User:IssaEm/Pelvic inflammatory disease

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Pelvic Inflammatory Disease (PID)

Epidemiology (Work done by group is bolded)

Prevalence/Incidence

Globally about 106 million cases of chlamydia and 106 million cases of gonorrhea occurred in 2008. The number of cases of PID; however, is not clear. This is largely due to diagnostic tests being invasive and not included in routine check-ups, despite PID being the most common reason for individuals to admit themselves under gynecological care.^[1] It is estimated to affect about 1.5 percent of young women yearly. In the United States PID is estimated to affect about one million people yearly. Rates are highest with teenagers and first time mothers. PID causes over 100,000 women to become infertile in the US each year. Those who are at risk due to previous STIs and increased prevalence of PID.

Records show that...

• 18/10000 recorded discharges in the US after a diagnosis of PID.^[2]
• Prevalence of self reported cases of PID for 18-44 was approximately 4.4%.
• Findings that PID has an associated risk with previous STI diagnosis compared to women with no previous STI diagnosis

• 1.1% of women, 16-46 years of age, in England and Wales are diagnosed with PID.^[1]

Despite the indications of a general decrease in PID rates, there is an observed rise in the prevalence of gonorrhea and chlamydia. With that, in order to decrease the prevalence of PID, one should test for gonorrhea and chlamydia.^[3]

Two nationally representative probability surveys referenced are the National Health and Nutrition Examination Survey (NHANES) and the National Survey of Family Growth (NSFG) surveyed women aged 18 to 44 from 2013 to 2014.[1]

The results:

• 2.5 million women have had a PID diagnosis in the past.^[4]
• The self-reported history decreased from 4.1% in 2013 to 3.6% in 2017.
• It is possible that increased screening at annual gynecologist appointments has led to an earlier detection and prevention of PID.
  • In white non-Hispanic women, the prevalence decreased from 4.9% to 3.9%, and in Hispanic women, the prevalence decreased from 5.3% to 3.7%. In black non-Hispanic women, the prevalence increased from 3.8% to 6.3%.

• The highest burden of PID recently is in black women and women living in the Southern United States where there is a higher prevalence of STIs as well.
  • Disparities between races could be due to lower socioeconomic status. Those with a lower income are less likely to get an annual gynecologist appointment or other preventative measures and are more likely to be uninsured.

Population at risk.^[5]:

• Those who are sexually active with female (intact)reproductive organs and are under the age of 25.

• Rarely observed in females who have had a hysterectomy.

• Overall age range 18-44.

• Those who have an STI that has gone untreated.
• Women with more than one sexual partner.
• Inconsistent condom use for those not in a mutually monogamous relationship.

Distribution/Etiology/Risk factors for PID^[6]:

• Untreated STD/STI.
• multiple sexual partners.
• Sexually active under the age of 25.
• Usage of a Douche
  • causes damage to the bacteria that lives within the vagina.
• Slight increase risk when using an IUD not a massive increase in risk.

Prevention

Regular testing for sexually transmitted infections is encouraged for prevention. The risk of contracting pelvic inflammatory disease can be reduced by the following:

• Using barrier methods such as condoms; see human sexual behavior for other listings; Using latex condoms to prevent STD's that may go untreated.
• Seeking medical attention if you are experiencing symptoms of PID.
• Using hormonal combined contraceptive pills also helps in reducing the chances of PID by thickening the cervical mucosal plug & hence preventing the ascent of causative organisms from the lower genital tract.
• Seeking medical attention after learning that a current or former sex partner has, or might have had a sexually transmitted infection.
• Getting a STI history from your current partner and strongly encouraging they be tested and treated before intercourse.
• Diligence in avoiding vaginal activity, particularly intercourse, after the end of a pregnancy (delivery, miscarriage, or abortion) or certain gynecological procedures, to ensure that the cervix closes.
• Reducing the number of sexual partners.
• Being in a monogamous relationship.
• Abstinence

Treatment

Treatment is often started without confirmation of infection because of the serious complications that may result from delayed treatment. Treatment depends on the infectious agent and generally involves the use of antibiotic therapy although there is no clear evidence of which antibiotic regimen is more effective and safe in the management of PID. If there is no improvement within two to three days, the patient is typically advised to seek further medical attention. Hospitalization sometimes becomes necessary if there are other complications. Treating sexual partners for possible STIs can help in treatment and prevention. There should be no wait for STI results to start treatment. Treatment should not be avoided for longer than 2-3 days due to increasing the risk of infertility.^[3]

.For women with PID of mild to moderate severity, parenteral and oral therapies appear to be effective. It does not matter to their short- or long-term outcome whether antibiotics are administered to them as inpatients or outpatients. Typical regimens include cefoxitin or cefotetan plus doxycycline, and clindamycin plus gentamicin. An alternative parenteral regimen is ampicillin/sulbactam plus doxycycline. Erythromycin-based medications can also be used. A single study suggests superiority of azithromycin over doxycycline. Another alternative is to use a parenteral regimen with ceftriaxone or cefoxitin plus doxycycline. Clinical experience guides decisions regarding transition from parenteral to oral therapy, which usually can be initiated within 24–48 hours of clinical improvement.

• When PID is caught early there are treatments that can be utilized, however these treatments will not undo any damage PID may has caused.
• If previously having a PID diagnosis and were to be exposed to another STD the risk of having PID reoccur is higher
• Early treatment can not prevent the following:
  • chronic abdominal pain.
  • infertility and or ectopic pregnancies.
  • scar tissue within or outside the fallopian tubes.

Prognosis

Early diagnosis and immediate treatment are vital in reducing the chances of later complications from PID. Delaying treatment for even a few days could greatly increase the chances of further complications. Even when the PID infection is cured, effects of the infection may be permanent, or long lasting. This makes early identification essential.

A limitation of this is that diagnostic tests are not included in routine check-ups, and cannot be done using signs and symptoms alone; the required diagnostic tests are more invasive than that.^[1] Treatment resulting in a full cure is very important in the prevention of damage to the reproductive system. Around 20 percent of cis-gendered women with PID develop infertility.^[1] Even women who do not experience intense symptoms or are asymptomatic can become infertile.^[7] This can be caused by the formation of scar tissue due to one or more episodes of PID, and can lead to tubal blockage. Both of these events increase the risk of a damaged ability to get pregnant, and 1% results in an ectopic pregnancy.^[1][39]. Chronic pelvic/abdominal pain develops post PID 40% of the time.^[1] Certain occurrences 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.[27]

References (Remove citations before thrown in live page)

Curry A, Williams T, Penny ML. Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention. Am Fam Physician. 2019 Sep 15;100(6):357-364. KM, Llata E, Haderxhanaj L, Pearson WS, Tao G, Wiesenfeld HC, et al. The burden of and trends in pelvic inflammatory disease in the United States, 2006–2016. The Journal of Infectious Diseases. 2021;224(Supplement_2). doi:10.1093/infdis/jiaa771^[8]

Kreisel K, Torrone E, Bernstein K, Hong J, Gorwitz R. Prevalence of Pelvic Inflammatory Disease in Sexually Experienced Women of Reproductive Age — United States, 2013–2014. MMWR Morb Mortal Wkly Rep 2017;66:80–83. DOI: http://dx.doi.org/10.15585/mmwr.mm6603a3^[9]

STD facts - pelvic inflammatory disease [Internet]. Centers for Disease Control and Prevention; 2022 [cited 2023 Nov 14]. Available from: https://www.cdc.gov/std/pid/stdfact-pid.htm^[10]

Jennings LK, Krywko DM. Pelvic Inflammatory Disease. [Updated 2023 Mar 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499959/^[11]

“Pelvic Inflammatory Disease (PID).” Mayo Clinic, Mayo Foundation for Medical Education and Research, www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/symptoms-causes/syc-20352594. Accessed 15 Nov. 2023.