Pelvic inflammatory disease and its correct management

Boala inflamatorie pelvină și managementul său corect

Pelvic inflammatory disease may present mild or absent symptoms, so it often goes unnoticed. In the long run, in the absence of proper and timely treatment, it can cause significant complications, from the development of scar tissue in the genital tract to infertility.

Causes for Pelvic inflammatory disease

A wide range of bacteria can be responsible for the onset of pelvic inflammatory disease, but most often there is involved gonorrhea, chlamydia or mycoplasma (in 1 in 4 cases), which usually occur after unprotected sex. It happens that these bacteria enter the genital tract during menstruation, after birth, pregnancy loss or abortion; they rarely enter after an IUD or surgery (such as an endometrial biopsy).

Risk factors for pelvic inflammatory disease should be mentioned, namely: several sexual partners, starting sexual activity earlier than 25 years, unprotected sexual contact with a condom, regular use of the vaginal douche, a medical history of sexually transmitted infections.

Symptoms Pelvic inflammatory disease

The symptoms of this condition can be difficult to identify and they are often absent. When present, they include: abdominal or pelvic pain, but also in the lower back (the degree of pain varies), abnormal or excessive vaginal discharge (sometimes unpleasant odor), abnormal vaginal bleeding during sexual intercourse or between menstrual cycles ) or absence of menstruation (amenorrhea), pain on sexual intercourse, fever (sometimes with chills), painful / frequent / difficult urination, feeling of exhaustion, lack of appetite.

Remember that even in situations where the symptoms of pelvic inflammatory disease that you have are not in severe form, you should not be consulted by a doctor as soon as possible. There are situations in which they are associated with a sexually transmitted disease.

Diagnosis for Pelvic inflammatory disease

There is no specific test to diagnose the pelvic inflammatory disease, but your doctor will take into account your medical history (contraceptive methods, previous sexually transmitted diseases, sexual habits), symptoms and he will perform a pelvic exam during which he can take samples like vaginal discharge to be tested in the laboratory. Your gynecologist may also recommend blood tests (C-reactive protein, erythrocyte sedimentation rate, or complete blood count) or urine tests to check for sexually transmitted diseases or to assess the level of infectious or inflammatory markers. A pelvic ultrasound helps the medic to visualize the reproductive organs. In the cases where the diagnosis is not accurate, exploratory laparoscopy or endometrial biopsy may be helpful (a sample of endometrial tissue is taken and analyzed for signs of infection and inflammation).

Treatment of Pelvic inflammatory disease

An early drug treatment can cure the infection that causes pelvic inflammatory disease. But there is no way to reverse the scarring or the lesions in the genital tract that have already occurred. Treatment for this condition usually involves antibiotics for 14 days, sometimes starting with a dose given intravenously (prescribed depending on the results of laboratory tests), which is important to be followed for the period indicated by your doctor to avoid the development of resistance to antibiotic. If you experience chronic pevic pain, you may be given painkillers to relieve symptoms.

To prevent reinfection, the sexual partner should also be examined by a doctor (even if he has no symptoms) and treated, and sexual contact should be stopped during treatment, until the symptoms disappear. Some women experience repeated episodes of pelvic inflammatory disease; this happens either because the treatment has not been completed or because the partner has not been tested and treated. If an episode of the disease affects the uterus or fallopian tubes, the bacteria will infect these areas more easily and increase the chances of developing the disease again.

Hospitalization is required for women who have severe symptoms, who do not respond to oral medication, or who are pregnant. Surgery is required only if an abscess ruptures or drains. If you are diagnosed with ectopic pregnancy, you may be given medication or you will be recommended to surgery to terminate the pregnancy.
Complications of the disease include the development of scar tissue and abscesses in the genital tract, which can permanently affect the reproductive organs. In this sense may occur: infertility (the risk of infertility increases in proportion to the number of diseases), ectopic pregnancy (when scar tissue develops in the fallopian tubes), chronic pelvic pain for several months or years (present during ovulation or sexual contact), tubo-ovarian abscess (most often occurs in the ovaries and fallopian tubes, but can also occur in the uterus or other organs and can cause a potentially fatal infection in the absence of treatment). It is estimated that about 1 in 10 women affected by the disease become infertile, with the highest risk in those who have delayed treatment or have had repeated episodes of pelvic inflammatory disease. However, there are studies that show that the pregnancy rate remains good for those who have received the right treatment.

You should see a doctor immediately if you have a fever higher than 38.5 degrees Celsius, nausea and vomiting, severe abdominal pain.