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Pid patient stories: Pelvic inflammatory disease: Michelle deals with PID

Pelvic inflammatory disease: Michelle deals with PID


Dealing with Sexually Transmitted Infection: Michelle’s experience with PID

Everyone dreads getting a sexually transmitted infection (STI). It’s that embarrassing kind of problem you really don’t want to have to talk to a doctor, or even your best friend, about. But not all sexually transmitted infections have symptoms like vaginal discharge, itch and pain.

Pelvic inflammatory disease is an STI that causes symptoms like stomach pains, nausea and vomiting, and fever. It makes the condition hard to diagnose. Many women like Michelle, who was 31 years old when she got PID, make several trips to the doctor, not suspecting they have an STI, before getting diagnosed.

What on earth is wrong with me?

“It must have been at least six weeks and on my third visit to the doctor that I received a suspected diagnosis of PID. When I first visited the clinic, I’d just become sexually active after a bit of a break. I had developed vaginal thrush and was feeling a bit run down. I also had a small lump on my vagina. I wasn’t really worried about the lump because I’d had a similar thing before and it was nothing. But because I was having sex again, I wanted to check.

“I was kind of shocked when the nurse told me the lump was an infected pimple and I needed to take antibiotics. She also gave me cream to insert into my vagina to fix the thrush. I was pleased that there was no major problem.”

Little did Michelle know, there was a major problem, hidden in her left ovary. The antibiotics she was prescribed to treat the ‘infected pimple’ didn’t clear it up (it was actually a cyst that didn’t need treatment). The antibiotics probably masked the symptoms of PID.

“I got better for a while and the thrush cleared up, but I started feeling run down again later that month. It was just before Christmas and I had kids staying with me, so I thought I was just worn out. But a couple of days after Christmas, I started feeling really bad.

“I woke up one morning vomiting and dry retching. It was horrible! I rested and tried to eat, and felt a bit better as the day wore on. But the next morning, the same thing happened. This time the nausea was worse and wouldn’t go away.”

But I can’t be pregnant!

The kind of nausea and vomiting Michelle experienced is often the first warning of an unintended pregnancy, and that’s what the second doctor suspected when she got there.

“I didn’t think I was pregnant. My periods were due but not overdue. I was having sex but I had used condoms every time. There was one time when the condom broke but my boyfriend hadn’t ejaculated, so I was pretty sure I was okay. I took a pregnancy test just in case but it was negative.

“In the end, my blood test showed that I had an infection. The doctor prescribed more antibiotics and I started to get better. But a couple of weeks later, I had my head in the toilet again. I’d lost a lot of weight by then because I hadn’t been eating much. If anything, I usually gain weight at Christmas time, so was starting to get really worried.”

Perhaps it’s all in my head?

But when Michelle described her illness, it didn’t really sound that severe.

“It sounded like a little stomach pain and a headache, nowhere near as bad as it felt. I started wondering if I was making it all up, but I couldn’t eat, had bad stomach pains and a fever, and was extremely low on energy. In hindsight, I realise I was so sick I could barely be bothered getting out of the house to go to the doctor.”

Luckily, Michelle’s friend dragged her to another doctor.

“The third doctor spent a lot of time feeling my stomach. I had bad pains in my lower stomach, especially on the left side near my hip bone (which I found out later is where my ovary is located). I also had pain behind my right rib. The doctor suspected I had PID, prescribed me antibiotics and referred me for a trans-vaginal ultrasound the next day.”

Michelle wasn’t sure what to expect when she went for the ultrasound.

“It was a bit scary, but fascinating at the same time. The doctor had to put an ultrasound camera – which was attached to a thing that looked like a big dildo – into my vagina. The camera looked inside, at my ovaries and fallopian tubes. It showed up on a fuzzy black and white TV screen. The doctor explained to me where all my organs were on the screen.

“He also pointed out a chunk of something he called ‘debris’, which he measured with an electronic ruler on the ultrasound screen. This was the cause of the problem. The diagnosis of PID was confirmed.”

I have to tell my new boyfriend what?!

“My boyfriend also had to get treatment, because I probably got the infection from him. I’ll never be 100% sure, but given the timing and his reaction when he found out I had an STI, I think it’s highly likely.

“I’d always dreaded having to tell a boyfriend (or even a doctor) I had problems down there. But by the time I found out what the problem was, almost everyone I knew, including my boyfriend, was aware of my illness. I was too sick to bother trying to keep it a secret, and I ended up telling a lot of people I had an STI. No one was judgmental, but they were kind of shocked I was telling them.

“In the end, talking to my boyfriend was easy. We went to the clinic together and he took antibiotics as well.

“It took me a while to get better. I was in bed for several more days and unable to do normal things like exercise for a couple of weeks. I took antibiotics for two weeks and didn’t really feel myself again for about a month. I lost a lot of weight when I was sick, and it took me months to get back to my normal weight.

“But I recovered, and am very glad I went to the doctor when I did. PID can make you infertile if it’s left untreated for too long. But when the doctor did my ultrasound, he said that the infection hadn’t damaged my fallopian tubes, so I should be able to get pregnant without any problems.”


More information

For more information on pelvic inflammatory disease,
including risk factors, statistics, progression, diagnosis and treatment, see Pelvic Inflammatory Disease (PID).

For more information on sexually transmitted infections, including the progression and incidence of common STIs, prevention and treatment of STIs, effects on sperm production and preconception screening, see Sexually transmitted infections (STIs).

The female urogenital system consists of all the organs involved in reproduction and the formation and release of urine. For more information
, see Female Urogenital System.

Have a health experience you want to share? Contact us

A 41-Year-Old Patient with a Rare Cause of Severe Abdominal Sepsis Misdiagnosed as PID

Case Rep Surg. 2018; 2018: 9561798.


Anastasia Mikuscheva

1Department of Gynecology and Obstetrics, Dunedin University Hospital, Dunedin, New Zealand

David Becker

2Department of Surgery, Dunedin University Hospital, Dunedin, New Zealand

Mark Thompson-Fawcett

2Department of Surgery, Dunedin University Hospital, Dunedin, New Zealand

1Department of Gynecology and Obstetrics, Dunedin University Hospital, Dunedin, New Zealand

2Department of Surgery, Dunedin University Hospital, Dunedin, New Zealand

Corresponding author.

Academic Editor: Beth A. Schrope

Received 2017 Dec 31; Revised 2018 Feb 28; Accepted 2018 Mar 6.

Copyright © 2018 Anastasia Mikuscheva et al.

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Infectious pelvic inflammatory disease is a common condition and a frequent cause of abdominal pain in a young female patient. In a patient who has not completed family planning, the diagnosis is often made with a low threshold and treatment started on a low suspicion of diagnosis to avoid a negative impact on fertility. Here, we present a case of a 41-year-old woman who was misdiagnosed with infectious pelvic inflammatory disease and treated ineffectively with antibiotics when the underlying condition of her persistent abdominal pain was a midgut neuroendocrine tumor that had caused bowel perforation and formation of an abscess in the pouch of Douglas.

1. Introduction

Pelvic inflammatory disease (PID) is defined as an infection-induced inflammation of the female upper reproductive tract. The hallmark of the diagnosis is pelvic tenderness combined with inflammation of the lower genital tract. Acute (≤30 days’ duration), clinically diagnosed PID is caused by spontaneous ascension of microbes from the cervix or vagina to the endometrium, fallopian tubes, and adjacent structures. More than 85% of infections are due to sexually transmitted cervical pathogens (C. trachomatis and N. gonorrhoeae) or bacterial vaginosis-associated microbes, and approximately 15% are due to respiratory or enteric organisms that have colonized the lower genital tract. The symptoms associated with acute PID include pelvic or lower abdominal pain of varying severity, abnormal vaginal discharge, intermenstrual or postcoital bleeding, dyspareunia, and dysuria. Systemic manifestations are not a prominent feature of PID. Occasionally, right-upper-quadrant pain suggestive of inflammation and adhesion formation in the liver capsule (perihepatitis or the Fitz-Hugh–Curtis syndrome) can accompany PID[1].

Neuroendocrine tumors (NETs) are slow-growing epithelial tumors with predominant neuroendocrine differentiation. Being a rare form of neoplasm, they are frequently not considered in the differential diagnosis. Clinical manifestations are often nonspecific and may include abdominal pain, bowel obstruction, diarrhoea, weight loss, and gastrointestinal bleeding [2].

Here, we present a case of a female patient with nonspecific abdominal symptoms, raised inflammatory markers, and inconclusive imaging initially misdiagnosed with PID. The correct diagnosis was obtained histologically after a second acute presentation with abdominal symptoms that led to a diagnostic laparoscopy and eventually laparotomy and tumor resection.

2. Case Report

Miss T is a 41-year-old Caucasian woman who was admitted to the intensive care unit of our hospital for an episode of severe diabetic ketoacidosis. The day prior to admission, the patient had been unwell and vomiting and was eventually found unconscious and admitted to hospital. The patient’s medical history was significant for poorly controlled type 1 diabetes on insulin, diabetic retinopathy, depression, anxiety, and inactive hepatitis C. She was a previous intravenous drug user, was on buprenorphine treatment with intermittent abuse of benzodiazepines and opioids, and was a cigarette smoker. Her surgical history included laparoscopic bilateral tubal ligation and a LLETZ conisation for a CIN 2 cervical lesion.

On admission, her temperature was 29.4°C, her respiratory rate was 28, pulse was 75, BP was 134/87 mmHg, and GCS was 10. Laboratory testing showed severe metabolic acidosis and acute renal failure and inflammation. The patient was started on treatment as per hospital DKA protocol and meropenem intravenously, given her severely raised inflammatory markers with an unclear infection focus. After stabilisation of her status, the patient was discharged to the medical ward. She became febrile several days later and began reporting lower abdominal pain, nausea, and intermenstrual vaginal bleeding. Rising inflammatory markers were noted. She was reviewed by the surgical team, found to be constipated, and treated with laxatives. A pelvic ultrasound was organised to locate the infection focus. This reported “complex fluid within the pouch of Douglas” (), with pelvic infection representing the most likely cause. The patient was reviewed by the gynaecology team and switched to oral co-amoxicillin.

On this treatment, the inflammatory markers, that had begun to drop on meropenem, started to rise again. The antibiotic regime was hence changed to oral ciprofloxacin and metronidazole. During her hospital admission, the patient complained repeatedly of nausea, which was considered a side effect of metronidazole. The patient was discharged home on oral antibiotics when she was afebrile and feeling better.

Three weeks later, the patient returned to the emergency department of our hospital reporting predominantly right iliac fossa pain, persistent nausea, and anorexia. On a transvaginal bedside ultrasound scan, a hyperechogenic mass was seen in the pouch of Douglas which, given the previous diagnosis of PID, was interpreted as an adnexal mass (). The scan had to be abandoned due to patient discomfort. To further evaluate the mass, an abdominal CT scan was organised. The transvaginal pictures were reviewed with the radiological colleagues and however could not be correlated with the CT findings which reported the appearances in the pelvis as nonspecific. There were some pockets of fluid and some thickened loops of small bowel, which were potentially consistent with secondary involvement of small bowel in a pelvic inflammatory process (). The patient was rediscussed with the surgical team; however, their advice was that a surgical cause for the patient’s presentation was unlikely. A diagnostic laparoscopy was organised by the gynaecological team with the surgical team on standby. Whilst awaiting the procedure, the patient started vomiting profusely and required a nasogastric tube placement.

Mass in the pouch of Douglas.

CT scan with unspecific inflammatory changes.

On diagnostic laparoscopy, normal internal genitalia were seen, however adherent bowel tissue became apparent; the surgical team was called, and the operation was converted to a midline laparotomy. There was a complex inflammatory mass containing an abscess cavity in the upper portion of the pelvis, and a 10 to 15 cm segment of the ileum was completely gangrenous and necrotic but still structurally intact. Surprisingly, there was no small bowel obstruction, and the small bowel contents appeared to be passing through the lumen of the gangrenous ileum. There was an enlarged node in the ileal mesentery associated with significant fibrosis raising the suspicion that there may be a NET nodal metastasis causing occlusion of the mesenteric vessels. The inflammatory mass was removed, an ileocolic resection was performed, and a double-barrelled stoma was created.

The patient recovered well from the operation and was discharged home a week later. The histology report showed the presence of a well-differentiated ileal neuroendocrine primary tumor that was not apparent on laparotomy. One of the 20 mesenteric lymph nodes present in the resected material was metastatic. On postoperative review of the CT scan, neither the primary tumor nor the nodal mass was distinguishable from the inflamed tissue.

The patient was discussed at a multidisciplinary tumor meeting, and a staging CT chest-abdomen-pelvis was performed. Fortunately, this showed no evidence of local recurrence or metastases. The patient currently remains well and has since undergone stoma reversal surgery.

3. Discussion

PID is a common cause for lower abdominal pain in women. Risk factors include age < 25 years, age at first sexual intercourse < 15 years, lower socioeconomic status, being single, a self-reported history of a sexually transmitted disease, and exposure to C trachomatis [3].

In our case, the patient was a previous drug user and had poor socioeconomic status with an inactive hepatitis C infection and a history of LLETZ conisation for CIN 2 which classified her as a high-risk patient for sexually transmitted disease [3]. Moreover, seeing as her abdominal pain was accompanied by fever, raised inflammatory markers, intermenstrual bleeding, and “complex”, free fluid in the pouch of Douglas, a diagnosis of PID was readily made. The fact that she was in a stable relationship and had bilateral tubal ligation was considered as risk-reducing factors; however, it was insufficient to refute the diagnosis. On reflection, the history and clinical course, combined with failure to resolve on standard antibiotic treatment, were not entirely typical for PID. In addition, the imaging was suggestive but not conclusive of PID. Earlier consideration of a wider differential diagnosis may have led to an earlier laparoscopy.

NETs are composed by neuroendocrine cells which are scattered through the mucosa of the gastrointestinal tract. These cells get their name from their ability to express some proteins classically attributable to neural cells, such as neuron-specific enolase and synaptophysin, and to their capacity to produce hormones, such as somatostatin, substance P, and vasoactive intestinal peptide. It is estimated that 64% of all NETs originate in the gastrointestinal tract and 28% originate in the lungs and bronchi. Within the gastrointestinal tract, the most frequently affected sites are the small intestine (29%), rectum (14%), stomach (5%), and appendix (5%) [4, 5].

NETs are a rare tumor entity, and 60% of patients with NETs are asymptomatic and discover their tumors incidentally during medical workup for something else [4], that is, irritable bowel syndrome [6]. At diagnosis, if they are not an incidental finding, lesions are commonly > 2 cm, with invasion of muscularis propria and metastases to regional lymph nodes. Midgut NETs are associated with mesenteric fibrosis, which can compress mesenteric vessels, and cause bowel ischemia and malabsorption, even in the absence of an obvious abdominal mass [7]. Multiple lesions may be found in up to 40% of cases [8]. The annual incidence of NETs has risen in the last years from 40 to 50 cases per million, probably not due to a real increase in incidence but rather due to better diagnostic tools that have become progressively available [9].

The evaluation of a young female patient in the emergency department often creates a diagnostic dilemma that has been highlighted repeatedly in the literature [10–17], to name but a few examples. However, in all those cases, CT or ultrasound imaging was helpful in obtaining the correct diagnosis. In our case, an ultrasound scan performed during the patient’s first presentation showed what was described as “complex fluid” but was unable to visualize any masses. During her 2nd presentation, a transvaginal scan showed a mass in the pouch of Douglas which, given the previous diagnosis of PID, was interpreted as an adnexal mass (). Retrospectively, it was recognized to be the abscess which was part of the inflammatory mass seen intraoperatively, not the tumor itself. In our hospital, bedside ultrasound pictures cannot be saved onto the electronic system and accessed by the radiology department. Printouts of the images were discussed with the radiology trainee who was present at the hospital but not the consultant who was not on site. Despite prior discussion, the transvaginal ultrasound images could not be correlated on the CT scan which showed nonspecific bowel changes only and thus did not contribute to obtaining the correct diagnosis. Our case demonstrates that despite the advances in the development of diagnostic tools, meticulous history taking and clinical examination remain indispensable and cannot be replaced by imaging only.

When the patient kept complaining of gastrointestinal symptoms and responded poorly to antibiotic treatment, alternative diagnoses were not sufficiently considered. Her persistent nausea, for instance, was wrongly attributed to metronidazole treatment, and she was discharged home with significantly raised inflammatory markers. Interestingly, she developed profuse vomiting only on the 3rd day of her 2nd presentation and was able to pass stool regularly until her operation. This is likely due to the fact that her bowel lumen remained patent at least intermittently for a long time despite the space occupying tumor, ischemia, and abscess formation. The bowel perforation which was evident during the operation finally interrupted the bowel passage. It is likely that this patient had at least partial ischemia during her first hospitalisation and then developed an infarction of a short segment of ileum causing the symptoms which led to her second presentation.

Our case was complicated by the patient’s type 1 diabetes. DKA symptoms can mimic acute abdominal infection and per se cause abdominal pain and nausea. Misdiagnosis of DKA as PID has been reported [18]. It is not clear whether the patient’s DKA was exacerbated by catecholamine production by the ileal tumor or whether her poorly controlled type I diabetes had led to DKA. It is possible that the DKA caused a transient episode of hypotension which contributed to bowel ischemia and necrosis or that the increased circulating levels of glucagon and catecholamines or other hormones accompanying ketoacidosis impeded gastrointestinal motility [19].

4. Conclusion

It is important to question your diagnosis, especially if a patient continues to exhibit persistent symptoms despite adequate therapy for the initial diagnosis. Common things are common; however, rarer differential diagnosis must be considered in the patient who remains unresponsive to therapy. Finally, in case of diagnostic uncertainty, exploratory surgery will often be important to resolve the problem and should be undertaken without undue delay.


The patient provided written consent for this case report.

Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this paper.


1. Brunham R. C., Gottlieb S. L., Paavonen J. Pelvic inflammatory disease. New England Journal of Medicine. 2015;372(21):2039–2048. doi: 10.1056/nejmra1411426. [PubMed] [CrossRef] [Google Scholar]2. Strodel W. E., Eckhauser F., Thompson N. Surgical therapy for small-bowel carcinoid tumors. JAMA Surgery. 1983;118(4):391–397. [PubMed] [Google Scholar]3. Simms I., Stephenson J. M., Mallinson H., et al. Risk factors associated with pelvic inflammatory disease. BMJ. 2006;82(6):452–457. [PMC free article] [PubMed] [Google Scholar]4. Hassan M. M., Phan A., Li D., Dagohoy C. G., Leary C., Yao J. C. Risk factors associated with neuroendocrine tumors: A U.S.-based case–control study. International Journal of Cancer. 2008;123(4):867–873. doi: 10.1002/ijc.23529. [PubMed] [CrossRef] [Google Scholar]5. Hassan M. M., Phan A., Li D., Dagohoy C. G., Yao J. C., Leary A. J. C. Family history of cancer and associated risk of developing neuroendocrine tumors: a case-control study. Cancer Epidemiology, Biomarkers & Prevention. 2008;17(4):959–965. doi: 10.1158/1055-9965.epi-07-0750. [PubMed] [CrossRef] [Google Scholar]6. Wilson H. M. Chronic subacute bowel obstruction caused by carcinoid tumor misdiagnosed as irritable bowel syndrome. Cases Journal. 2009;2(1):p. 78. doi: 10.1186/1757-1626-2-78. [PMC free article] [PubMed] [CrossRef] [Google Scholar]8. Klöppel G., Perren A., Heitz P. U. The gastroenteropancreatic neuroendocrine cell system and its tumors: the WHO classification. Annals of the New York Academy of Sciences. 2004;1014(1):13–27. doi: 10.1196/annals.1294.002. [PubMed] [CrossRef] [Google Scholar]9. Sofia Xavier B. R., Cotter J. Small bowel neuroendocrine tumors: from pathophysiology to clinical approach. World Journal of Gastrointestinal Pathophysiology. 2016;7(1):p. 117. doi: 10.4291/wjgp.v7.i1.117. [PMC free article] [PubMed] [CrossRef] [Google Scholar]10. Kuo V. C., Schmidt J. F., Linder J. D. A young woman with abdominal pain. Gastroenterology. 2015;148(7):e1–e2. doi: 10.1053/j.gastro.2014.10.045. [PubMed] [CrossRef] [Google Scholar]11. Singh N., Rydberg J., Imperiale T., Fogel E., McHenry L. Intractable abdominal pain in a young woman: a classic presentation in a not so classic patient. American Journal of Gastroenterology. 2002;97(9):p. S215. doi: 10.1016/s0002-9270(02)05137-7. [CrossRef] [Google Scholar]12. Cusimano A., Abdelghany A. M. A. B., Donadini A. Chronic intermittent abdominal pain in young woman with intestinal malrotation, Fitz-Hugh-Curtis Syndrome and appendiceal neuroendocrine tumor: a rare case report and literature review. BMC Women’s Health. 2016;16(1) doi: 10.1186/s12905-015-0274-2. [PMC free article] [PubMed] [CrossRef] [Google Scholar]13. Jones D. Young woman with abdominal pain. Annals of Emergency Medicine. 2014;64(4):423–425. doi: 10.1016/j.annemergmed.2014.01.024. [PubMed] [CrossRef] [Google Scholar]14. Haller S., Kölzer V., Fux C. A., Glaser C., Cathomas G. Junge frau mit unterbauchschmerzen rechts. Der Chirurg. 2017;88(2):155–157. doi: 10.1007/s00104-016-0260-8. [PubMed] [CrossRef] [Google Scholar]15. Hong J.-H., Jeon S., Lee J.-H., Nam K.-H., Bae D.-H. Multicystic benign mesothelioma of the pelvic peritoneum presenting as acute abdominal pain in a young woman. Obstetrics & Gynecology Science. 2013;56(2):126–129. doi: 10.5468/ogs.2013.56.2.126. [PMC free article] [PubMed] [CrossRef] [Google Scholar]16. Mock J. N., Orsay E. M. Primary mesenteric venous thrombosis: an unusual cause of abdominal pain in a young, healthy woman. Annals of Emergency Medicine. 1994;23(2):352–355. doi: 10.1016/s0196-0644(94)70050-8. [PubMed] [CrossRef] [Google Scholar]17. Stiefelhagen P. Was steckt hinter der submukösen raumforderung im sigma. MMW–Fortschritte der Medizin. 2010;152(20):p. 21. doi: 10.1007/bf03366590. [PubMed] [CrossRef] [Google Scholar]18. Ameyaw E., Barnes N. A., Asafo-Agyei S. B., Ansah A. D. A. Misdiagnosis of diabetic ketoacidosis as pelvic inflammatory disease in a Ghanaian teenager: a case report. Clinical Research and Trials. 2017;3(3) doi: 10.15761/crt.1000176. [CrossRef] [Google Scholar]19. Barrett E. J., Sherwin R. S. Gastrointestinal manifestations of diabetic ketoacidosis. Yale Journal of Biology an Medicine. 1983;56(3):175–178. [PMC free article] [PubMed] [Google Scholar]

Pelvic Inflammatory Disease – a Patient’s Guide by Daisy Mae

Imagine you have just been to a clinic and been told you have PID – Pelvic Inflammatory Disease. You have probably never even heard of the condition. You are probably frightened, and very unhappy.

So here are some factors about PID that might help you to understand the condition, and ensure it is properly treated.

What is pelvic inflammatory disease? – a simple explanation

Even doctors don’t understand PID very well! The name – PID – is pretty nonspecific. This means inflammation of the tissues and organs in your pelvis – that is the womb (the uterus), the neck of the womb (the cervix) , the Fallopian tubes and the ovaries.

Inflammation means redness and swelling. For example, if you burn your finger it becomes red, hot, swollen and painful. This is similar to what is happening to your female organs. There is inflammation in the womb, cervix, Fallopian tubes and ovaries. These organs are fixed in position inside your pelvis by layers of tissue.

When tissue is inflamed, this is your body producing an inflammatory response. Large numbers of white blood cells rush to the area to produce antibodies to fight the infection. There is also an accumulation of tissue fluids, with resultant swelling, as well as production of fibrous tissue that will eventually form a scar. This fibrous tissue when produced in the pelvic organs, may cause sticky bands to develop – known as adhesions. This means that sometimes the tubes, ovaries and the abdominal wall, may stick together in a sort of clump.

What are the signs and symptoms of inflammation in the body?

You are likely to have lower tummy pain, back pain and feel unwell. In chronic infection, the bands of scar tissue described above, may cause painful sex.

Pressure on the cervix from the penis during sex, can cause pain, which may last after sex for some time. There may also be bleeding during or after sex.

The womb lining – the endometrium – is shed every month when you have a period. If you have PID, the endometrium is inflamed, hence it is thicker, and monthly bleeding can be heavier and more painful. You may also bleed in between your periods or after sex.

PID affecting the Fallopian tubes – is called ‘salpingitis’. Inflammation can cause tubal swelling and production of fibrous tissue. If this is not properly treated, this may result in tubes becoming blocked, infertility, and/or ectopic pregnancy.

PID affecting the ovary, may result in ovarian swelling, cyst formation and even bleeding or rupture of cysts. The tubes can become filled with pus and occasionally need surgical drainage.

PID symptoms may be mild and disappear quickly with treatment. Occasionally PID can be severe and requires hospital admission for intravenous antibiotics and fluids.

Strangely, many women have PID and have no symptoms at all! In the infertility clinic, a woman may be found to have tubal blockage, but no knowledge of ever being infected. This is why screening for chlamydia is so important.

Information, advice and guidance

· Knowing the diagnosis of PID is good. Now you can be treated.

· Most (not all) PID is caused by the Sexually Transmitted Infections (STI’s) chlamydia and gonorrhoea. These infections do not always cause symptoms. Your current or most recent partner may not know they have it.

· Most PID will clear up promptly with the correct antibiotic regime – usually three types of antibiotic: doxycyline, ceftriazone and metronidazole. (There are alternatives – your doctor will choose those most appropriate).

· You should have a full testing for sexually transmitted infections, including an HIV and syphilis test, and microscopy of your vaginal and cervical secretions – this is done in a specialist Sexual Health Clinic.

· Other tests may be needed e.g. a pregnancy, urine and a blood test.

· Start antibiotics before these results are known. Remember the infection is up inside your pelvis and it is only possible to swab the cervix – swabs cannot be taken from inside your pelvis. These tests may be negative, but that doesn’t mean you haven’t got PID! Take the antibiotics even if your test results are negative.

· Any partners in the past six months should have at a course of antibiotics to treat chlamydia, even if they test negative. Tests are not 100% accurate.

· No sex on treatment, not even oral sex or sex with a condom – for the two weeks while on antibiotics. Also until your test results are known and you have been reviewed in the clinic.

· Rest, take regular painkillers such as ibuprofen and paracetamol, and drink plenty of fluids.

· You should be followed up, after 72 hours, and then after 2-4 weeks. Usually symptoms resolve quickly if you follow this advice.

· Do not stop your contraception. If you have an intrauterine device (IUD) fitted the doctor will discuss this. Most studies show the outcome is no different if the IUD is removed. It is rarely the cause of the infection, especially if it has been in place for the longer term. If the coil has recently been inserted (within the past 20 days) and your symptoms are severe, the doctor may advise removal.

· The most important thing about PID is to try not to get it again! The risk is associated with having multiple partners, overlapping partners, or with not using barrier contraception.

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UK National Guideline for the Management of Pelvic Inflammatory Disease 2011 (updated June 2011) Clinical Effectiveness Group British Association for Sexual Health and HIVhttps://www.bashhguidelines.org/media/1143/pid-2012.pdf

Pelvic Inflammatory Disease and Blocked Tube – Success Story

I wanted to write a case study about a patient who has gone through the trauma of severe Pelvic Inflammatory Disease (PID) during her fertility journey. If you have gone through PID you know the severe discomfort and possible impact it can have on your fertility. The good news is there was a silver lining in my patient’s story!


My patient (lets name her Tanya) had been trying to conceive for years with her husband without a pregnancy. After having a fertility work up with her gynecologist they found out they were up against several factors. Her husband was diagnosed with low sperm motility while she was diagnosed with a blocked tube, fibroids and likely endometriosis. They began seeing a fertility clinic and started the process of doing medicated IUI cycles.  Unfortunately this is where she was diagnosed with PID.  


She developed a severe fever, abdominal pain and other symptoms associated with an infection. She went to a local hospital and the emergency doctor prescribed strong antibiotics that didn’t help much followed by IV antibiotics. Unfortunately after a short period of relief she relapsed and needed several courses of IV antibiotics again before the infection was under control.  


Although relieved her PID improved the antibiotics had taken it’s toll on her overall health. She was experiencing constant bloating, nausea and diarrhea.  She had lost over 10 pounds in a matter of weeks. She was feeling helpless and didn’t know what to do.


I first started seeing Tanya a few months after this event. She was frustrated, fatigued and feeling somewhat helpless at this point. She had been trying to conceive for years and after every thing she had been through felt the most ill she ever had and there was no energy for her to do anything about it.   


We started treatment with getting her digestive tract back to a healthy state. So much depends on proper digestion that it was imperative this be strong. A few diet changes, regular acupuncture and a few supplements started the process. Within 2 weeks she noticed a dramatic improvement in both digestive complaints and energy.  


As her digestive system was getting stronger we added Chinese herbs to her treatment plan. She followed the dietary and lifestyle changes as strict as she could and continued noticing improvements. Her cycles also showed improvement with her PMS being minimized and period pain that she had had for years had almost disappeared.  


It was at this point that she went in for surgery to open her blocked tube. To both her and her Reproductive Endocrinologists surprise both tubes were open and healthy. 


Taking advantage of having both of her tubes now open she decided to do a medicated IUI cycle again. Her husband still had low motility so an IUI optimized their chances of conceiving. She was now doing regular acupuncture, taking a chinese herbal formula, eating a healthy diet and feeling the best she had in a very long time. Finally after almost 6 months of treatment Tanya had finally achieved a healthy pregnancy.


Tanya had put in the effort and time to prepare her body. She changed her cycles from being painful to healthy and regular. She was now energetic and vibrant feeling strong in her pregnancy.  


Our approach to fertility is to create an environment that allows a pregnancy to occur. A healthy, optimized environment not only improves pregnancy rates but also minimizes the chances of a losing the pregnancy. Tanya’s case above illistrates this approach nicely.


If you have questions about our approach to fertility and how it can affect you please call to set up a free 15 minute phone consultation.  


Best of Health



Dr. Ryan Funk

Doctor of Chinese Medicine

Fellow of the ABORM

Acubalance Wellness Centre

Pelvic Inflammatory Disease (PID) | ACOG

Abscess: A collection of pus found in tissue or an organ.

Antibiotics: Drugs that treat certain types of infections.

Bacteria: One-celled organisms that can cause infections in the human body.

Bacterial Vaginosis (BV): A condition in which the normal balance of bacteria is changed by an overgrowth of other bacteria. Symptoms may include vaginal discharge, fishy odor, pain, itching, and burning.

Birth Control: Devices or medications used to prevent pregnancy.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Chlamydia: A sexually transmitted infection caused by bacteria. This infection can lead to pelvic inflammatory disease and infertility.

Chronic Pelvic Pain: Pain in the pelvic region that lasts for more than 6 months.

Ectopic Pregnancy: A pregnancy in a place other than the uterus, usually in one of the fallopian tubes.

Egg: The female reproductive cell made in and released from the ovaries. Also called the ovum.

Endometrial Biopsy: A procedure in which a small amount of the tissue lining the uterus is removed and examined under a microscope.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Gonorrhea: A sexually transmitted infection that can lead to pelvic inflammatory disease, infertility, and arthritis.

Gynecologists: Doctors with special training and education in women’s health.

Infertility: The inability to get pregnant after 1 year of having regular sexual intercourse without the use of birth control.

Intravenous (IV) Line: A tube inserted into a vein and used to deliver medication or fluids.

Laparoscopy: A surgical procedure in which a thin, lighted telescope called a laparoscope is inserted through a small incision (cut) in the abdomen. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.

Ovaries: Organs in women that contain the eggs necessary to get pregnant and make important hormones, such as estrogen, progesterone, and testosterone.

Pelvic Exam: A physical examination of a woman’s pelvic organs.

Pelvic Inflammatory Disease (PID): An infection of the upper female genital tract.

Sexual Intercourse: The act of the penis of the male entering the vagina of the female. Also called “having sex” or “making love.”

Sexually Transmitted Infections (STIs): Infections that are spread by sexual contact. Infections include chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Ultrasonography: A test in which sound waves are used to examine inner parts of the body. During pregnancy, ultrasonography can be used to check the fetus.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

Ethan’s story – Living with PID

Wow time really flies by so quickly. My precious little angel will be 6 years old this year. I found a meaning for my little boy’s name which I think describes him better than I could. Ethan means strong, optimistic, solid, enduring and permanent.

Ethan was born on the 17th July 2008 by emergency C-section. He was only 28 weeks. The doctors told me that he had a 50% chance of survival, a mother’s worst nightmare. That night Ethan lived up to his name. He pulled through but spent 35 days in NICU before he was allowed to go home.

Ethan has had a continuous battle with pneumonia from 6 weeks old. Very heart breaking for a new mom, who has no idea why this is happening. The reasons given were due to the fact that he was born premature and that his lungs were not fully developed. This was a 6 weekly occurrence and he would be in hospital for 5 to 10 days at a time.

This was his life for 4 years. The hospitals had become our second home and nobody could give us a reason or even a solution. We decided to move to Orkney to be close to my family and with that we gained a support system. Ethan was referred by his GP, Dr. A van Tonder, to a new pediatrician Dr. J Strauss, in Klerksdorp. Dr Strauss was wonderful and after being admitted for his third time for pneumonia while under his care, he started to do some further research.

It was not until early 2012 that he brought me something to read, Hyper IgE Syndrome. He was convinced that this is what Ethan had. All Ethan’s symptoms and blood work pointed in this direction. He got in contact with a colleague of his who referred him to Dr. Monika Esser in Cape Town. Ethan was diagnosed on the 3rd September 2012 with Hyper IgE Syndrome.

After 4 years of not knowing what was wrong or why this was happening we now finally had an answer. We started him on maintenance therapy which consists of 5 medicines and vitamins daily. Not to mention the medication for his Eczema. This maintenance therapy is not covered by our medical and remains a financial challenge for us. Since Ethan was diagnosed he has had infections every 6 weeks but with the help of additional antibiotics and his wonderful doctors, we have kept the infections under control. He has however been in hospital 3 times since he was diagnosed.

This whole process has been tough on my family and very heartbreaking for his all his grandparents. Ethan and his sister have a special bond and it is really tough on her every time he goes to hospital. For me and my husband this has been a true test on our marriage and our family life. Life for us has changed in so many ways and all for the better.

My husband and I have considered Genetic testing for Ethan and have been in contact with a genetic doctor.

This unfortunately can only be done overseas as South Africa does not have the facilities to perform these tests. The tests are quite costly and range from USD 2500 to USD 2950 depending what test is to be done. We feel having this test done will put our minds at ease and Ethan will eventually have to have it done anyway.

We are also trying to educate ourselves, stay on top of new developments with regards to PID and educate our family members about PID in order for us to give Ethan a normal life as possible.

Ethan has been through a lot in his short little life. He is on medication daily, has speech and occupational therapy every second week and still does his school work daily with everything he has. He does not know what it feels like to be able to run without getting tired very quickly or to swim without getting sick 2 days later. He still has his good and bad days and he takes one day at a time. But this little boy has a mission in life and there is no way anything is going to stop him.

Pelvic inflammatory disease (PID) | Health Information

Treatment of PID


If you have pelvic inflammatory disease (PID), it’s important to see your GP, who will prescribe antibiotics (see below). You can’t treat yourself.

If your symptoms are very bad, you should get plenty of rest until you feel better. If you’re in pain, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Your GP may prescribe you some stronger painkillers. Always read the patient information that comes with your medicine. If you have any questions, ask your pharmacist or GP for advice.


Pelvic inflammatory disease (PID) treatment involves taking two or more different types of antibiotics. You’ll usually need to start taking antibiotics straightaway, rather than wait for the results of the tests. This is because the long-term effects of pelvic inflammatory disease can be serious, so it’s best to start treatment as soon as possible.

Your GP might prescribe antibiotic tablets. You’ll usually need to take the antibiotic tablets for 14 days. It’s important to finish the whole course of antibiotics, even if you feel better, to make sure the infection clears up. Sometimes, your GP might also give you an antibiotic injection.

Make sure you finish the antibiotics before you have sex again (including oral sex) or use a barrier method of protection, such as a condom. Ideally, wait a week after you finish treatment before having sex, to be on the safe side.

If you don’t get better or your symptoms get worse after you’ve been taking antibiotics for two to three days, speak to your GP. You may need to have antibiotics through a drip. You’ll usually need to go to hospital for this. If you have an intrauterine device (IUD) and antibiotics aren’t helping, your GP may suggest you have the IUD taken out.

If you’re pregnant, you’ll need to go to the hospital for antibiotics through a drip as well.


If you have a very bad infection, or antibiotics through a drip aren’t working, you may need to have some fluid drained from the affected area. You may also need to have some damaged tissue taken away from inside your uterus. You may need:

  • a laparoscopy – this involves putting a tube with a camera into your tummy
  • the infected fluid drained with a needle – your surgeon will use an ultrasound scan to guide them to the right spot

Treating sexual partners

If you have pelvic inflammatory disease, your GP will test you for sexually transmitted infections (STIs), such as chlamydia and gonorrhoea. They’ll also ask you to tell any sexual partner that you have pelvic inflammatory disease. You’ll need to ask any sexual partner to get tested and treated for these infections too. This includes any sexual partners you may have had in the last six months.

Staff at a sexual health clinic can contact your past partners for you.

90,000 In the district cardiology center, they told about the story of a patient’s rescue, which began live

On July 30, Maria Franz, deputy chief physician for therapy at the Regional Cardiological Dispensary, Center for Diagnostics and Cardiovascular Surgery, answered online questions from subscribers of the Regional Department group health “Listen, doctor. KhMAO-Yugra “. Neither the organizers of the “Ask the Doctor” live broadcast on the VKontakte social network, nor the speaker, knew that the Internet meeting would help save a resident of Nefteyugansk.

The story of Valentin from Nefteyugansk, without exaggeration, is now being followed by doctors from several departments of the cardiac center. Accidental fame came after his daughter turned to a doctor as part of a live broadcast, which has been broadcast by the Department of Health for the fifth year. The girl was worried about her father’s health. According to her, once he had already suffered a heart attack “on his feet” – the girl was afraid that the situation could repeat itself. The rescue operation began literally live. Feedback was prompt.Experienced cardiologist Maria Franz made the decision to hospitalize the patient.

Maria Franz, Deputy Chief Physician for Therapy of the District Cardiac Dispensary, Cardiologist, Candidate of Medical Sciences: “According to the information provided by the girl, we assumed that her father needed the help of doctors. Taking into account these data, it was decided to admit the man to the cardiology center, and on the same day he underwent stenting. Due to the defeat of atherosclerosis, the lumen of the artery supplying the heart has decreased.We managed to prevent myocardial infarction, which could happen at any time.

The clinic’s specialists did a great team work and saved the heart, which was already working at its limit. As noted in the clinic, the majority of patients with a heart attack, acute coronary syndrome and unstable angina pectoris are admitted to the clinic after contacting the ambulance service. About social and medical projects such as “Listen, doctor. Khanty-Mansi Autonomous Okrug-Ugra ”, can also be very useful to society – no doubt about it.Amazing salvation stories are an example!

Irina Urvantseva, chief physician of the district cardiac dispensary, honored doctor of the Russian Federation, candidate of medical sciences: “Modern healthcare is unthinkable without digital technologies that help doctors and patients stay in touch and erase geographic barriers. The interaction format allows you to communicate on social media platforms and resolve various issues. For the first time, thanks to this, we managed to save a person’s life! We strive to ensure that no patient with pathology of the cardiovascular system is left without qualified assistance. Now Valentine is on the mend. Ahead of the man is treatment, rehabilitation and a new life of the heart. Julia, the patient’s daughter, never ceases to thank the doctors and the organizers of the project ”.

Yulia patient’s daughter: “I am delighted with how quickly it all happened. The specialists of the cardiac center contacted me, coordinated the actions and the very next day my father was operated on. Of course, I noticed that it was hard for him: blood pressure rose, there was shortness of breath. I turned to the “Listen, Doctor” group, because once they helped me there.And again my trust was justified. Many thanks to the organizers of the group and the doctors of the cardio center for the saved life of my father. ”

90,000 patient histories of the Shebekinskiy kovidny hospital

Photo: “The World of Belogorya” Seriously ill patients continue to be admitted to kovidny hospitals deployed on the basis of the central district hospitals of the Belgorod region. The occupancy of the bed capacity of the Shebekinskaya CRH site alone is more than 85%. Moreover, the youngest patient is not yet 30 years old! Our film crew managed to find out about his health.

Not long ago, Ilya Denisov entered the Shebekinskaya Central Regional Hospital with a temperature under 40 and almost total lung damage. He is the youngest patient in the intensive care unit. He is only 28. Unlike his wife, who is already with the first component of the vaccine, the young man did not have time to get vaccinated against the coronavirus. As soon as I got here, the first words were a request to the head of the department for patients with covid.

“Tearfully asked that when my wife would call, you tell her that my dad must get vaccinated,” recalls Ilya Denisov .

Covid-hospital of Shebekinskaya CRH is already filled by more than 85%. Anesthesiologists-resuscitators provide assistance to unstable patients. Seriously ill patients are constantly admitted to the intensive care unit. There are no empty places.

“A very large flow of patients. Patients are seriously ill. They are very often decompensated – already with severe respiratory failure, ”explains Denis Filimonov, an anesthesiologist-resuscitator at the Shebekinskaya Central District Hospital .

Out of 110 beds in the surgical department, 93 are occupied. The maternity hospital of Shebekinskaya CRH accepts people from different districts of the region. Now there are 21 patients and three children in the obstetric unit.

There are now 10 people in the intensive care unit on mechanical ventilation. The leadership of the Shebekinskaya Central Regional Hospital decided to install additional oxygen gasifiers for another three tons. This oxygen is mainly intended for patients with coronavirus.

“This is done to ensure that there is a reserve of oxygen with an increase in its consumption, in order to refuel less often, so that the supply is more,” says the chief physician of Shebekinskaya CRH Olesya Nesterenko .

But so that supplies are not required at all, doctors remind: the only reliable way to protect yourself from coronavirus is vaccination.

90,000 Patient Stories – Family Dentistry “Clinic 32”

Our Favorite Patients – Part 1

Our Favorite Patients – Part 2

Review by Daria Sysoeva

All the good time of the day! So a month has passed since I became the happy owner of beautiful teeth

I had a problem with the front teeth when I was 12 years old.From where she appeared at such an early age, I will not describe, otherwise, the entire Internet will drown in tears

Since then I have dreamed of a beautiful smile. And my wish came true, but … They put seemingly beautiful crowns, but the neighboring tooth darkened a month later .. I don’t really remember why this happened, and the doctor did not answer this question for me .. She left Petersburg altogether …

Since then, I again began to live with the dream that someday I will have a perfect smile

And so, like that in the morning, I go to my favorite site and see the competition from Clinic 32 at first, I was not sure of my winnings, and it was a shame as it was.But my husband and friends supported me! And almost at the last moment I applied.

Fortunately, there was no limit when I saw myself as a winner. Immediately, the clinic administrators wrote to me in HP, we phoned, and I was invited to the clinic on a convenient day for me!

My first visit was exciting. But as I entered the clinic, I immediately stopped worrying. Administrator Daria congratulated me by handing over the certificate Immediately they offered me tea / coffee / sweets and even tried to take off my jacket

Then there was the first acquaintance with Dr. Vladislav Gennadievich Everything happened in a warm atmosphere and it seems they listened to my every word and sympathized with my problem and, most importantly, promised me to make my smile beautiful and real! From the first visit, I still did not know what to choose as a prize: dental treatment (there were several problems) or the installation of a smile zone with veneers.We agreed that I would scan the jaw and then decide on what I need more.

After the scan, it turned out that everything is fine with my teeth and we will make me a perfect smile!

I was happy

It also turned out that on one tooth (front) I had a poorly healed canal and I was sent to a doctor who healed my canal. True, it took time … 4 plus hours ..

The rest of the visits took place with the removal of temporary crowns and taking impressions for the crowns (for the two anterior teeth) and veneers (for the posterior teeth).I had crowns and veneers made with e-max ceramic inlays. The e-max material is considered the latest development in the field of metal-free ceramics. Pros of e-max:

  • Metal-free ceramics
  • Natural and long-lasting color
  • Ceramic veneers are fully transparent
  • Less plaque accumulates on the ceramic surface
  • Ceramic veneers are highly resistant to abrasion and wear
  • Durability.I don’t see any minuses yet, only pluses. Previously, I had metal-ceramic crowns on my front teeth, which over time began to blacken the gums, and 2 white spots were obtained in the photo, that is, the crowns were dense and did not let light through. At subsequent visits, adjustments were made for the size and length of crowns and veneers.

And now my next visit and everything is perfect, but I’m not even ready for the fact that I will go home with a new smile

I remember driving home, looking at people and smiling at everyone

People did not know that I had a new and perfect smile, but I knew and almost cried with joy

I want to express my deep gratitude to the entire Clinic 32! Thank you littleone! And most importantly THANKS Vladislav Gennadievich! I saw so many people who came out happy and satisfied from your office, and then I came out happy! I sincerely say thank you! Thank you for your valuable work! May God grant you health and your loved ones! Clinic 32 will undoubtedly visit, and I will try more often!

Online medical history – All information about patients’ health will be transferred to electronic form

All information about patient’s health will be transferred to electronic form

By 2024, patient records will become electronic.And each person, having entered the portal of state services in the section “My health”, will be able to view their medical history without leaving their home or office.

Deputy Minister of Health of Russia Oleg Salagay spoke about the development of digitalization in healthcare at a meeting in the Federation Council. According to him, today only 4 percent of medical organizations provide their patients with full access to electronic information about their health. But by 2024, Salagai said, 100 percent of healthcare facilities will be able to provide patients with their medical history electronically.”In the country’s healthcare institutions as a whole, an information and telecommunications infrastructure has been formed. By the end of 2017, more than 11 thousand medical organizations use information systems,” said Vice Speaker of the Federation Council Galina Karelova at the meeting. more than 3 thousand medical institutions located in remote settlements received access to the Internet. ” At the same time, Salagay noted that 3.7 million people have used e-services in the health sector this year.

“By 2024, we need to bring this figure to 38 million people,” the deputy minister added.

The most popular and currently available service in the “My health” section of the public services portal is an online appointment with a doctor. According to Galina Karelova, this service is available in 78 regions. Also, through “My Health” you can call a doctor at home, find out information about the medical institution to which it is attached, about the insurance organization to which the compulsory medical insurance policy was issued. In some regions, you can request the results of laboratory tests electronically, find out if the drug you need is available at the pharmacy.

Remotely choosing the dates of a visit to a doctor, changing them, and even more so before going to bed, opening a computer and reading your medical history at night is certainly a convenient matter. But won’t third parties be able to access the medical history? Now hackers are breaking into the Pentagon network! And medical records can be quite valuable information, for example, for company leaders. After all, it is important for bosses to know what is with the health of their subordinates, especially those in key positions.

“The complex for protecting the portal of public services meets the best world practices,” RG was assured in Rostelecom, which is the operator of the portal.This includes protection against DDoS attacks at the provider’s backbone, two-level firewalling, prevention of network attacks and protection of web applications. “The necessary anti-virus protection measures have been applied in the infrastructure, and the availability of security updates is being monitored,” Rostelecom said. But at the same time, they drew attention to the fact that users entering the portal should also not neglect anti-virus protection in order to completely exclude the possibility of unauthorized access to confidential information.