Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is a term that refers to an infection of the reproductive organs of a woman, which include her fallopian tubes (tubes in which an egg moves from the ovaries to the uterus), ovaries, and uterus (womb). It is most commonly caused by the bacterial sexually transmitted diseases (STDs) Chlamydia and gonorrhea, but can be caused by other organisms as well.

Some women with PID may experience mild or no symptoms, while others will experience more pronounced symptoms. Women in either case, symptoms or not, are still at risk of developing complications from PID. Those complications include ectopic pregnancy (pregnancy outside the uterus that can be potentially fatal), sterility, and chronic pelvic pain. While PID can be cured and treated, these complications usually can not be.

Causes / Risks

Pelvic inflammatory disease (PID) is most commonly caused by the bacterial sexually transmitted diseases (STDs) Chlamydia and gonorrhea. It can also be caused by other organisms. For PID to occur, after an organism infects a woman’s vagina or cervix, it needs to spread into her reproductive organs. Those include her fallopian tubes (tubes in which an egg moves from the ovaries to the uterus), ovaries, and uterus (womb).

Women who are sexually active have an increased risk of developing PID. The more sexual partners a woman has, the higher her risk of PID becomes. Teenage girls and young women are also at a higher risk of developing PID because their cervix is not fully matured, which increases their risk of being infected with one of the STDs that can cause PID.

Douching can increase a women’s risk of developing PIDs. Douching can change the vaginal flora (organisms living in the vagina) in ways that could be harmful, making the vagina more likely to be infected. It can also spread an already occurring infection into the reproductive organs.

Using an intrauterine device (IUD) can also be a risk increaser.
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Symptoms

Some women with pelvic inflammation disease (PID) will have no symptoms or symptoms so mild they will not recognize they have it. For women who do experience symptoms, the most common symptom is pain or tenderness of the lower abdomen. Other symptoms can include pain during vaginal sex, pain or burning during urination, changed or increased vaginal discharge that may have an odor, bleeding between menstrual periods, fever, nausea, or vomiting.
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Testing / Diagnosis

During a pelvic exam, if a health care provider finds tenderness of the fallopian tubes (tubes in which an egg moves from the ovaries to the uterus), ovaries, cervix, and abdomen, a diagnosis of pelvic inflammation disease (PID) may be made. Before making a diagnosis the health care provider will usually perform tests to discover what type of organism is causing the symptoms and/or tests to better clarify if it is PID or other illnesses that have similar symptoms.

The health care provider could also perform a pelvic ultrasound. The ultrasound can show whether or not the fallopian tubes are enlarged or whether or not there is the presence of an abscess (inflamed tissue surrounding a collection of pus). If it is needed, the health care provider could also perform a laparoscopy, a surgical procedure in which a laparoscope (a flexible, thin tube with a lighted end) is inserted into the lower abdomen through a small incision. The laparoscope enables the health care provider to view the internal reproductive organs and take samples for testing.
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Treatment

Pelvic inflammatory disease (PID) can be treated and cured. The recommended treatment for PID is broad-spectrum antibiotics (more than one antibiotic), because more than one organism can be responsible for PID. The antibiotics may be prescribed before the laboratory tests are known, because PID needs to be treated as quickly as possible to prevent any permanent damage from occurring. Once the test results are known, the health care provider may adjust which antibiotics are being used. Usually the antibiotics are taken orally, and a health care provider may also prescribe a pain killer and recommend bed rest.

Hospitalization is not usually needed to treat PID. For women who are not responding to oral antibiotics, are pregnant, HIV positive, severely ill (high fever, vomiting), or have an abscess (inflamed tissue surrounding a collection of pus) on one of their fallopian tubes (tubes in which an egg moves from the ovaries to the uterus), hospitalization may be recommended. At the hospital antibiotics may be received intravenously, followed by antibiotics given orally. Rarely, surgery will be preformed to drain an abscess or to try and improve the chronic pain from the scarring that can occur from PID.
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Complications

While some women may have mild or no symptoms of pelvic inflammation disease (PID), they can still have damage and scarring occur to their reproductive organs. Meaning, women who think they might have PID should be tested and treated as soon as possible to prevent that damage and scarring.

Untreated PID can cause the tissue of the fallopian tubes (tubes in which an egg moves from the ovaries to the uterus) to become scarred. The scarred tissue can prevent an egg from leaving the fallopian tube and entering the uterus (womb). If the egg is fertilized while it remains in the fallopian tube, an ectopic pregnancy will occur. An ectopic pregnancy can cause the fallopian tube the egg is in to rupture, resulting in severe pain, internal bleeding, and possibly death.

The scarring to the fallopian tubes can also cause women to become infertile. Women who have scarring to the fallopian tubes and other pelvic organs could also develop chronic pelvic pain. Chronic pelvic pain can last for months or years. Women who have had multiple cases of PID, have an increased risk of ectopic pregnancies, infertility, and chronic pelvic pain.
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Prevention

Untreated Chlamydia and gonorrhea are the most common causes of pelvic inflammation disease (PID). Since both are bacterial sexually transmitted diseases (STDs), they can be prevented by abstaining from sexual contact, having sex with an uninfected partner in a monogamous relationship, or properly using latex condoms.

Women who think they may be experiencing symptoms of an STD should see a health care provider immediately, because early treatment can prevent it from developing into PID.

Sexually active women under the age of 25 and sexually active older women who have new or multiple sexual partners, have sexual partners who have other sexual partners, or do not use protection when sexually active, should be tested regularly for STDs. This can help prevent cases of STD that present with no symptoms from developing into PID.
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