Abstract
Pelvic inflammatory disease (PID) is an infectious and inflammatory disorder of the upper female genital tract, including the uterus, fallopian tubes, and adjacent pelvic structures. Incidence of pelvic inflammatory disease in India varies from 1-2 %. The organisms most commonly isolated in cases of acute PID are N gonorrhoeae and C trachomatis. Homoeopathic remedies are effective in treating acute and chronic pelvic inflammatory disease and also helps in preventing further complications.
Keywords: Pelvic inflammatory disease (PID), N gonorrhoeae and C trachomatis, Homoeopathic Therapeutics.
Introduction
Pelvic inflammatory disease (PID) is an infectious and inflammatory disorder of the upper female genital tract, including the uterus, fallopian tubes, and adjacent pelvic structures.
Infection and inflammation may spread to the abdomen, including peri-hepatic structures (Fitz-Hugh−Curtis syndrome)
Epidemiology
Incidence of pelvic inflammatory disease in India varies from 1-2 %.
A crude marker of PID in resource-poor countries can be obtained from reported hospital admission rates, where it accounts for 17% to 40% of gynaecological admissions in sub-Saharan Africa, 15% to 37% in Southeast Asia, and 3% to 10% in India.
Currently there certain changes in epidemiology of PID
Shift from inpatient PID to Outpatient PID.
Change in clinical presentation.
Shift in the microbial etiology of more C.trachomatis than gonococcus.
Risk Factors
The classic high-risk patient is a menstruating woman younger than 25 years who has multiple sex partners, does not use contraception, and lives in an area with a high prevalence of sexually transmitted disease (STD).
Etiology
The organisms most commonly isolated in cases of acute PID are N gonorrhoeae and C trachomatis. C trachomatis is an intracellular bacterial pathogen and the predominant sexually transmitted organism that causes PID.Clinically, gonorrheal infection may be asymptomatic or may manifest similarly to chlamydial infection; however, it more often produces more acute symptomatic disease. An estimated 10-20% of untreated chlamydial or gonorrheal infections progress to PID.
Pathophysiology
Most cases of PID are presumed to occur in 2 stages.
The first stage is acquisition of a vaginal or cervical infection. This infection is often sexually transmitted and may be asymptomatic.
The second stage is direct ascent of microorganisms from the vagina or cervix to the upper genital tract, with infection and inflammation of these structures.
In addition, antibiotic treatment of sexually transmitted infections can disrupt the balance of endogenous flora in the lower genital tract, causing normally nonpathogenic organisms to overgrow and ascend.
Signs & Symptoms
Pain areas: in the pelvis, abdomen, lower back, or vagina
Pain circumstances: can occur during sexual intercourse or during urination
Whole body: chills, fatigue, or fever.
Groin: cervical motion tenderness, vaginal discharge, or vaginal odour
Gastrointestinal: nausea or vomiting
Also common: cramping or painful menstruation
Clinical Diagnostic Criteria of PID
Minimum Criteria
Lower Abdominal Tenderness
Adnexnal tenderness
Cervical motion tenderness
Additional criteria
Rise in Oral temperature
Mucopurulent Cervical discharge
Raised ESR
Definitive Criteria
Biopsy showing evidence of endometritis
TVS – Tubo-ovarian complex
Laproscopic eveidence
Differential Diagnosis
Acute Appendicitis
Disturbed Ectopic Pregnancy
Torsion of ovarian pedicle, hemorrhage or rupture of ovarian cyst
Endometriosis
Diverticulitis
Urinary Tract infection
Investigations
Identification of Organism – Discharge from urethra
Cervical Canal -C. trachomatis
Serological test includes- raised ESR
Leucocytosis
Laproscopy
Sonography – Abdomen and Pelvis
Culdocentesis
Complications of PID
Immediate & Late
Pelvic peritonitis
Dyspareunia
Septicemia- producing arthritis or myocarditis
Infertility – 12% (After 2 episodes- 25%, After 3 episodes- 50%)
Formation of adhesions or hydrosalpinx
Chronic pelvis pain
Recurrent pyogenic infection
Increased risk of ectopic pregnancy
Treatment & Management
Community based approach to increase public health awareness.
Prevention of STD’s with knowledge of healthy safer intercourse.
Liberal use of contraceptives.
Routine screening of high-risk population.
To control infection.
To prevent infertility and late sequelae.
Homoeopathic Approach
Rubric Selection
Murphy Repertory
Female – PELVIC inflammatory disease, uterus
Acon. Agn. alum. APIS Arn. ARS. Aur. Aur-m. BELL. Bry. bufo Cact. calc. CANTH. Carb-an. carbn-s. caul. Cham. chin. cocc. Coff. coloc. con. croc. ferr. ferr-ar. graph. Ham. Hep. hydr. Hyos. hyper. ign. Iod. ip. iris kali-c. kali-p. kreos. LAC-C. LACH. LYC. Lyss. mag-m. MED. Merc. Nux-v. op. ph-ac. Phos. PULS. Rhus-t. Sabad. SABIN. SEC. Sep. Sil. Stram. Sulph. TER. thuj.
Synthesis Repertory
FEMALE GENITALIA/SEX – INFLAMMATION
Acon. ambr. anan. Apis ARS. Asaf. aur-m. Bell. borx. bry. Calc. calc-s. cann-s. canth. carb-v. Coc-c. coll. con. ferr. ferr-ar. Ferr-p. ign. Kali-c. KREOS. Lyc. med. MERC. Merc-c. Nat-m. nat-s.
Therapeutics
Apis mellifica- action on cellular tissue esp. of eyes, face, throat, ovaries causing oedema. In general it produces inflammation with effusion. Burning ,stinging pain in ovaries or uterus < coition.
Arnica montana- ill effects from excessive use of any organ , vaginitis in females.Mind and uterine symtoms alternates . Ailments from injuries , fall, blows. Haemorrhage after coition.
Arsenicum album- Deep acting on mucous membranes causing profuse , acrid yellowish thick leucorrhoea , Ca of uterus. Burning pain in ovarian region. Stitching pain in ovary into thigh which feels numb.
Belladonna- acts on blood vessels and capillaries causing congestion , throbbing and dilatation of arteries. Burning, Swelling , Hot are characteristic. Inflammation of ovaries causing violent apin in genitals. Leucorrhoea with colicky.
Bryonia alba- Marked action on serous membranes and viscera causing Inflammation and exudation. It disorders the circulation causing cangestion.Great abdominal and pelvic soreness. Ovaritis Stitches in ovaries on taking deep breath.
Cantharis- Act on urinary and sexual organs causing violent inflammation. Inflammation are violently acute – Smarting or Burning. Nymphomania, cutting burning in oavries , ovaritis , leucorrhoea with sexual excitement.
Kreosotum- Acts on Mucous membrane of Female genitals causing excoriation , burning like fire. Profuse acrid hot foul discharges, violent pain during coition.
Lachesis mutus- Acts on circulation and Nerves , lest side affection – ovaries , swollen indurated , painful. Uterine and ovarian pains are better after flow. Ovarian tumors .
Lycopodium- Acts esp on urinary organs and genitals. Vagina dry burning < coition. Right ovarian affection with ovarian tumors .
Medorrhinum- Ailments due to suppressed gonorrhoea , chronic pelvic disorders of women .Intense menstrual colic. Leucorrhoea fishy odour. Drawing in ovaries better pressure.
Pulsatilla- Acts on Veins and Mucous Membrane. Changing and shifting of symptoms. Leucorrhoea milky thick like cream, with pain in back. Violent sore aching pain in ovaries
Sabina- Special action on female pelvic organs.itching in genitals pain from sacrum to pibis or reverse, shooting up vagina. Leucorrhoea foul, acrid thick yellow with pruritis. Ovaritis after abortion.
Secale cornutum- Acts on muscles , blood vessels and uterus causing hemorrhage .Dark foetid menses , brownish offensive leucorrhoea, gangrene of female organs. Puperal fever , never well since abortion.
Conclusion
Homoeopathy has got wide range of remedies in treating Pelvic inflammatory disease. Further evidence based studies must be conducted show the efficacy of Homoeopathic remedies.
Acknowledgement- I heartfully thank my PG guide Dr Jyoti A Moolabharati, Asso.Prof,Dept of Materia Medica, GHMC, Bengaluru for guiding me in preparing this article.
References
Dutta DC. Textbook of gynaecology. New central book agency; 2003.
Padubidri VG, Daftary SN. Shaw’s Textbook of Gynecology E-Book. Elsevier Health Sciences; 2014 Dec 11.
Shepherd SM, Karjane NW, Rivlin ME, Talavera F. Pelvic Inflammatory Disease. Medscape; 2014.
Shrikant Kulkarni. Gynaecology & Obstetric Therapeutics.B Jain Publishers; 2012
Murphy Repertory.Synthesis Repertory.RADAR soaftware
Author
Dr S R Bharath Kumar ,BHMS
PG scholar, MD part –I,Dept. Of Materia Medica
GHMC, Bengaluru.
