Pelvic inflammatory disease refers to an ascending infection of the upper genital tract i.e. the uterus, fallopian tube, ovaries and the pelvic cavity. It is initiated by two main organisms, chlamydiae trachomatis and Neisseria gonorrhea followed by other organisms that are essentially countless. Often times, women especially do not present with any symptoms at the initial stage of infection until many years later, after causing irreparable damage to the female genital tracts. But occasionally, they do present in an acute state known as acute PID, with symptoms of fever, lower abdominal pain and foul smelling vaginal discharge. Not unsusual, long standing cases of PID may present with long standing history of lower abdominal pain and abnormal menstrual flow pattern along with or without foul smelling vaginal discharge. Diagnosis (in our environment and many other developing countries) is made mainly from the clinical presentation of the patient and from suspicion of the infection, as the actual screening tests and culture of these two organisms are quite expensive and not readily available because most labs lack the facilities to confirm these infection but not so in developed countries where screening and culture of these organisms are readily available. Please dont be fooled by many of the HVS (high vaginal swab) results peddled by most labs out there who keep on culturing staphylococcus as a way of diagnosing PID.
Having said all these, treatment is mainly emperical and aimed at eradicating these two organisms and thier cohorts of other organisms. Standard treatment include the use of intravenous ceftriaxone, with oral azithromycin and flagyl tablets or injections based on presentation of the patient. Rarelly if there is a proper culture result showing the sensitivity of the inciting gonorrhea and or chlamydia infection, then the drugs can be tailored to suite the result. Other complications of PID may need specific forms of treatment.