Pelvic inflamatory disease(PID)

PID

• Merupakan komplikasi dari sexually transmitted disease (STDs) pada wanita.

• USA, 1 jt kasus akut pid pertahun.

Definition

• Pid adalah infeksi klinik drpd satu atau lebih dari struktur berikut ini:

• Cervix (cervisitis)• Endometrium (endometritis)• Fallopian tube (salpingitis)• Ovary (oophoritis)• Uterin wall (myometritis)• Uterin serosa & broad ligaments

(parametritis)• Pelvic peritoneum (peritonitis)

PID

• Acute pid (acute salpingitis) refers the acute clinical syndrom of ascending infection.

• Chronic pid refers to the long-term sequelae of such as adhesions and hydrosalpinges.

Etiology

• Pid is the result of polymicrobial infection ascending from the bacterial flora of the vagina and cervix.

• Chlamydia trachomatis and / or neisseria gonorrhoeae > 50%.

• 15% of cases follow a surgical procedure (endometrial byopsi, intrauterine device (IUD) placement)

Risk factors

• Sexually active women• Young age at first intercourse• Multiple partners• Frequency of intercourse• Incidence 75% < 25 years old• Desease of menstruating women• Increased risk IUD, decreased risk

barrier contraception• Previous pid (25%).

Symptoms and signs

• 90%, pain in the lower abdomen and pelvis.• 75%, mucopurulent cervical discharge.• 40%, abnormal vaginal bleeding,

metrorrhagia.• 33%, fever > 100,4 F.• Nausea and vomiting.• 5%, Fitz-Hugh-Curtis syndrome• (perihepatic inflammation and • adhesions)• = pleuritic upper quadrant pain• # pneumonia or acute cholecystitis.

Diagnosis

• Pid is a clinical diagnosis.• 1/3 misdiagnosed : acute appendicitis,

endometriosis and rupture of and adnexal mass.

• Endocervical cultures for chlamydia and GO.

• USG (abscess), purulent fluid on culdocentesis, ^ erythrocyte sediment rate.

• Laparoscopy.

Treatment of acute pid

• AB treatment should be started as soon as possible.

• 75% can be managed as outpatients.• TOA (tuboovarian abscess) drained

immediately.• Male partners.• Education for the prevention of

reinfection.

Surgical

• Laparotomy • ~ ruptured TOA• ~ not respond to• conservative therapy

• Bilateral salpingo-oophorectomy• With hysterectomy.

Long-term sequelae of PID

• 25% long-term sequelae• 20% infertility• Ectopic pregnancy• Chronic PID, pelvic adhesions,

hydrosalpinges.

Rare causes of PID

• Actinomycosis• ~ actinomyces israelii• ~ high-dose parenteral • penicillin + oral doxycyclin• for 6 weeks.

• Pelvic tuberculosis• ~ chronic PID and infertility• ~ mycobacterium tuberculosis• ~ multiple antituberculosis.