Pelvic Inflammatory Disease
An umbrella term, pelvic inflammatory disease (PID) refers to any acute, subacute, recurrent, or chronic infection of the oviducts and ovaries, with adjacent tissue involvement. It includes inflammation of the cervix (cervicitis), uterus (endometritis), fallopian tubes (salpingitis), and ovaries (oophoritis), which can extend to the connective tissue lying between the broad ligaments (parametritis). (See Features and test findings in pelvic inflammatory disease, page 670.)
About 60% of cases result from overgrowth of one or more of the common bacterial species found in the cervical mucus. Early diagnosis and treatment help prevent damage to the reproductive system, as does well-planned nursing care. Untreated PID may be fatal.
Causes
PID can result from infection with aerobic or anaerobic organisms. The organisms Neisseria gonorrhoeae and Chlamydia trachomatis are the most common causes because they most readily penetrate the bacteriostatic barrier of cervical mucus.
Common bacteria found in cervical mucus include staphylococci, streptococci, diphtheroids, chlamydiae, and coliforms, including Pseudomonas and Escherichia coli. Uterine infection can result from any one or several of these organisms or may follow the multiplication of normally nonpathogenic bacteria in an altered endometrial environment. Bacterial multiplication is most common during parturition because the endometrium is atrophic, quiescent, and not stimulated by estrogen.
Risk factors include:
any sexually transmitted infection
multiple sex partners
conditions or procedures, such as conization or cauterization of the cervix, that alter or destroy cervical mucus, allowing bacteria to ascend into the uterine cavity
any procedure that risks transfer of contaminated cervical mucus into the endometrial cavity by an instrument (such as a biopsy curet, an intrauterine device, or an irrigation catheter) or by tubal insufflation or abortion
infection during or after pregnancy
infectious foci within the body, such as drainage from a chronically infected fallopian tube, a pelvic abscess, a ruptured appendix, or diverticulitis of the sigmoid colon
cigarette smoking
multiparity
douching
intercourse during menses.
Features and test findings in pelvic inflammatory disease
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