PID is a disease of the upper genital tract.

It is a spectrum of infection and inflammation of the upper genital tract organs typically involving the uterus (endometrium), fallopian tube, ovaries, pelvic peritoneum and surrounding structures.

It is attributed to the ascending spread of microorganisms from the cervicovaginal canal to the contiguous pelvic structure.

The clinical syndrome is not related to pregnancy and surgery.

Risk factors

• Menstruating teenagers
• Multiple sexual partners
• Abscess of contraceptives pill use.
• Previous history of acute PID
• IUD users.
• Area with high prevalence of sexually transmitted disease.

Clinical Feature

• Bilateral lower abdomen and pelvic pain which is dull in nature.
• The onset of pain is more rapid and  acute in gonococcal infection (3 days) than in Chlamydial infection (5-7 days) There is fever, lassitude and headache.
• Irregular and excessive vaginal bleeding is usually due to associate endometritis.
• Abnormal vaginal discharges which become purulent and copious.
• Nausea and vomiting
• Dyspareunia
• Pain and discomfort in right hypochondrium due to concomitant perihepatitis may occur in 5-10% of acute salpingitis.The liver is involved due to transperitoneal or vascular dissemination of either  gonococcal or Chlamydial infection.

Signs

The temperature is elevated to beyond 38.3degree c . Abdominal palpation reveals tenderness on both the quadrants of lower abdomen. The liver may be enlarged and tender.

Vaginal examination reveals

1.  Abnormal vaginal discharges which may be of purulent.
2.  Congestion external urethral meatus or openings of Bartholin's ducts through which pus may be seen escaping out on pressure.
3.  Speculum examination shows congested

Investigation

Identification of organism 

• Discharge  from the urethra or Bartholin's gland

Laparoscopy

• Collection of pus from fallopian tubes during laparoscopy.

Differential Diagnosis

• Appendicitis
• Disturbed ectopic pregnancy
• Torsion of ovarian pedicle.
• Haemorrhage or rupture of ovarian cyst
• Endometriosis
• Diverticulitis
• Urinary tract infection

Complications

• Speticaemia
• Dyspareunia
• Infertility rate 12 %
• Increased risk of ectopic pregnancy
• Formation of adhesion

Treatment

Ambulatory  Management of Acute PID

Patient should have oral therapy for 14 days.

Regimen A

• Levofloxacin 500mg, once daily
• Metronidazole 500  PO bid

Regimen B

• Doxycycline 100 PO bid with or without
• Ceftriaxone 250 mg IM single dose PLUS
• Metronidazole 500 mg OP bid  for 14 day.

Inpatient Antibiotics Therapy

Regimen A

• Cefoxitin 2 gm IV every 6 hours for 2-4 Days

                      PLUS

• Doxycycline 100 mg PO for 14 days

Regimen B

• Clindamycin 900 mg IV every 8 hours

                          PLUS

• Gentamicin 2 mg /kg IV ( loading dose), followed by 1.5 mg / kg IV (maintenance dose) every 8 hours.

Alternative Regimen

• Levofloxacin 500mg IV once daily with or without.
• Metronidazole 500 mg IV every 8 hours

Homoeopathic Remedies for PID

1. Kreosote
2. Phosphorus
3. Belledona
4. Platina
5. Apis Mel

Kreosote

Kreosote is a good remedy for pelvic inflammatory diseases. 

Patient is complaining of pain in abdomen, especially before the menstruation.

Burning and scratching sensation at vulval region and medial sides of thighs.

Sudden desire for urination.

Patient is not in position to hold urine and she has to hurry for urination.

Fullness and burning pain in the stomach Nausea ends in vomiting This drug can be used for the palliation of malignancy of genital organs.

All symptoms worse at the time of menses is the keynote symptoms of this drugs.

All mucus membranes of the body are raw and inflammed with bleeding and ulcerations.

All the discharges of the body are very offensive.

Patient is very irritable during menses.

Patient desires many things, but is not satisfied  with those when she gets them. 

Always unsatisfied.

Endometrial polyps or the abnormal growth of the uterine cavity.

Burning and soreness in external and internal parts.

Menses are too early, prolonged and the flow is black and offensive.

The discharges excoriate the thighs.

Leucorrhoea  before menses, which is yellow, acrid, excoriating and offensive.

Bleeding from uterine cavity is continuous in nature, and the flow increase on exertion.

Phosphorus

Pelvic inflammatory disease such as chronic salpingo-oophoritis, chronic endometriosis  usually tubercular in origin  or malignancy of genito - urinary tract is well treated by this remedy.

Dysfunctional uterine hemorrhage.

Polycystic ovarian disease may be seen  developed if the patient has sycosis as a predominant miasm.

Menses too early and scanty but last too long. Stitching pains. Bleeding is copious, dark, red and non coagulable.

Ovaries are inflammed and painful at the time of menses. There is numbness, trembling and paralytic weakness of the extremities. Stitching pain in breast during menses. Great debility and prostration. Stupor, dizziness, sluggishness and delirious condition of the patient.

Modalities

Aggravation in evening, on the left side, cold in general.

Ameliorated by warmth in general, lying on righ side.

Belledona

Belledona is a great remedy for pelvic inflammatory disease. 

Strong bearing down pain she feels as if everything would escape from the vagina.

The patient has got active congestion of the vulval region.

Acute inflammation of vulval region.

There is cutting pain from hip to hip.

She becomes hypersensitive during ailments.

Many times there is pyogenic vulvitis.

Parasitic infection like trichomona and bacterial vulvitis is the best by this remedy.

Vulval region is very hot and red.

There is a throbbing type of pain.

Acute and sudden attack is characteristic in belladona.

Menses of belledona is profuse  and bright red colour due to excess of blood.

Bell is a very chilly person.

She has violent congestion in her body.

Modalities

Aggravation - draught of air, heat of sun, moving about, bending lying down.

Better by sitting in erect position.

Platina

Severe bearing down with numbness of pelvic organs.

Patient has tingling sensation in her part.

After menses there is profuse leucorrhoea.

She is very hot patient.

Parts  are sensitive to touch and go into spasm on touch.

Coliky pain in abdomen.

Platina is known for hyperasthesia leading into vaginismus and nymphomania.

She cannot complete the coition due to vaginismus.

Spasmodic pain.

Pain comes and goes gradually.

Menses of platina lady are much earlier, too profuse but their duration may be short or long.

The blood is very dark and clotted.

Modalities

Aggravated by rest, excitement, while sitting and standing.

Better by moving in open air.

Apis Mel

There is inflammation of pelvic region.

Stitching cutting pain, soreness and inflammation with redness of vulval region.

Apis Mel is a great remedy for inflammation.

Vulval region has burning, stinging, tearing and cutting pain.

After inflammation, there is chill and fever.

Patient is thirstless.

Lady is indifferent.

She feels as if she will die.

Jealous.

Wants to cry.

Menses are suppressed.

The selection of homoeopathic remedies based on symptom similarities and doses according to the Susceptibility of patient.

Don't take homoeopathic medicine without any prescription / without any advise of physician.