Chapter 7 - Recent advancements of pelvic inflammatory disease: A review on evidence-based medicine

Abstract

Pelvic inflammatory disease (PID) is an inflammatory disorder and polymicrobial infection of the upper female reproductive tract, which encompasses endometritis, parametritis, salpingitis, and oophoritis. It generally affects young and sexually active women. It poses the main health problem of reproductive age women in both developing and developed countries. Subclinical PID/uncomplicated PID (uPID) is difficult to detect clinically as there are no signs or symptoms of acute PID, which is accountable for a larger percentage of PID-related problems than a clinically recognized condition. Chronic PID refers to both late detected and untreated acute and sub-acute recurrence of a previous upper reproductive tract infection. Chronic pelvic pain, ectopic pregnancy, infertility, pelvic scarring and adhesions, and recurrent PID are long-term sequelae of PID. Following one bout of infection, the chances of infertility rise from 8% to 43% after three or more episodes of infection. Risk factors include previous gonorrhea, minority ethnicity, multiple sexual partners, substance and alcohol use, douching, bacterial vaginosis (BV), lower socioeconomic status, young age (under 30 years), uterine instrumentation (HSG, curettage), nulliparity, intrauterine contraceptive (IUCD), early coital, previous history of pelvic inflammatory disease, previous stillbirths, and not using a barrier contraceptive method and Women typically present with lower pelvic or abdominal pain, which might be mild. Abnormal or unusual vaginal discharge, low back pain, nausea, vomiting, cramping, fever or chills, abnormal or postcoital bleeding, dysuria, abnormal vaginal bleeding, deep dyspareunia, secondary dysmenorrhea, and vulvar itching are some of the other symptoms. There may be no symptoms at all or atypical symptoms, such as Fitz-Hugh-Curtis syndrome, a right upper quadrant pain caused by perihepatitis. PID is usually diagnosed clinically, however, a conclusive diagnosis can be made laparoscopically by viewing inflamed, purulent fallopian tubes directly. It can have serious consequences for women's reproductive health. As a result, a reproductive-aged woman who has pelvic or abdominal pain should be evaluated and treated. If not treated, reproductive tract infections (RTIs) can cause adverse health outcomes such as infertility and increased susceptibility to the human immunodeficiency virus. It typically results due to ascending infection from the endocervix leading to a tubo-ovarian abscess (TOA), pelvic peritonitis, oophoritis, salpingitis, endometritis, and/or parametritis. The main aim is not only to alleviate the acute inflammatory condition, clinical cure, and microbiological cure but also to reduce the chance of long-term consequences. The disease's definitive medical effect is hampered by side effects because of the disease's complex mechanism and long-term process. Further, a high resistance level to pathogenic bacteria/multidrug resistance (MDR) in bacterial pathogens and a sharp diminution in the efficiency of conventional antibiotic therapy led to an increasing need for safer drug products. The recommendations for antibiotic therapy for PID treatment are based on the most up-to-date best evidence available currently. Hence, there has been a re-emergence and renaissance of awareness in medicine, which is regarded as cost-effective, readily available, safe, and easily affordable, with minimal or no adverse effects.