SINGS AND SYMPTOMS
-Pain in your lower abdomen and pelvis
-Heavy vaginal discharge with an unpleasant odor
-Irregular menstrual bleeding
-Pain during intercourse
-Low back pain
-Fever, fatigue, diarrhea or vomiting
-Painful or difficult urination
(P.I.D.) may cause only minor signs and symptoms or none at all. Asymptomatic (P.I.D.) is especially common when the infection is due to chlamydia.
TESTS AND EXAMS
A health care practitioner usually will diagnose (P.I.D.)by taking the individual's medical history, doing a physical exam, and ordering appropriate tests.
Physical exam findings in (P.I.D.)often include the following:
-a temperature greater than 101 F (38.3 C);
-abnormal vaginal discharge;
-lower abdominal tenderness when exterior pressure is applied;
-tenderness when the cervix is moved (during a bimanual or speculum exam); or
-tenderness in female organs (ovaries).
Laboratory tests may include the following:
*a urine or serum pregnancy test if the female is of childbearing age;
*urinalysis to check for bladder and kidney infection;
*a complete blood count (although fewer than half of women with acute (P.I.D.)have a high white blood cell count indicating an infection);
*cervical cultures for gonorrhea and chlamydia;
*tests for other sexually transmitted diseases, including syphilis and HIV
Imaging
A pelvic ultrasound, although not routinely done, can be an important tool in diagnosing complications such as tubo-ovarian abscesses, ovarian torsion, ovarian cysts, and ectopic pregnancy. Although unlikely to occur in pregnancy, (P.I.D.) is the most commonly missed diagnosis in ectopic pregnancies and can occur during the first 12 weeks of pregnancy.
PREVENTION
-Risk reduction against sexually transmitted infections through barrier methods such as condoms; see human sexual behavior for other listings.
-Going to the doctor immediately if symptoms of (P.I.D.), sexually transmitted infections appear, or after learning that a current or former sex partner has, or might have had a sexually transmitted infection.
-Getting regular gynecological (pelvic) exams with STI testing to screen for symptomless (P.I.D.).
-Discussing sexual history with a trusted physician in order to get properly screened for sexually transmitted -diseases.
-Regularly scheduling STI testing with a physician and discussing which tests will be performed that session.
-Getting a STI history from your current partner and insisting they be tested and treated before intercourse.
-Treating partners to prevent reinfection or spreading the infection to other people.
-Diligence in avoiding vaginal activity, particularly intercourse, after the end of a pregnancy (delivery, miscarriage, or abortion) or certain gynecological procedures, to ensure that the cervix closes.
-Exposing under garments to sunlight or heat to dry well.
-Avoid excessive douching of vagina.
RISK FACTORS
There are several things which would put a woman at risk for (P.I.D.), including:
-Women with sexually transmitted diseases -- especially gonorrhea and chlamydia -- are at greater risk for -developing (P.I.D.).
-Women who have had a prior episode of (P.I.D.) are at higher risk for another episode.
-Sexually active teenagers are more likely to develop (P.I.D.) than are older women.
-Women with many sexual partners are at greater risk for sexually transmitted diseases (STDs) and (P.I.D.).
-Some studies suggest that douching may contribute to (P.I.D.). Douching may push bacteria into the upper genital tract and may mask the discharge that could alert a woman to seek medical attention.
TREATMENTS (detailed 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 intravenously to the patient while in the hospital to begin treatment immediately, and to increase the effectiveness of antibiotic treatment. Hospitalization may be necessary if the patient has Tubo-ovarian abscesses; is very ill, immunodeficient, pregnant, or incompetent; or because a life-threatening condition cannot be ruled out. Treating partners for STIs is a very important part of treatment and prevention. Anyone with PID and partners of patients with (P.I.D.) since 6 months prior to diagnosis should be treated to prevent reinfection. Psychotherapy is highly recommended to women diagnosed with (P.I.D.) as the fear of redeveloping the disease after being cured may exist.[citation needed] 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.
A systematic review of the literature related to (P.I.D.) treatment was performed prior to the 2006 CDC sexually transmitted infections 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.
Regimens include cefoxitin or cefotetan plus doxycycline, clindamycin plus gentamicin, ampicillin and sulbactam plus doxycycline, and ceftriaxone or cefoxitin plus doxycycline
COMPLICATION
Even though (P.I.D.) is a relatively harmless condition, if it is not treated quickly and effectively, it can result in permanent damage to the Fallopian tubes. This makes it more difficult for eggs and sperm to pass through and increases the risk of infertility or an ectopic pregnancy.If the first or subsequent episodes of inflammation are not adequately treated then the condition can become chronic. If this happens, abscesses can form in the pelvis and surgery is often required. This may involve the loss of a Fallopian tube, an ovary or, occasionally, the removal of the womb in a hysterectomy. Fortunately, most women seek advice early and treatment is prompt and appropriate.
