ORGANUM
Acute pelvic infections may progress to a chronic state with dilatation and obstruction of the tubes forming bilateral hydrosalpinges with multiple pelvic adhesions. Chronic pelvic pain occurs in 25%-75% of women with a past history of PID.
The symptoms are varied but include:
Chronic pelvic pain
Chronic purulent vaginal discharge
Epimenorrhagia and dysmenorrhoea
Deep-seated dyspareunia
Infertility
Chronic salpingitis is also associated with infection in the connective tissue of the pelvis known as parametritis.
On examination, there can be purulent discharge from the cervix. The uterus is often fixed in retroversion, and there is thickening in the fornices and pain on bimanual examination.
Conservative management of this condition is rarely effective, and the problem is only eventually resolved by clearance of the pelvic organs. Women with a history of PID are eight times more likely to have a hysterectomy than the general population. If the problem is mainly inferility due to tubual disease, the best treatment is in vitro fertilisation (IVF). Tubual removal prior to IVF is usually indicated if hydrosalpinges are present because this improves the pregnancy rate achieved.