Pelvic Inflammatory Disease: A Pathophysiological Exploration and CDC Recommendations

Instructions

Ann is a 32-year-old married female who presents to her nurse practitioner reporting lower abdominal pain, cramping, slight fever, and dysuria of 3 days duration.

History

• LMP 2 weeks ago (regular)
• Reports oral contraceptive use
• Reports pain in lower abdomen with cramping and pain on urination for 3 days
• Denies any GI problems, and reports regular bowel movements.
• Denies vaginal discharge
• Ann is married and in a monogamous relationship. Has one child age 2
• Reports no use of condoms/sexual intercourse 2-3 times per week
• Denies any history of STDs

Physical Exam

• Temp 100. 6, P 80 BP 100/62 Wt. 125 Ht. 5\’3\’\’
• HEENT WNL
• No CVA tenderness
• Pain in lower quadrants with light palpation. Positive inguinal lymphadenopathy
• External genitalia without lesions or discharge
• Pelvic exam reveals minimal cervical mucopus
• A bimanual exam reveals uterine and adnexal tenderness and cervical motion pain. Uterus anterior, midline, smooth, not enlarged

Based on the above case the diagnosis is pelvic inflammatory disease (PID), What is the pathophysiology relating to PID? Review the CDC recommendations.

Solution

In the case study, the patient reported to the clinical setting with complaints of abdominal pain, slight fever, cramping, and dysuria for 3 days. Further assessment revealed that the patient was suffering from pelvic inflammatory disease (PID).  This week’s discussion is about the pathophysiology of pelvic inflammatory disease. According to Greydanus & Bacopoulou (2019), PID is a sexually transmitted disease usually characterized by upper genital tract infection in females. The illness affects the uterus, fallopian tubes, and ovaries. Most of the illnesses are related to sexually transmitted infections.

According to Jennings & Krywko (2022), infection of the upper female genital tract results in inflammatory damage, which in turn leads to adhesion, scarring, and total or partial obstruction of the fallopian tube. This situation can cause the loss of the ciliated epithelial cells in the fallopian tube lining, affecting ovum transport and increasing the risk of infertility and ectopic pregnancy.

Adhesion can result in chronic pelvic pain. Greydanus & Bacopoulou (2019) state that classic PID is an infection that starts in the cervical-vaginal area (Jennings & Krywko, 2022). The infection often spreads to the upper genital tract causing a combination of complex conditions such as endometritis, oophoritis, pelvic peritonitis, salpingitis, perihepatitis, and turbo-ovarian abscess (TOA).

Loss of the cilia on the epithelial cells in the fallopian tubes interferes with ovum transport and increases the risk of infertility and ectopic pregnancy. Chronic pelvic pain may develop because of adhesions (Greydanus & Bacopoulou, 2019). Females between the ages 16 and 24 are majorly infected by C. trachomatis compared to Neisseria gonorrhoeae (N. gonorrhoeae).

Research has presented several risk factors associated with pelvic inflammatory disease including, age, immature immune system, ectropion of young adolescent females, multiple coital partners, history of PID, vaginal douching, and others (Greydanus & Bacopoulou, 2019). A higher prevalence of pelvic inflammatory disease is seen among adolescent females.

Patients diagnosed with PID may manifest few or no symptoms while others might show serious illness. Lower abdominal pain is the most common presenting complaint. Other signs may include vaginal bleeding and urinary symptoms such as dysuria and urinary frequency (Greydanus & Bacopoulou, 2019).

Others are post-coital bleeding, dyspareunia, chills, fever, and gestational symptoms. Jennings & Krywko (2022) state that chronic pelvic pain occurs in about one-third of females with PID. Recurrent PID is a strong predictor of chronic pelvic pain. PID can lead to severe damage to the fallopian tube, which has serious ramifications on fertility. PID related to Chlamydia is strongly associated with infertility.

References

Greydanus, D. E., & Bacopoulou, F. (2019). Acute pelvic inflammatory disease: a narrative review. Pediatric Medicine, 2. doi:10.21037/pm.2019.07.05

Jennings, L., & Krywko, D. (2022). Pelvic Inflammatory Disease. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK499959/