Acute Pelvic Inflammatory Disease and Its Long – Term Sequelae: The University of Port Harcourt Experience

Abstract

Background: Pelvic inflammatory disease is a very common gynaecological problem among women, especially in sub-Saharan Africa. It is often implicated in the misery suffered by women with subfertility, chronic pelvic pain and ectopic gestation. Objective: The objective of this study is to determine the pattern of presentation of acute pelvic inflammatory disease, and its long-term complications at the University of Port Harcourt Teaching Hospital in Nigeria. It would also determine the socio-demographic characteristics of the subjects, the probable sources of infection, the radiological manifestation, the pathogenic organisms and sensitivity pattern, and mode of treatment. It would also recommend the most suitable broad-spectrum antibiotics while awaiting culture results. Methodology and Subjects: A retrospective observational study of 4,909 women diagnosed with gynaecological problems at the University of Port Harcourt Teaching Hospital, from January 2008 to January 2013. Out of these, a total of 280 women who were managed for the acute pelvic inflammatory disease were identified. Their case notes were retrieved from the hospital medical records and data concerning their socio-demographic characteristics, risk factors, clinical features, and mode of treatment was retrieved. Also retrieved were the radiological findings, culture and sensitivity results and complications experienced within the period of study. The date was then analyzed. Results: The prevalence rate of PID  in UPTH was quite low 5.7%, The mean maternal age was 29.3 ± 6.31 years, significantly more married women has PID, P = 0.002, and nulliparous women were 3 times more likely to have PID than multiparas, Odds Ratio = 3.35[2.37, 4.75]. Majority of the women were unemployed, and the commonest source of infection was STI (74.3%), 89.3 has offensive vaginal discharge and a great majority (95%) had lower abdominal pain, which was severe in 30%. The most consistent finding on ultrasound scan was fluid in the pouch of Douglass (45.7%), and infertility was the commonest long-term complication. The in-patient treatment rate was only 11.8%; the most predominant organism isolated was klebsiella species, and the most sensitive antibiotic was ceftriaxone. Conclusion: The prevalence of acute PID in UPTH is relatively low, and it affects mostly unemployed, middle age, married, and nulliparous women. The disease is predominantly sexually transmitted, and infertility is the most consistent long-term complication. Though ceftriaxone was the most sensitive broad-spectrum antibiotic, oral cefuroxime is recommended for out-patient treatment.