Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is 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).
Early diagnosis and treatment prevents damage to the reproductive system. Untreated PID may cause infertility and may lead to potentially fatal septicemia, pulmonary emboli, and shock.
Causes
PID can result from infection with aerobic or anaerobic organisms. The aerobic organism Neisseria gonorrhoeae is its most common cause because it readily penetrates the bacteriostatic barrier of cervical mucus.
Normally, cervical secretions have a protective and defensive function. Therefore, conditions or procedures that alter or destroy cervical mucus (including conization or cauterization of the cervix) impair this bacteriostatic mechanism and allow bacteria present in the cervix or vagina to ascend into the uterine cavity.
Uterine infection can also follow the transfer of contaminated cervical mucus into the endometrial cavity by instrumentation. Consequently, PID can follow insertion of an intrauterine device (IUD), use of a biopsy curet or an irrigation catheter, or tubal insufflation. Other predisposing factors include abortion, pelvic surgery, and infection during or after pregnancy.
Bacteria may also enter the uterine cavity through the bloodstream or in drainage from a chronically infected fallopian tube, pelvic abscess, ruptured appendix, diverticulitis of the sigmoid colon, or other infectious foci.
The most common bacteria found in cervical mucus are staphylococci, streptococci, diphtheroids, chlamydiae, and coliforms, including Pseudomonas and Escherichia coli.
Uterine infection can result from one or several of these organisms or it 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.
