Causes of PID





Sexually transmitted diseases are the commonest causes of PID or pelvic inflammatory disease. This is by no means the only cause of PID.

Almost any infection can cause PID. These infections could be blood borne, or as a result of direct contact from devices like intrauterine contraceptive device, or even through our lymphatic channels.We shall discuss these causes of PID below.


PID from Sexually Transmitted Diseases


Over 90 percent of PID are acquired via sexual route. Gonorrhoea and Chlamydia are the major organisms found in these cases.

Syphilis is no longer very common, but remains a cause of pelvic inflammatory disease.

It may be surprising to know that despite PID being caused by sexually transmitted disease, test for these infections may be negative in up to 30 percent of patients with PID (CEG, 2005).

Specialised test like the use of Nucleic Acid Amplification Test (NAAT) or Polymerase Chain Reaction (PCR) where available and affordable may improve yield and organism identification.


Causes of PID through Direct Infection


Organisms like Bacteriodes, Peptostreptococcus, and organisms from the bowel may ascend through the vagina up to reach the womb to cause PID.

This could be the case in women who clean themselves from behind towards the front, transferring bowel organism from the anus into the vagina, where they find a save passage upwards.

Direct infection can also follow insertion of Intra Uterine Contraceptive Devices – coils or IUCD, as well as following the use of improperly sterilized instruments in a woman’s vagina or womb, say during termination of pregnancy, delivery, or other procedures. Actimomycetes infection is commonly found in PID associated with IUCDs.

Causes of PID through direct infection from hospital procedure is also common where improperply sterilized instruments are used.


Through the Blood


Infection transmitted through the blood stream could cause PID in a woman too. Such infections include schistosomiasis and tuberculosis, which could spread to the womb years after the original exposure to this disease. Tuberculosis as a cause of PID is still seen in communities where the disease still reigns supreme. It is a cause of chronic pelvic inflammatory disease .


Through the Abdomen


Infection of the appendix or even diverticulitis could spread to involve the tubes, ovaries and womb, to be a cause of pelvic inflammatory disease. This is a rare but possible cause of PID.

So, Apart from these conditions being a potential cause of PID, they also cause abdominal pain that mimics PID.

Apart from knowing the above causes of PID, it is vital to recognise risk factors for PID which includes:

  • Multiple sexual partners

  • Sex During Mestruation

  • Smoking

  • Termination of Pregnacy
.
You can read more on these associated causes of PID here.


References:

1. CEG (2005) National guideline on the management of pelvic inflammatory disease. Clinical Effectiveness Group (Association for Genitourinary Medicine and the Medical Society for the Study of Venereal Diseases). www.bashh.org [Accessed: 31/10/2005]

2. Barrett, S. and Taylor, C. (2005) A review on pelvic inflammatory disease. International Journal of STD & AIDS 16(11), 715-720

3. Undergraduate Obtretricks and Gynaecology by M G R Hull, D N Joyce and Gillian Turner

4. http://www.prodigy.nhs.uk/pelvic_inflammatory_disease/view_whole_guidance


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