Pelvic inflammatory disease, whether symptomatic or not, can lead to irreversible damage of the female reproductive system. Early diagnosis and management of this condition enable women to avoid these complications. It matters not whether the infection is due to Chlamydia or some other microorganism because asymptomatic cases of pelvic inflammatory disease have resulted in scarring of the fallopian tubes in so many women.
Scar tissue which forms in the fallopian tubes may prevent fertilization of the egg, but if fertilization is successful, the zygote may form and grow in the tube rather than the uterus. It continues to develop in the fallopian tube until it ruptures and bleeds, and this may lead to the mother’s death unless she has emergency surgery.
Clinical Evaluation
The clinical signs and symptoms of this condition are nonspecific as they may occur in other gynecologic illnesses. Nevertheless, they include lower abdominal pain, fever, unusual vaginal discharge with a foul odor, painful intercourse, painful urination, irregular menstrual bleeding, and, uncommonly, right upper quadrant pain. None of these presentations, however, is sufficient to confirm a diagnosis of pelvic inflammatory disease (Centers for Disease Control, 2010).
Aside from the history and physical examination, the physician can depend on pelvic sonogram, cultures, and various blood tests to arrive at the diagnosis. The pelvic sonogram may identify enlargement of the fallopian tubes or abscesses which are present. Some physicians may include C-reactive protein and erythrocyte sedimentation rate, but there are really no tests which are specific for this disease.
Laparoscopy is also useful to identify abnormalities of the internal pelvic organs in these women. And to differentiate between pelvic inflammatory disease and something else, an endometrial biopsy may be necessary.
Hospitalization for Pelvic Inflammatory Disease
Since the prevalence of this disease is quite high in adolescent girls, there was, many years ago, a tendency to hospitalize nearly all of these patients. There is no current recommendation to do this, and hospitalization is only necessary in severely ill patients with pelvic inflammatory disease. Specifically, inpatient care is an indication when there is nausea, vomiting, or fever. Pregnant women with the disease also require hospitalization.
When the patient has an abscess in the fallopian tube or ovary, admission to a hospital is mandatory. Moreover, patients who cannot take oral antibiotics or who do not respond to them will need hospitalization so they can receive intravenous antibiotics. Finally, patients whose clinical appearance suggests that they may have another serious medical condition such as appendicitis should enter an inpatient facility for close observation and management.
Women who undergo outpatient therapy for pelvic inflammatory disease need two oral antibiotics. It is usually advisable that she return to visit the doctor two or three days after the initiation of therapy to ensure that progress is satisfactory. Even though her symptoms may resolve within a few days, it is imperative that the patient complete the course of antibiotics and refrain from sex while she is in treatment.
Naturally, her sexual partners must go for a medical evaluation, obtain treatment, and refrain from sex during that time as well. This is a requirement regardless of whether the partners have any clinical signs or symptoms.
Sources
- Centers for Disease Control. (2010). Pelvic inflammatory disease. Retrieved October 27, 2011.
- U.S. Department of Health and Human Services. Office on Women’s Health. (2011). Pelvic inflammatory disease fact sheet. Retrieved October 27, 2011.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.
Michael Koger - Dr. Koger obtained his medical education at Meharry Medical College and specialized in Internal Medicine.
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