Pelvic inflammatory disease is among the most serious diseases that affect the female reproductive system. The disease is transmitted through sexual intercourse and affects the female reproductive system. In most cases it leads to irreversible damage to the ovaries, uterus, the fallopian tube and other organs of the female reproductive system. It is usually the cause of the high percent of infertility in women. More than one million of women suffer from pelvic inflammatory disease (PDI) in America each year and it cause about 100,000 infertility cases in women each year. This paper will focus on the signs and symptoms, the pathogenic action and treatment and prevention of PID.
Signs and Symptoms:
In her article on pelvic inflammatory disease Suzanne (2013), described the PDI as an infectious, inflammatory disorder that affect the upper female reproductive tract including the uterus, ovaries, fallopian tube and other pelvic structures. The infection if not treated may spread to other organs in the abdomen as in the case of Fitz-Hugh-Curtis syndrome that affects the perihepatic structures. According to Suzanne (2013), the disease mostly affects menstruating women below the age of 25 years who does not use contraceptives and have more than one sex partners. The disease has also been found to be common among adolescents who start engaging in sexual intercourse and also among women living in areas with high prevalence rate of sexually transmitted diseases (STDs). According to Suzanne (2013), Chlamydia trichomatis is the major pathogen that causes pelvic inflammatory disease though other organisms such as Neisseria gonorrhoea, Gardnella vaginalis, Haemophilus influenza and other anaerobes such as Peptococus and Bacteroides species are associated with the disease. The infection originates from infection in the vagina and ascends to the cervix and into the upper genital tract.
The disease according to Suzanne (2013) is characterized by lower abdominal pains fever, nausea, vomiting and abnormal vaginal discharge. Gonorrhea and Chlamydia related infections are likely to cause symptoms at the end of menses and in the first ten days after menstruation. When the abdominal pains are present, they are said to be dull, crampy, constant and bilateral (Shibley, 2012). They usually begin a few days after menstrual period and are accentuated by exercise, motion or sex. The pains caused by pelvic inflammatory disease are experienced for less than seven days, and in case they last for more than three weeks, the likelihood of PID is disputed. Abnormal vaginal discharge is present in about 75% of PID cases. About 40% of PID patients are reported to have vaginal bleeding after coitus. Fever, nausea and vomiting are experienced in later stages of the disease. Many patients may have few or no symptoms while a few have acute and serious illness. Other symptoms include appendicitis, cervicitis, adnexal tumors, endometriosis and urinary tract infections. At times, the symptoms of cervical inflammatory disease may be mistaken with those of ectopic pregnancies. Pregnancy test is necessary to women of childbearing age who complains of lower abdominal pains.
Delayed diagnosis and treatment of pelvic inflammatory disease according to Suzanne (2014) can lead to tubal infertility and chronic pelvic pains. The disease may also produce tuba-ovarian abscess (TOA) which may progress to Fitz-Hugh-Curtis syndrome (perihepatitis) and peritonitis. Laparoscopy is the current method used to diagnose the disease but since no particular test is sensitive for the disease, studies such as erythrocyte sedimentation (ESR), computed tomography, ultrasonography and C-reactive protein (CPR) level can be applied to support the diagnosis.
Mechanism of Pathogenic Action at Cellular and Molecular Level:
Infection by Chlamydia trachomatis on the reproductive tract of women leads to a reproductive sequelae. The inflammatory reaction is initiated and sustained by the epithelial cells that are primary the targets of the pathogens (Solar, 2013). The infected epithelial cells act as the first respondents that initiate and propagate immune response. The infected epithelial cells produce chemokines that recruit inflammatory leukocytes into the infected area and cytokines that induce the cellular inflammatory reaction. The cytokines and the inflammatory leukocytes directly damage the tissue. During re-infection, the host cells release cytokines that leads to the recruitment of Chlamydia specific immune cells that amplify the response. The release of clotting factors and tissue growth factors and protease by the infected cells and infiltration of inflammatory cell lead to damage of the tissue and eventual scarring. Both the professional innate immune cells and adaptive lymphocytes population are believed to be involved in the pathogenesis (Darville, 2010). Since chronic Chlamydia infections are common, they lead to a continued release of cytokine and leucocytes that promote continued infiltration of inflammatory cells thus continued damage of host epithelia, fibrosis and scarring. Repeated infections lead to repeated inflammation that lead to repeated insult on the tissue and eventual scarring. These repeated inflammatory responses finally may lead to pelvic inflammatory disorders. On the other hand, the cell infection by gonococci induces reaction of the polymorphonuclear leukocytes that release toxic metabolites that damage the infected tissues. The gonococci invade only non-ciliated since they are toxic to ciliated cells (lamina, 2013).
Treatment and Prevention:
Treatment of PID is started immediately one is diagnosed with the disease. The initial treatment involves oral intake of antibiotic medications. In the case, oral antibiotics are not effective, or when the infection is severe, intravenous medication can be applied (Shibley, 2012). Patients who don’t improve after three days after using the antibiotics, laparoscopy should be used on them to diagnosis and other treatment procedures like surgery applied if the diagnosis is positive. It is recommended that when a spouse is diagnosed with cervical inflammatory disease it is advisable for the other partner to be treated to avoid a re-infection as they are likely to have coitus. In case the disease causes an abscess an inflamed tissue with pus), antibiotics cannot be effective. It is necessary for the abscesses to be removed by surgery or the patients put under laparoscopic drainage where the pus is constantly sucked (Darville, 2010). This prevents the abscess from bursting and spreading the infection to other structures in the pelvic and abdomen. If the inflammation has formed on the uterus or ovaries removal of the uterus (hysterectomy) or removal of ovaries (oophorectomy) is recommended by a doctor. Chronic pain can be treated by means of another surgical procedure that involves the destruction of nerves. In this type of surgery, the sensory nerves of the affected organ in the pelvis are removed. This type of surgery is effective in eliminating pain. Laparotomy is also another treatment procedure reserved for patient’s ruptured abscesses or those who are not fit for laparoscopic management (Shibley, 2012).
The disease can be prevented by offering education, empirical treatment of infections and routine screening. These practices help reduce the incidence and prevalence of pelvic inflammatory disease. Education should focus on reducing STIs and PID by one sexual partner, using appropriate protection during coitus, and avoiding unsafe sexual practices (Sereina, 2012). Adolescents should be advised to desist from early onset of sexual intercourse until they attain the age of 16 years. Women should be sensitized on the need of regular gynecologic check-ups and screening as several cervical infections can be treated if identified early before they spread to other organs of the reproductive duct. They should also seek treatment immediately they notice signs of PID or any other sign of a sexually transmitted disease.
Pelvic inflammatory disease affects mostly women under the age of 26 six years. This disease affects the reproductive system of women and may lead to infertility. This paper has discussed a number of its symptoms which include fever, vomiting, abdominal pain and abnormal vaginal discharge. The research equips me with knowledge that can be used to prevent and manage PID. If PID is identified in its earlier, it can be treated by oral application of antibiotics or ne can undergo a surgery if the disorder has fully developed. Women the age blanket with high risk of PID infections should have regular gynecological screening and checkup as the disease is easily treated if diagnosed in its early stages. Adolescents should avoid engaging in coitus at early stages of life, women should not have multiple partners and they should use appropriate contraceptives.
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Solar P, Velasquez L (2013) Consequences of nongenomic actions of estradiolon pathogenic genital tract response, Journal of Molecular Signaling 2013, 8:1
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