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Pelvic Inflammatory Disease Pathophysiology

Introduction of Disease

Pelvic inflammatory disease (PID) is a disease of pelvic organs in women. Specifically, it is defined as “an infection of the upper genital tract occurring predominantly in sexually active young women” (Curry et al., 2019, p. 357). PID can cause infectious processing spreading through different parts of the reproductive system, including fallopian tubes, ovaries, the endometrium, and the peritoneal space (Curry et al., 2019). The disease presents a significant risk for young sexually active women as it affects most reproductive organs and can result in discomfort for the patient and impact their fertility.

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According to Kreisel et al. (2017), 4.4% of women aged 18-44 in the United States, or approximately 2.5 million women, reported PID diagnosis in 2013-2014. Self-reports indicate a 5.7% prevalence among women of reproductive age during 2006-2010 (Kreisel et al., 2017). Furthermore, PID and other sexually transmitted infections (STI) are more likely to be undiagnosed in black women due to limited access to healthcare (Kreisel et al., 2017). As PID can be asymptomatic, it can be argued that the prevalence of the infection is higher than reported, while some patients prefer not to disclose the information.

Etiology and Risk Factors

PID is generally associated with a wide variety of etiologies. Thus, chlamydia and gonorrhea infections, two of the most common STIs, can cause PID development (Reekie et al., 2017). It can also be caused by different bacteria, including Mycoplasma genitalium and Trichomonas vaginalis (Reekie et al., 2017). PID is common for women of reproductive age (18-44 years) who are sexually active. It has to be noted that women younger than 25 years are at an increased risk of contracting PID (Kreisel et al., 2017).

Other risk factors include unprotected sexual intercourse, engaging in intercourse with multiple partners or a person who has multiple partners, intercourse with a symptomatic individual, and early onset of sexual activity (Curry et al., 2019). Furthermore, patients with STI are more likely to develop the infection. Overall, it can be argued that the patient’s lifestyle can be a risk factor for PID.

Pathophysiological Processes

Pathophysiology of PID involves the spread of infection through the reproductive system of the patient. Initially, the infection spreads from the vagina to the cervix and then to the upper genital tract and such organs as the fallopian tubes, ovaries, and the endometrium (Tao et al., 2018). PID can reach the upper genital tract organs from the tissue surrounding the uterus through the lymphatic system (Curry et al., 2019). The typical immune response to PID is a substantially increased white blood cell level that leads to fever, aches, and pelvic pain (Curry et al., 2019). However, PID can also be asymptomatic, leading to the infection remaining undiagnosed and untreated.

Clinical Manifestations and Complications

Several symptoms and clinical manifestations can indicate that the patient has PID. Pelvic pain and pain in the lower abdominal area that worsens during sexual intercourse is the primary symptom of the infection (Curry et al., 2019). Other signs include uterine bleeding, abnormal vaginal discharge, increased urinary frequency, and dysuria (Curry et al., 2019). In addition, the patient may experience fever, body aches, and nausea. If untreated, PID can lead to infertility, increased risk of ectopic pregnancy, and chronic pelvic pain (Kreisel et al., 2017). Overall, the majority of the symptoms can be associated with other infections and reproductive tract disorders. Therefore, it is essential for women with any discomfort to undergo diagnostic tests to determine whether they have PID.

Diagnostics

A presumptive diagnosis of PID is recommended for sexually active young women. According to Curry et al. (2019), the presence of mucopurulent discharge and other manifestations of lower genital tract infections and STIs can serve as the basis for PID diagnosis. However, it is recommended to conduct saline microscopy and assess its white blood cell count to diagnose PID (Curry et al., 2019). Other diagnostic procedures include bimanual examination for cervical motion, uterine tenderness, adnexal masses, and tubo-ovarian abscess (Curry et al., 2019). Overall, the infection can be diagnosed through a series of clinical procedures, speculum examination, and the patient’s history.

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References

Curry, A., Williams, T., & Penny, M. M. (2019). Pelvic inflammatory disease: Diagnosis, management, and prevention. American Family Physician, 100(6), 357–364.

Kreisel, K., Torrone, E., Bernstein, K., Hong, J., & Gorwitz, R. (2017). Prevalence of pelvic inflammatory disease in sexually experienced women of reproductive age – United States, 2013-2014. MMWR. Morbidity and Mortality Weekly Report, 66(3), 80–83. Web.

Reekie, J., Donovan, B., Guy, R., Hocking, J. S., Kaldor, J. M., Mak, D. B., Pearson, S., Preen, D., Stewart, L., Ward, J., Liu, B., Liu, B., Preen, D., Hocking, J., Donovan, B., Roberts, C., Ward, J., Mak, D., & Guy, R. (2017). Risk of pelvic inflammatory disease in relation to chlamydia and gonorrhea testing, repeat testing, and positivity: A population-based cohort study. Clinical Infectious Diseases, 66(3), 437–443. Web.

Tao, X., Ge, S., Chen, L., Cai, L., Hwang, M., & Wang, C. (2018). Relationships between female infertility and female genital infections and pelvic inflammatory disease: A population-based nested controlled study. Clinics, 73, 1–7. Web.

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