required as it may even be an ectopic slow leaking if the fluid is not too much .
So that was a case of false PID so what about a real case of PID . Unfortunately like many diseases PID can be asymptomatic i . e . the person has no symptoms of the disease . This is very common when the causative organism is Chlamydia . The most common causes of PID are Chlamydia and Gonorrhea , which we all know are sexually transmitted infections .
Because of the disease process there is ascending infection from the genital tract into the uterus and abdomen . The sad thing for asymptomatic individuals is that they normally discover that they must have had the infection much later , when they are trying to conceive and nothing is happening . Many such people have blocked tubes . The good news is that in the advent of laparoscopic surgery and in-vitro fertilization ( IVF ), options are available to help these women achieve their ultimate goal .
Should the person get symptoms they normally present with history of a per vaginal discharge that usually has a foul odour . The hallmark of a diagnosis of Pelvic inflammatory disease is pain . They normally have very severe pain in the pelvis and even intercourse is not feasible due to the severity of the pain .
Other people present with intermenstrual bleeding and even bleeding after intercourse which we call post-coital bleeding . In some cases the patient may also have fever and chills and others may have painful urination . During abdominal and pelvic examination , the health care provider may illicit abdominal tenderness and tenderness in the regions surrounding the uterus , which we refer to as the adnexa . We do a test where we try to move the cervix and the patient can have a severe reaction . We call this cervical motion tenderness and in our jargon , while writing notes we normally comment CMT positive . If this is the case and pregnancy has been ruled out with very sensitive beta HCG test most likely the diagnosis is PID .
A swab from the vagina and blood can be taken to test for Gonorrhea and Chlamydia and should these be positive one can confirm that the diagnosis is definitely a PID .
For pelvic inflammatory disease , traditionally the treatment is inpatient with intravenous and oral antibiotics that mainly target Gonorrhea and Chlamydia . There are currently some new regimens that are oral . However , the duration is about 10-14 days and during that period the patient should abstain from sexual intercourse .
We apply the 4C ’ s of STI treatment which include :
• Compliance : the patient should complete the dose of antibiotics given .
• Counseling for prevention : on safe sex practices such as condom use , have only one sexual partner and so on .
• Condom use : we all know that condoms prevent transmission of STIs .
• Contact management : all current sexual partners should be looked for and treated . Men are usually asymptomatic and will pass the disease to their unsuspecting partners .
Special mention on IUCD users who are at slightly higher risk of developing PID as the device provides an easy route for bacteria to ascend into the uterus . However , if the woman has one sexual partner who is mutually exclusive it is highly unlikely for her to develop a PID . For those who have multiple sexual partners and insist on the IUCD as their method of contraception then dual method of protection is advised so they should use condoms along with the device .
Prevention is better than cure so please look after yourselves . In the words of Beyonce if he hasn ’ t put a ring on it chillax or at the very least insist on consistent condom use .
I wish you happy festivities and a fruitful 2023 .
Dr . Maureen Owiti is a practicing Obstetrician Gynaecologist and fertility consultant based in Nairobi . You can commune with her on this or related matters via email at : Drmaureenowiti @ gmail . com .