Pelvic Inflammatory Disease and Homoeopathy

Dr S R Bharath Kumar 

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 perihepatic 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

  • Identifaction 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 preganancy.

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 sequele.

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– 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– ill effects from excessive use of any organ , vaginitis in females.Mind and uterine symtoms alternates . Ailments from injuries , fall, blows.Haemorrhage after coition.

Ars.album– Deep acting on mucous membranes causing profuse , acrid yellowish thick leucorrhoea , Ca of uterus. Burning pain in ovarian region. Stictching pain in ovary into thigh which feels numb.

BELL– acts on blood vessels and capillaries  causing congestion , throbbing and dilatation of arteries. Burning, Swelling , Hot are characteistic. Inflammation of ovaries causing violent apin in genitals.Leucorrhoea with colicky.

Bry. – 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.

CANTH– 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.

Kreosote- Acts on Mucous membrane of Female genitals causing excoriation , burning like fire. Profuse acrid hot foul discharges, violent pain during coition.

Lachesis.-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.

 Sec.cor-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

  1. Dutta DC. Textbook of gynaecology. New central book agency; 2003.
  2. Padubidri VG, Daftary SN. Shaw’s Textbook of Gynecology E-Book. Elsevier Health Sciences; 2014 Dec 11.
  3. Shepherd SM, Karjane NW, Rivlin ME, Talavera F. Pelvic Inflammatory Disease. Medscape; 2014.
  4. Shrikant Kulkarni. Gynaecology & Obstetric Therapeutics.B Jain Publishers; 2012
  5. Murphy Repertory.Synthesis Repertory.RADAR soaftware

Dr S R Bharath Kumar ,BHMS
PG scholar, MD part –I,Dept. Of Materia Medica
GHMC, Bengaluru.

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