Pelvic Inflammatory Diseases: Symptoms, Diagnosis, and Treatment

Q: Pelvic Inflammatory Diseases: Symptoms, Diagnosis, and Treatment

Hello, Miss Anonymous：<br>1. <br>It can sometimes be difficult to differentiate between urethritis and cystitis, which is why they are often collectively referred to as urinary tract infections. <br>The two organs are very close in proximity, and inflammation typically starts in

Urethritis, cystitis, vaginitis, pelvic inflammatory disease, cervicitis?

Hello, doctor.
Thank you for taking the time to answer my questions.
I am quite troubled by the recurring gynecological issues.
As I am approaching the age for conception, I would like to better understand the impact of gynecological infections.
I have annual blood tests, and everything is normal.
In early 2020, I had an ultrasound that showed a 1 cm cyst on my left ovary.
I had a history of urethritis and candidiasis two to three years ago, and I have been confirmed to have no diabetes or kidney stones.
My menstrual cycle is 29 days, with my last period ending on August 5, and I experienced some ovulation spotting.
On August 10, I noticed frequent urination, with a very slight pinkish-brown discharge on the tissue, which I suspect came from the vaginal area (no other discomfort).
I mistakenly thought it was ovulation spotting.
In the evening, while exercising, I felt a slight stinging sensation in my clitoris (I thought it was due to long pubic hair).
On the morning of August 11, I began to experience frequent urination with pain at the end of urination, and occasionally there was blood on the tissue.
I suspected an infection and drank a lot of water, which improved the situation (no pain during urination).
In the afternoon of August 11, I started to have a fever (oral temperature 38.2°C), with a feeling of fullness in the lower abdomen, dizziness, nausea, muscle aches, particularly in the lower limbs.
I went to see a doctor who performed a urinalysis, which showed cloudy urine, blood, and a high white blood cell count.
The doctor conducted an abdominal examination, noting fullness and tenderness in the lower abdomen.
There was no pain in the lower back.
The doctor prescribed a 5-day course of Xorimax 500 mg antibiotics and Abbot Ural Effervescent Granules.
On August 12, my fever subsided, and there was no significant pain during urination, but the vaginal discharge increased significantly, and the lower abdominal pain persisted with a feeling of heaviness.
There was slight tenderness when pressing on the abdomen.
Based on the above situation:
1.
Does the urinalysis confirm a simultaneous infection of urethritis and cystitis? If not, which part is more inflamed?
2.
Is the increased vaginal discharge indicative of a uterine infection?
3.
Is Xorimax effective in treating cervical infections?
4.
Would you recommend an ultrasound of the pelvic area?
5.
During intercourse, there is a burning sensation in the vagina; should I get tested for Chlamydia?
6.
Is the increased vaginal discharge due to ovulation or pelvic inflammatory disease?
Thank you very much for your time and assistance!

Niming, 30~39 year old female. Ask Date: 2021/08/12

Dr. Huang Yiwen reply Obstetrics and Gynecology

Hello, Miss Anonymous:
1.
It can sometimes be difficult to differentiate between urethritis and cystitis, which is why they are often collectively referred to as urinary tract infections.
The two organs are very close in proximity, and inflammation typically starts in the urinary tract and then progresses to the bladder.
Your current condition can be described as cystitis.
2.
Whether there are medications for uterine inflammation would need to be determined by a healthcare provider.
3.
Xorimax is a broad-spectrum antibiotic and should theoretically be effective for cervicitis as well.
4.
An ultrasound can certainly be performed to investigate further.
5.
If you are concerned, you may also consider testing for Chlamydia.
6.
Whether the symptoms are due to ovulation or pelvic inflammatory disease should be discussed with the physician who is conducting your examination.

Reply Date: 2021/08/12

More Info

Pelvic inflammatory disease (PID) is a significant health concern that can affect women of reproductive age. It encompasses a range of infections that can involve the uterus, fallopian tubes, and ovaries, often resulting from sexually transmitted infections (STIs) or other bacterial infections. Understanding the symptoms, diagnosis, and treatment of PID is crucial, especially for those experiencing recurrent gynecological issues.

Symptoms of Pelvic Inflammatory Disease
The symptoms of PID can vary widely among individuals, but common signs include:
1. Pelvic Pain: This is often the most prominent symptom, which can range from mild discomfort to severe pain. It may be constant or intermittent and can worsen during intercourse or during menstruation.

2. Abnormal Vaginal Discharge: Women may notice an increase in discharge, which can be yellow or green and may have a foul odor. In some cases, there may be blood in the discharge.

3. Fever: A low-grade fever may accompany other symptoms, indicating an infection.

4. Painful Urination: This can occur if the infection spreads to the bladder, leading to cystitis or urinary tract infections.

5. Irregular Menstrual Bleeding: Some women may experience changes in their menstrual cycle, including heavier periods or spotting between periods.

6. Nausea and Vomiting: These symptoms can occur, particularly if the infection is severe.

Diagnosis of Pelvic Inflammatory Disease
Diagnosis typically involves a combination of the following:
1. Medical History and Physical Examination: A healthcare provider will take a detailed history of symptoms and perform a pelvic exam to check for tenderness or abnormal discharge.

2. Laboratory Tests: Urinalysis and cultures can help identify infections. Blood tests may also be conducted to check for signs of infection or inflammation.

3. Imaging Studies: An ultrasound or CT scan may be used to visualize the reproductive organs and check for abscesses or other complications.

Treatment of Pelvic Inflammatory Disease
Treatment usually involves antibiotics to address the underlying infection. The choice of antibiotics may depend on the suspected causative organisms. Commonly prescribed antibiotics include:
- Ceftriaxone: Often used for gonorrhea.

- Doxycycline: Effective against chlamydia and other bacteria.

- Metronidazole: Used for anaerobic bacteria and certain protozoa.

In some cases, if there is an abscess or severe infection, hospitalization and intravenous antibiotics may be necessary.

Addressing Your Specific Concerns
1. Urinary Tract Infections: Based on your symptoms and urinalysis results, it is likely that you have both urethritis and cystitis. The presence of blood and white blood cells in your urine indicates an infection in the urinary tract.

2. Increased Vaginal Discharge: The increase in discharge could suggest a possible uterine infection, especially if accompanied by pelvic pain. It is essential to monitor this symptom closely.

3. Effectiveness of Xorimax: Xorimax (a brand name for azithromycin) is effective against certain bacterial infections, including those that may cause cervicitis. However, it is essential to ensure that the antibiotic regimen is appropriate for your specific infection.

4. Ultrasound Examination: An ultrasound can be beneficial in assessing the pelvic organs for any abnormalities, such as cysts or signs of PID.

5. Testing for Chlamydia: Given your symptoms of burning during intercourse, it would be prudent to test for chlamydia and other STIs, as these can contribute to PID.

6. Increased Discharge During Ovulation: While some women experience increased discharge during ovulation, the combination of your symptoms suggests that it may be more related to an infection rather than normal ovulatory changes.

Conclusion
It is crucial to follow up with your healthcare provider for further evaluation and management of your symptoms. PID can lead to serious complications, including infertility, if left untreated. Regular monitoring and appropriate treatment are essential to ensure your reproductive health, especially as you consider pregnancy. Always communicate openly with your healthcare provider about your symptoms and concerns to receive the best care possible.

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