Pelvic inflammatory disease (PID) is an infection of the female upper genital tract including the uterus, fallopian tubes, and ovaries. It is commonly caused by sexually transmitted pathogens like Neisseria gonorrhoeae and Chlamydia trachomatis. Left untreated, PID can lead to serious long-term complications like tubal infertility, ectopic pregnancy, chronic pelvic pain, and increased risk of premature delivery. Treatment involves broad-spectrum intravenous antibiotics and sometimes surgery to drain abscesses.

1. Pelvic inflammatory disease
Gaya 

2. Definition
Infection of the upper genital tract
Endometritis -infection of the uterine cavity
Salpingitis -infection of the tubes
Salpingo oophoritis -infection of tubes & ovaries
Tubo-ovarian abscess
Pelvic peritonitis -infection of peritonium

3. Epidemiology
Mainly affects women of child bearing age
Commonly sexually acquired
Incidence – 1-2% among sexually active females
One of major cause for maternal death in
srilanaka

4. Organisms
• Neisseria gonorrhoeae
• Chlamydia trachomatis commonest
• E. coli, Group-B streptococcus &
staphylococcus
• Anaerobic - Bacteroides
• Mycoplasma hominis
• Ureaplasma urealyticum

5. Mode of transmission
• Ascending infection (Canalicular spread)
COMMONEST
• Ascend of gonococcal & chlamydial organisms by
surface extension from the lower genital tract
through the cervical canal by way of the
endometrium to the fallopian tubes
• Facilitated by the sexually transmitted vectors such
as sperms

6. • Under normal circumstance most of the
bacteria cannot penetrate through the
mucosal barrier plugging the endo cervical
canal
• Cla.t and Nei.gon can ascent through this
protective barrier and cause endometritis and
progressing to PID (10%)

7. • Through uterine lymphatic & blood vessels across
parametrium
• Gynecological procedures favoring ascend of infection
E.g. D&C, ERPC, IUI, Hysterosalpingography,manual
removing placenta , HyCoSy ,HSG ,illegal and septic
abortion
• Direct spread from contaminated structures in
abdominal cavity
E.g. Appendicitis , Diverticulitis
• Miscarriages (spontaneous and induced)

8. Spread of infection
Endometritis
Salphingitis
Salpingo-oophoritis
Pelvic peritonitis

9. General peritonitis
Septicaemia and death

10. Risk factors
• Multiple sexual partners
• Past history of STI
• Termination of pregnancy
• IUCD insertion
• Hystero salpingography
• IVF procedure
• Post partum endometritis
• Recent new sexual partner

11. Diagnosis
• Symptoms
• Acute PID – fever ,lower abdominal pain , purulent
discharge ( N.gon)
• Chlamydia cause more of a subclinical infection and
leads to peritubal and pelvic adhesion
• Commonly patient presented with :
– Fever > 38 ◦ C
– Abnormal vaginal discharge
– Unexpected vaginal bleeding
– Lower abdominal pain
– Dyspareunia

12. • Both gon.and chlamydia infection can be
followed by secondary bacterial infection by
endogenous aerobic and anaerobic bacteria
such as bacteroids ,coliforms , and
streptococci

13. • Signs
– Lower abdominal tenderness
– Bimanual examination
 adnexal tenderness
 cervical excitation
– Pyrexia

14. Differential diagnosis
• Ectopic pregnancy
• Acute appendicitis
• Urinary tract infection
• Endometriosis
• Twisted and ruptured ovarian cyst
• Degenerating fibroid

15. Investigations
• FBC
• CRP
• High vaginal swabs
• Ultra sound scan – Tubo - ovarian abscess
• Diagnosis laparoscopy – gold standard to
diagnose, but perform only in doubtful cases or if
tubo-ovarian abscess is suspected
Hyperaemia ,oedema of fallopian tubes , sticky
purulent exudate presence of pus in pelvic cavity
can be seen

16. • Gonorrhea suspected triple swab test (high
vaginal swab + swab from urethral meatus +
and from endocervix ) done
• For chlamydia ,chlamydia antibody test

17. Management
• Life-threatening condition (ectopic) should be exclude
first
Intensity depend on the severity of the patient condition
Start antibiotics empirically until confirmation by
investigations
• Most case IV antibiotics are indicate 10-14 days (broad
spectrum antibiotic to cover gram- and anaerobes )
Neisseria - cephalosporins,penicillins
Chlamydia - doxycycline,azythromycin
anaerobic - metranidazole

18. • Always admit if systemically unwell
• Analgesic give if there is a pain
• Always treat the partner
• Consider removing the IUCD

19. • Laparotomy
If any evidence of pelvic abscess formation or
generalized peritonitis laparotomy done without
delay and pus drained out
This patient need treatment on the ICU as they
can go to gram – septicaemia shock

20. • In chronic pelvic inflammatory disease with
adnexal masses only a hysterectomy with
bilateral salphingo-oophorectomy will help to
relive the patient’s symptoms
•
• when tubal infertility occur due to blockage
invitro fertilization is the successful tratment

21. Disease can progress in to chronic if it fails to
resolve completely due to inadequate antibiotic
treatment or reinfection
This may leads to hydrosalpinx , pyosalpinx ,
tubo –ovarian masses or chronic salpingitis

22. Complications
• Tubo – ovarian abscess and pelvic abscess can spread
to peritoneal cavity and cause pyoperitonum
• Pelvic adhesion – cause blockage and subacute bowel
obstruction
• Chronic PID
– Long term complication-pelvic pain
– Severe dysmenorrhoea
– Recurrent episodes and exacerbation not respond to
antibiotics

23. • Increase risk of ectopic pregenecy –due to
scarring of tubes and peritubal adhesion
(chlamydia)
• Tubal infertility – blockage of both tubes can
leads to infertility

24. Fitz-Hugh–Curtis syndrome
• Fitz-Hugh–Curtis syndrome is a rare
complication of pelvic inflammatory disease
(PID) involving liver capsule
inflammation(patient develops peri-
hepatitis)leading to the creation of adhesions.
The condition is named after the two
physicians, Thomas Fitz-Hugh, Jr and Arthur
Hale Curtis who first reported this condition in
1934 and 1930 respectively.

25. • Present with right hypochondrial pain ,
tenderness and fever ,
• DD are –acute cholecystitis
• Diagnosis –laparoscopy
Showed “violin string” adhesion between the
liver capsule and visceral peritoneum

27. Reiter’s syndrome
• Condition follows chlamydia infection
• Patient present with arthritis , uveitis , and
rash which may be similar to psoriasis