What is PID (Pelvic Inflammatory Disease)?

Pelvic inflammatory disease, commonly called PID, is an infection of the female reproductive organs. PID is one of the most serious complications of a sexually transmitted disease in women: It can lead to irreversible damage to the uterus, ovaries, fallopian tubes, or other parts of the female reproductive system, and is the primary preventable cause of infertility in women.

Each year, more than 1 million women in the U.S. experience an episode of PID. As a result of PID, more than 100,000 women become infertile each year. In addition, a large proportion of the 100,000 ectopic (tubal) pregnancies that occur each year can be linked to PID. The rate of infection is highest among teenagers.
What causes PID?

PID occurs when bacteria move upward from a woman's vagina or cervix (opening to the uterus) into her reproductive organs. Many different organisms can cause PID, but many cases are associated with gonorrhea and chlamydia, two very common bacterial STDs. A prior episode of PID increases the risk of another episode because the reproductive organs may be damaged during the initial bout of infection.

Sexually active women in their childbearing years are most at risk, and those under age 25 are more likely to develop PID than those older than 25. This is partly because the cervix of teenage girls and young women is not fully matured, increasing their susceptibility to the STDs that are linked to PID.

The more sex partners a woman has, the greater her risk of developing PID. Also, a woman whose partner has more than one sex partner is at greater risk of developing PID, because of the potential for more exposure to infectious agents.

Women who douche may have a higher risk of developing PID compared with women who do not douche. Research has shown that douching changes the vaginal flora (organisms that live in the vagina) in harmful ways, and can force bacteria into the upper reproductive organs from the vagina.

Women who have an intrauterine device (IUD) inserted may have a slightly increased risk of PID near the time of insertion compared with women using other contraceptives or no contraceptive at all. However, this risk is greatly reduced if a woman is tested and, if necessary, treated for STDs before an IUD is inserted.

A number of factors may increase your risk of pelvic inflammatory disease, including:
- Being a sexually active woman younger than 25 years old
- Having multiple sexual partners
- Being in a sexual relationship with a person who has more than one sex partner
- Having unprotected sex
- Having had an IUD inserted recently
- Douching regularly, which upsets the balance of good versus harmful bacteria in the vagina and may mask symptoms that might otherwise cause you to seek early treatment
- Having a history of pelvic inflammatory disease or any sexually transmitted infection
What are PID symptoms?

Signs and symptoms of pelvic inflammatory disease may include:
- Pain in your lower abdomen and pelvis
- Heavy vaginal discharge with an unpleasant odor
- Irregular menstrual bleeding
- Pain during intercourse
- Low back pain
- Fever, fatigue, diarrhea or vomiting
- Painful or difficult urination

PID may cause only minor signs and symptoms or none at all. Asymptomatic PID is especially common when the infection is due to chlamydia.
How is PID diagnosed?

PID is difficult to diagnose because the symptoms are often subtle and mild. Many episodes of PID go undetected because the woman or her health care provider fails to recognize the implications of mild or nonspecific symptoms. Because there are no precise tests for PID, a diagnosis is usually based on clinical findings. If symptoms such as lower abdominal pain are present, a health care provider should perform a physical examination to determine the nature and location of the pain and check for fever, abnormal vaginal or cervical discharge, and for evidence of gonorrheal or chlamydial infection. If the findings suggest PID, treatment is necessary.

The health care provider may also order tests to identify the infection-causing organism (e.g., chlamydial or gonorrheal infection) or to distinguish between PID and other problems with similar symptoms. A pelvic ultrasound is a helpful procedure for diagnosing PID. An ultrasound can view the pelvic area to see whether the fallopian tubes are enlarged or whether an abscess is present. In some cases, a laparoscopy may be necessary to confirm the diagnosis. A laparoscopy is a surgical procedure in which a thin, rigid tube with a lighted end and camera (laparoscope) is inserted through a small incision in the abdomen. This procedure enables the doctor to view the internal pelvic organs and to take specimens for laboratory studies, if needed.
How is PID treated?

PID is commonly treated with several types of antibiotics. A health care provider will determine and prescribe the best therapy. However, antibiotic treatment does not reverse any damage that has already occurred to the reproductive organs. If a woman has pelvic pain and other symptoms of PID, it is critical that she seek care immediately. Prompt antibiotic treatment can prevent severe damage to reproductive organs. The longer a woman delays treatment for PID, the more likely she is to become infertile or to have a future ectopic pregnancy because of damage to the fallopian tubes.

Because of the difficulty in identifying organisms infecting the internal reproductive organs and because more than one organism may be responsible for an episode of PID, PID is usually treated with at least two antibiotics that are effective against a wide range of infectious agents. These antibiotics can be given by mouth or by injection.  The symptoms may go away before the infection is cured. Even if symptoms go away, the woman should finish taking all of the prescribed medicine. This will help prevent the infection from returning. Women being treated for PID should be re-evaluated by their health care provider three days after starting treatment to be sure the antibiotics are working to cure the infection. In addition, a woman’s sex partner(s) should be treated to decrease the risk of re-infection, even if the partner(s) has no symptoms. Although sex partners may have no symptoms, they may still be infected with the organisms that can cause PID.

Hospitalization to treat PID may be recommended if the woman (1) is severely ill (e.g., nausea, vomiting, and high fever); (2) is pregnant; (3) does not respond to or cannot take oral medication and needs intravenous antibiotics; (4) has an abscess in the fallopian tube or ovary (tubo-ovarian abscess); or (5) needs to be monitored to be sure that her symptoms are not due to another condition that would require emergency surgery (e.g., appendicitis). If symptoms continue or if an abscess does not go away, surgery may be needed. Complications of PID, such as chronic pelvic pain and scarring are difficult to treat, but sometimes they improve with surgery.

What is seminal vesiculitis?

Seminal vesiculitis is an inflammation and often an infection of one or both vesicular glands, most often secondary to prostatitis, although it may occur independently. Seminal vesiculitis is mostly caused by staphylococcus aureus, streptococcus hemolyticus, and E. Coli. This condition often occur on men during 20 and 40 years old, with the typical symtom - blood in semen.
What are seminal vesiculitis causes?

Following is a list of causes or underlying conditions that could possibly cause Seminal vesiculitis includes:

The cause of vesiculitis appears to vary greatly as bacterial, viral, and unidentified causes have been blamed. Because of the expence of the antibiotic and labor to administer treatment, long term treatment with antimicrobials is not warrented unless one first collects a sample of seminal vescile fluid and determines that a bacterial infection is in fact present.
What are seminal vesiculitis symptoms?

Seminal vesiculitis symptoms include:
- Blood in semen. Red or pink semen is seen, sometimes blood clots can be found in semen fluid.
- Urinary discomfort. Pain with urination, burning with urination, urgent urination, frequent urination are all possible seminal vesiculitis symptoms.
- Pain. Lower abdominal pain is typical, the pain can spread locally in pelvic area to perineum area or the groins. Dull pain in upper pubis with perineum discomfort often occur on men with chronic seminal vesiculitis. Pain may aggravate with ejaculation.
- Others. Acute seminal vesiculitis may bring fever and chill. Blood in urine is one of acute seminal vesiculitis symptoms as well. Low sex drive, ED, premature ejaculation may occur on men with chronic seminal vesiculitis.
How is seminal vesiculitis diagnosed?

Seminal vesiculitis is diagnosed with semen analysis and digital rectal exam (DRE). Some times blood test is performed. Semen analysis is performed to check if there're large amount of white blood cells and red blood cells. Semen culture is also necessary to check if there's infection.
How is seminal vesiculitis treated?

Treatment of seminal vesiculitis is often the same with prostatitis treatment. Antibiotics and anti-inflammatory drugs are often prescribed for treating this disease. Herbal medicine "diuretic and anti-inflammatory pill" has also proven effective on curing seminal vesiculitis, it has helped thousand males get rid of Seminal vesiculitis symptoms completely without reoccur.

What is necrospermia?

Necrospermia is a condition in which the spermatozoa in seminal fluid are dead or motionless.

When semen has less of mature normal sperms & more of dead sperms this condition is abnormal. When ever there is less of normal sperm then chances of spontaneous pregnancy decreases (i.e. difficulty in conceiving i.e. wife does not becomes pregnant). This is one of the common causes of male factor infertility. This is also one of the most common semen abnormalities in men.
What are necrospermia causes?

1. Deficiency of central sperm producing hormones

Hypothalamic: pituitary deficiency: Idiopathic GnRH deficiency, Kallman syndrome, Prader-Willi syndrome, Laurence-Moon-Biedl syndrome, Hypothalamic deficiency, pituitary hypoplasia, Trauma, post surgical, postiradiation, Tumour (Adenoma, craniopharyngioma, other), Vascular (pituitary infraction, carotid aneurysm), Infiltrative (Sarcoidosis, histiocytosis, hemochromatosis) Autoimmune hypophysitis, Drugs (drug-induced hyperprolactinemia, steroids use)

Untreated endocrinopathies, Glucocorticoid excess, Hypopituitarism, Isolated gonadotropin deficiency (non acquired): Pituitary, Hypothalamic, Associated with multiple pituitary hormone deficiencies: Idiopathic pan hypo pituitarism (hypothalamic defects), Pituitary dysgenesis, Space-occupying lesions(craniopharyngioma, Rathke pouch cysts, hypothalamic tumors, pituitary adenomas), , Laurence-Moon-Beidl syndrome Prader-Willi syndrome , Frohlich syndrome, Hypergonadotropic hypogonadism : Klinefelter syndrome,  Noonan syndrome,  Viral orchitis, Cytotxic drugs, Testicular irradiation.

2. Testicular disorders (primary leydig cell dysfunction i.e. Hypoganadism), Chromosomal (Klinefelter syndrome and variants, XX male gonadal dysgenesis), Defects in androgen biosynthesis, Orchitis (mumps, HIV, other viral, ),Myotonia dystrophica, Toxins (alcohol, opiates, fungicides, insecticides, heavy metals, cotton seed oil), Drugs (cytotoxic drugs, ketoconazole, cimetidine, spironolactone)

3. Varicocele:  varicocele is dilatation of scrotal vein in the scrotum that leads to rise in temperature of testis and raise testicular temperature, resulting in less sperm production & death of whatever sperms are produced.

4. Drugs (e.g. spironolactone, ketoconazole, cyclophosphamide, estrogen administration, sulfasalazine)

5. Autoimmunity i.e. presence of Antisperm antibody. These Antisperm antibodies bind with sperms & either make them less motile, totally immotile or even dead which is called necrospermia.

6. Undescended Testicle (cryptorchidism). Undescended testis is a condition when one or both testicles fail to descend from the abdomen into the lower part of scrotum during fetal development. Undescended testicles can lead to less sperm production. Because the testicles temperature increase due to the higher internal body temperature compared to the temperature in the scrotum, sperm production may be affected.

7. Mosaic Klinefelter's syndrome In this disorder of the  chromosomes, of the man is abnormal. This causes abnormal development of the testicles, resulting in low sperm production. Testosterone production may be low or normal.

8. Viral Orchits as mumps or other viral infections.

9. Infections as tuberculosis, sarcoidosis involving testis or surrounding structures as epididymis.

10. Chronic systemic diseases as Liver diseases, Renal failure, Sickle cell disease, Celiac disease

11. Neurological disease as myotonic dystrophy

12. Development and structural defects as mild degree of Germinal cell hypo-plasia

13. Partial Androgen resistance

14. Mycoplasmal infection

15. Partial Immotile cilia syndrome

16. Partial Spermatogenic arrest due to interruption of the complex process of germ cell  differentiation from spermatid level to the formation of mature spermatozoa results in decreased sperm count i.e. oligospermia. Its diagnosis is made by testicular biopsy. This is found in upto 30% of all cases of dead sperm patients.

17. Heat Exposure to testis: as febrile illness or exposure to hot ambience induces a abnormality in spermatogenesis.

19. Infection – as bacterial epididimo-orchitis, even in prostatis spermatogenic defect have been noted

20. Hyper-thermia due to cryptorchidism

21. Chromosomal abnormality: has been found in many cases of low sperm count

22. Alcohol use, Cocaine or heavy marijuana use or Tobacco smoking may lower sperm count

23. Anti-sperm antibodies. In some people there occurs development of some abnormal blood proteins called anti-sperm antibodies, which binds with sperm and make them either immotile or dead or decrease their count.

24. Infections. Infection of uro-genital tract may affect sperm production. Repeated bouts of infections are one of the common causes associated with male infertility.

25. Klinefelter's syndrome. In this disorder of the  chromosomes, a man has two X chromosomes and one Y chromosome instead of one X and one Y. This causes abnormal development of the testicles, resulting in low or absent sperm production. Testosterone production also may be lower.

26. Trauma to testis

27. Environmental toxins: as Pesticides and other chemicals in food  or as ayurvedic medicines.

28. Genetic Factors: as idiopathic partial hypo-gonadotropic hypogonadism

How is the cause of necrospermia diagnosed?
For correct diagnosis of cause of necrospermia, we need detail history & physical examinations then certain relevant investigations are required.

History & Physical Examinations: First step in proper treatment is accurate diagnosis of cause of dead sperms. So we first try to find out cause. We take detailed history, thorough drug history and general physical examination, examination of testis, epididymis, testicular veins & sperm carrying duct examinations. These examinations give idea about whether testis is normally developed or not & how is its function. After that depending on likelihood of particular, cause relevant tests are done. All testing facilities are available at our centre. Thus you may consult us at our centre & at same time you may get all tests done. The time taken in getting all the reports ready is 36 hours.

Investigation & Diagnosis: For completes diagnosis of causes of dead sperms one or more of the following tests may be required as

1) Complete male hormone profile: This profile includes all the male hormone tests which control testicular development, functions including normal sperm Productions. The tests include L.H., F.S.H., Testosterones, prolactins, thyroids test, & other relevant hormone tests depending on history & examinations.

2) Antisperm antibody

3) USG or Doppler study of scrotum & testis

4) Semen culture sensitivity

5) Semen fructose

6) Immunobead test

7) Sperm Function Tests

8) Human Sperm-Zona Pellucida Binding Ratio

9) Human Sperm-Zona Pellucida Pentration test

10) Genetic Studies

11) FNAC Testis

12) Egg penetration test

13) Molecular genetic studies done in some special cases

14) Chromosome analysis i.e. Karyotype

15) Assessment of androgen receptor

16) Combined Pituitary hormone tests is performed when needed

17) MRI head if pituitary hormone defect suspected

18) Hemogram test for systemic diseases.

19) Sperm Function Tests

The hamster egg penetration assay (HEPA) and the hemizona assay (HZA) are sperm function tests which can help assess the ability of sperm to penetrate the egg. These tests will not definitively tell whether a pregnancy will occur, but an abnormal test result helps predict reduced fertilizing capability. These tests are performed only rarely today.

20) Semen Fructose

21) Sperm Coiling Test to find out whether the particular sperm is live or dead
How is necrospermia treated?

Secondary necrospermia can be treated once the cause of this condition is found. The treatment should be aiming at treating the cause before correcting the abnormity of testicles. Herbal meidicine "diuretic and anti-inflmmatory pill" could also eliminate all symptoms of necrosermia without reoccur.

What is orchitis?

Orchitis is an inflammation of one or both testicles, most commonly associated with the virus that causes mumps. At least one-third of males who contract mumps after puberty develop orchitis.
What are orchitis causes?

Orchitis may be caused by an infection from many different types of bacteria and viruses.

The most common virus that causes orchitis is mumps. It most often occurs in boys after puberty. Orchitis usually develops 4 - 6 days after the mumps begins. Because of childhood vaccinations, mumps is now rare in the United States.

Orchitis may also occur along with infections of the prostate or epididymis.

Orchitis may be caused by sexually transmitted infection (STI) such as gonorrhea or chlamydia. The rate of sexually transmitted orchitis or epididymitis is higher in men ages 19 - 35.

Risk factors for sexually transmitted orchitis include:
- High-risk sexual behaviors
- Multiple sexual partners
- Personal history of gonorrhea or another STD
- Sexual partner with a diagnosed STD

Risk factors for orchitis not due to an STD include:
- Being older than age 45
- Long-term use of a Foley catheter
- Not being vaccinated against the mumps
- Problems of the urinary tract that occurred at birth (congenital)
- Regular urinary tract infections
- Surgery of the urinary tract (genitourinary surgery)
What are orchitis symptoms?

- Orchitis symptoms include:
- Blood in the semen
- Discharge from penis
- Fever
- Groin pain
- Pain with intercourse or ejaculation
- Pain with urination (dysuria)
- Scrotal swelling
- Tender, swollen groin area on affected side
- Tender, swollen, heavy feeling in the testicle
- Testicle pain that is made worse by a bowel movement or straining
How is orchitis diagnosed?

Tests that your doctor may use to diagnose orchitis and to rule out other causes of your testicle pain include:

A physical exam. A physical exam may reveal enlarged lymph nodes in your groin and an enlarged testicle on the affected side; both may be tender to the touch. Your doctor also may do a rectal examination to check for prostate enlargement or tenderness.
STI screening. This involves obtaining a sample of discharge from your urethra. Your doctor may insert a narrow swab into the end of your penis to obtain the sample, which will be viewed under a microscope or cultured to check for gonorrhea and chlamydia.
Urinalysis. A sample of your urine, collected either at home first thing in the morning or at your doctor's office, is analyzed in a lab for abnormalities in appearance, concentration or content.
Ultrasound imaging. This test, which uses high-frequency sound waves to create precise images of structures inside your body, may be used to rule out twisting of the spermatic cord (testicular torsion). Ultrasound with color Doppler can determine if the blood flow to your testicle is reduced or increased, which helps confirm the diagnosis of orchitis.
Nuclear scan of the testicles. Also used to rule out testicular torsion, this test involves injecting tiny amounts of radioactive material into your bloodstream. Special cameras can then detect areas in your testicles that receive less blood flow, indicating torsion, or more blood flow, confirming the diagnosis of orchitis.
How is orchitis treated?

Treatments may include:
- Antibiotics -- if the infection is caused by bacteria (in the case of gonorrhea or chlamydia, sexual partners must also be treated)
- Anti-inflammatory medications
- Pain medications
- Bed rest with the scrotum elevated and ice packs applied to the area

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