PELVIC INFLAMMATORY DISEASE AND INFERTILITY (PART 2)

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Dr. Kemi Ailoje

Last week, we had an introduction to Pelvic Inflammatory Diseases, the causes and its symptoms. This week we will continue with the prevention and possible treatment of Pelvic Inflammatory Disease, how it may lead to infertility and the management of PID related infertility.

HOW PID LEADS TO INFERTILITY

Infertility is the inability of sexually active, non-contracepting couple to achieve pregnancy in one year. Pelvic Inflammatory Disease if left untreated or not properly treated, may cause complications which have damaging effects on the female reproductive system such as scarring in the fallopian tubes or ovaries. The scarring in the tubes does not allow for egg to pass through easily into the womb, thus hindering pregnancy and resulting infertility.

PID can sometimes cause a collection of infected fluid called ABSCESSES to develop, most commonly in the fallopian tubes and ovaries. These abscesses in the fallopian tubes, causes blockage, and just like scarring, does not allow for egg to pass through easily, thus, making pregnancy difficult. Although in some cases, fertilized egg may get stuck in the tube and begin to grow. This is known as ECTOPIC PREGNANCY in which case the fertilized egg implants itself outside of the womb, usually in one of the fallopian tubes. This can cause the tube to burst which can lead to serve internal bleeding. Once diagnosed, it has to be evacuated immediately, or medications be evacuated immediately, or medications can be administered to stop the egg from growing.

POSSIBLE TREATMENT OF PELVIC INFLAMMATORY DISEASES

The aims of treating pelvic inflammatory diseases are:
• Relief of acute symptoms such as pain, itching, fever, bleeding etc.
• Eradication of current infection.
• Prevention/minimization of risk of long term complication.

DIAGNOSIS OF PID

Doctors make diagnosis by doing a pelvic examination, collecting Samples of the vaginal discharge for culture and sensitivity, carrying out blood test and conducting an ultrasound scan as the need arises.

Treatment of PID must be prompt. Wide range of antibiotics may be used. Treatment is often started without confirmation of infection because of the serious complication that may result from delayed treatment.Treatment depends on the causative organism and generally involves the use of antibiotics. Self-medication is not recommended as improper use of antibiotics may cause resistance and recurrent infection. Your Health care provider assesses the severity of infection. Women may manifest with mild, moderate or severe PID. Depending on the severity; oral tablets or injectable may be prescribed. Medication may be given on a short or long term basis. Compliance with prescribed regimen will facilitate relief of symptoms and eradication of infectious.

PREVENTION OF INFERTILITY

Although prompt treatment of PID is highly recommended however prevention is always better than cure. Regular testing for PID is encouraged. The risk of PID can be reduced by the following:
• Abstinence: This entails avoiding every form of sexual activity including masturbation.
• Use of barrier methods such as condoms.
• Ensuring sexual monogamy.
• Reducing the number of sexual partners.
• Seeking medical attention if you are experiencing symptoms of PID.
• The use of hormonal contraceptive pills has been found help in the prevention of PID in some cases by thickening the cervical mucosal plug and hence preventing the ascent of causative organism from the lower genital tract.
• Seeking medical attention after learning that a current or former sexual partner has, or might have had a sexually transmitted infection
• Getting a STI history from your current partner and strongly recommending they be tested and if need be treated before intercourse
• Diligence in avoiding vaginal activity particularly intercourse after the end of a pregnancy (delivery,miscarriage or abortion) or certain gynaecological procedure, to ensure that the cervix closes properly.

PROGNOSIS

The effect of the PID infection may remain permanent even when the infection has been properly treated;this makes early detection and treatment very essential.

Treatment resulting in cure is very important in the prevention of damage to the reproductive tract. Formation of scar tissue due to one or more episodes of PID can lead to tubal blockage, increasing the risk of the inability to get pregnant and long term pelvic/ abdominal pain. Certain occurrence such as a post pelvic operation, the period of time immediately, after childbirth (postpartum) miscarriage or abortion increase the risk of acquiring another infection leading to PID

COMPLICATIONS OF PID

PID can cause scarring inside the reproductive system, which can later result into other serious complications, including:
• Chronic pelvic pain,
• Infertility
• Ectopic pregnancy ( the leading cause of pregnancy related death in adult females)
• Other complications of pregnancy
• The infections may spread to other part causing inflammation and formation of scar on the external surface of the kidney.

Pelvic Inflammatory Disease can be prevented, properly managed and cured if diagnosed early.