Pelvic Inflammatory Disease

- an infection in the upper genital tract not associated with pregnancy or intraperitoneal pelvic operations. - may include infection of the endometrium (endometritis), the oviducts (salpingitis), the ovary (oophoritis), the uterine wall (myometritis), the uterine serosa and broad ligaments (parametritis), and the pelvic peritoneum.

-occurs in 1-2% of young sexually active women -85% of these are spontaneous and the rest occur due to breakdown of the cervical mucus barrier due to procedures such as endometrial biopsies, IUD placement, hystereoscopy etc.

1. Infertility due to tubal obstruction 2. Ectopic pregnancy - incidence increases 6 to 10 fold 3. chronic pelvic pain - increases by 4 fold

- a polymicrobial infection caused by organisms ascending from the vagina and cervix along the mucosa of the endometrium to infect the mucosa of the oviduct.

25-50%

1. 15% 2. 30%

50%

- NO. it depends on the virulence of the strain or colony type. - Transparent colonies of N. gonorrhoeae on culture medium attach more readily to epithelial cells and thus produce tubal infection more frequently than opaque-appearing colonies

- acute complement-mediated inflammatory response with migration of polymorphonuclear leukocytes, vasodilation, and transudation of plasma into the tissues occurs during a PID infection. - This robust inflammatory response causes cell death of the ciliated epithelial cells and tissue damage. - The process of repair with removal of dead cells and fibroblast presence results in scarring and tubal adhesions.

1. Few days 2. Few months

- chlamydial 57-kDa protein and human 60-kDa heat shock protein have homologous region. - thus repeat exposures to Chlamydia may lead to a hypersentivity reaction causing severe tubal damage even if C. trachomatis is no longer present. - Immunologically sensitized studies have demonstrated that women with antibodies to chlamydial heat shock protein are more likely to have severe tubal scarring and Fitz-Hugh-Curtis syndrome (adhesions between the liver and diaphragm indicating prior peritonitis) than women who do not mount this antibody response

- a form of atypical PId - asymptomatic, inflammation of the upper genital tract - often associated with chlamydial infection

1. Sexually transmitted - GC, Chlamydia - usually positive during the beginning week of the infection 2. The most common aerobic organisms are nonhemolytic Streptococcus, Escherichia coli, GBS, and coagulase-negative Staphylococcus. 3. Anaerobic - predominate over aerobes. most common are Bacteroides, Peptostreptococcus, and Peptococcus. almost ubiquitous in pelvic abscesses associated with acute PID

Concurrent bacterial vaginosis or HIV infection.

1. younger age at first intercourse 2. older sex partners 3. involvement with a child protective agency 4. prior suicide attempt 5. alcohol use before intercourse, and 6. current C. trachomatis infection