PELVIC INFLAMMATORY DISEASE

What is Pelvic Inflammatory Disease (PID)?

More than 750,000 women each year are affected by Pelvic Inflammatory Disease (PID). PID is the most serious and common complications of sexually transmitted infections. It is an infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus) and other reproductive organs. Stemming from other untreated STIs such as chlamydia and gonorrhea, PID can damage the fallopian tubes and tissues in and near the uterus and ovaries. Untreated PID can lead to serious consequences such as infertility, ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere outside of the womb), and chronic pelvic pain ( 9 ).

How does one contract PID and how is it diagnosed?

PID occurs when disease-causing organisms (bacteria) transmit upwards from the vagina and cervix (opening to the uterus).

Women with sexually transmitted infections such as gonorrhea and chlamydia are at higher risk of developing PID. Sexually active teenagers are more likely to develop this STI than older women. The more sexual partners a woman has, the greater risk of developing PID.

Recent data indicate that women who douche are at higher risk of developing PID. Douching may flush bacteria into the upper reproductive organs.

Women who have an intrauterine device (IUD) inserted may have an 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 ( 2 ).

PID is difficult to diagnose because there are no tests for PID. A diagnosis is usually based on other symptoms such as lower abdominal pain, tenderness of the cervix, ovaries, and fallopian tubes during a pelvic exam.

What are the signs and symptoms?

The primary sign of PID is lower abdominal or pelvic pain. Symptoms vary from none to severe. In mild cases, there may be only slight cramping. In severe cases, the pain may be constant and intense. Other symptoms include abnormal vaginal discharge, abnormal and/or heavy bleeding.

When PID is caused by chlamydial infection, a woman may experience mild symptoms or no symptoms at all, while serious damage is being done to her reproductive organs. Women who have symptoms of PID most commonly have lower abdominal pain. Other signs and symptoms include fever, unusual vaginal discharge that may have a foul odor, painful intercourse, painful urination, and pain in the right upper abdomen (rare) ( 9 ).

What are the complications and how will it affect pregnancy?

Untreated infection can cause infertility because scar tissue can from around the pelvic organs. After one episode with PID, a woman has an estimated 15% chance of infertility and can lead up to 75% risk of infertility.

Another complication is having an ectopic pregnancy . An ectopic pregnancy is a pregnancy that occurs outside the uterus, most commonly in the fallopian tubes. Because PID can cause partial blocking or distortion of the fallopian tubes, the chances of an ectopic pregnancy are increased. Ectopic pregnancy is a very serious condition and must be treated surgically and immediately.

What are the treatments and prevention methods against PID?

PID can be cured with a combination of antibiotics. 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.

STIs (mainly untreated chlamydia or gonorrhea ) is the main preventable cause of PID. Women can protect themselves from PID by taking action to prevent STIs or by getting early treatment if they do get an STI.

The best way to avoid transmission of sexually transmitted diseases is to abstain from sexual contact. Also, being in a long-term monogamous relationship, that is, only have sex with one person who only has sex with you.

Any genital symptoms such as discharge or burning during urination or unusual sore or rash should be a signal to stop having sex and to see a doctor immediately. If a person has been diagnosed and treated for PID, he or she should notify all recent sex partners so they can see a health care provider and be treated. This will reduce the risk that the sex partners will develop serious complications from PID and will also reduce the person's risk of becoming re-infected. The person and all of her sex partners must avoid sex until they have completed their treatment for PID ( 8 ).