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
- Dutta DC. Textbook of gynaecology. New central book agency; 2003.
- Padubidri VG, Daftary SN. Shaw’s Textbook of Gynecology E-Book. Elsevier Health Sciences; 2014 Dec 11.
- Shepherd SM, Karjane NW, Rivlin ME, Talavera F. Pelvic Inflammatory Disease. Medscape; 2014.
- Shrikant Kulkarni. Gynaecology & Obstetric Therapeutics.B Jain Publishers; 2012
- Murphy Repertory.Synthesis Repertory.RADAR soaftware
Dr S R Bharath Kumar ,BHMS
PG scholar, MD part –I,Dept. Of Materia Medica
GHMC, Bengaluru.
ME Douglass hints at KREOSOTE craves smoked meat labia burning swelling leucorrhoea yellow acrid with odor of green corn left thumb pain as sprained.aconite is vascular irritation by some panic but Kreosote is serious malady functioning of cell itself makes mind constantly excited homeopaths recognize early with symptoms music cause weeping palpitation bitter taste appetite gone violent pulsation every part organ and pinching pain in every joint prone to nausea sour eructation small wounds profuse bleed,ITCH BURN HEAT visible on skin hot urination hot cheeks acne rosacea even gums hot,in layman language internal body is on fire life is burning candle if it burns at this rate uneducated grandma even can tell what will happen in future.when we rest body should rest but KREOSOTE is always on move preventive science is only homeopathy any delay is falling in hands of allopaths they will check for malignancy nuclear antibody ratio test for lupus etc.homeopaths are blessed by nature for third eye sensory can foretell something serious why cheek is constantly hot and red. capsicum cheek is red but cold to touch.bovista cheek is rosy weak capillary circulation.old era homeopaths say KREOSOTE urine is so hot emits steam smoke like.whole internal body on fire acidic can produce gangrene even of lungs.a serious disease may be healed by five paisa drop of homeopathic potency remedy if well selected and that disease fully blown may be untreatable even if one willing to spend lacs.adopt preventive medicine science early.KREOSOTE is incompatible with carbo veg chelidonium carbolic acid and contains guaiacol.females self test leucorrhoea stains linen yellow is hot burning sensation go to a homeopath.homeopaths do not name a disease it is cancer or auto immune disease etc if one is told you are having cancer he goes half dead.under arm perspiration stains linen yellow for fiery nature HEPAR SULPH can handle.homeopathy message is there is burning candle inside humans burn it at appropriate rate control by remedy or even by following code of conduct taught by parents religious teachers or even self mind control where soul resides making body inhabitant on earth.
RD Guchtenerrein article danger birth control printed heal thyself sep 1935 states artificial interruption of menses cycle by gynaecologist leads to chronic pelvic disorders utero-ovarian sclerosis fibromas adenomas of womb,thus premature senility,inflammatory lesions cervex precurser of cancer,overall mind becomes psychic.menses flow AC Coowperthwaite small booklet mentions remedies explained in nutshell form.but birth control pills is big business, modern females and modern doctors multinational drug manufacturers will laugh at 1935 article.in india even today see health of Haryana women they all day work hard in fields and cattle diaries.