it does alter their functionality in such a way that it does not allow the fertilized ovum to reach the uterus and then the ectopic pregnancy occurs or out of its natural place.

Other complications that it causes are related to the adhesions produced by scar tissue in the abdomen, producing a picture of chronic lower abdominal pain in 18% of women that can be accompanied by pain with sexual intercourse.

In a very high percentage of cases that a pelvic inflammatory disease occurs, the origin lies in a sexually transmitted disease. Therefore, the use of condoms reduces its incidence.