Pelvic Inflammatory Disease

Posted by
June 4, 2008

Overview

elvic inflammatory disease (PID) is a general term that refers to infection and inflammation of the upper genital tract in women. It can affect the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus), ovaries, and other organs related to reproduction. The scarring that results on these organs can lead to infertility, tubal (ectopic) pregnancy, chronic pelvic pain, abscesses (sores containing pus), and other serious problems. PID is the most common preventable cause of infertility in the United States.

Women at greater risk for PID include those at risk for sexually transmitted infections (STIs) and those with a prior episode of PID. Sexually active women under age 25 are at risk as well because the cervix (opening to the uterus) of teens and young women has greater susceptibility to STIs. This may be because the cervix of teenage girls and young women is not fully matured, increasing their risk for STIs linked to PID.

Other potential risk factors include douching, which women should avoid. In some women, using an intrauterine device (IUD) to prevent pregnancy can also cause PID. Rarely, PID results from gynecological procedures or surgeries.

In the United States, more than 1 million women seek treatment for acute PID each year, according to the Centers for Disease Control and Prevention (CDC). A similar or greater number of women may have PID and not know it. PID is more common among teenage than adult women. It is also more common among African-American and Hispanic women.

Every year, more than 100,000 women become infertile and more than 150 women die from PID or its complications..

Cause

PID is caused by bacteria that cause sexually transmitted infections such as chlamydia or gonorrhea.

Symptoms

Even if you have PID, you might not have symptoms. If you do have symptoms, they could be severe. The most common symptom of PID is pain in your lower abdomen. Other symptoms that you may or may not have include

Sometimes PID comes on suddenly with extreme pain and fever, especially if it is caused by gonorrhea.

Diagnosis

PID can be difficult for your health care provider to diagnose because symptoms can be subtle and mild and similar to those of some other diseases. If you think you might have PID, you should get medical care promptly because early treatment can limit long-term complications such as infertility and chronic pelvic pain.

If you have symptoms such as lower abdominal pain, your health care provider will perform a physical exam, including a pelvic (internal) exam, to find out the nature and location of the pain. Your health care provider also will check for

Health experts have found that about 70 percent and 50 percent of chlamydial and gonococcal infections, respectively, are asymptomatic (without symptoms) in women. These infections were found first through screening. You should get regular laboratory tests for chlamydia, gonorrhea, urinary tract infection, and if appropriate, pregnancy. Your health care provider may suggest these tests as part of a routine annual exam as well as tests for HIV infection and syphilis.

If necessary, your health care provider may do other tests such as an ultrasound (sonogram), endometrial (uterine) biopsy, or laparoscopy to distinguish between PID and other serious problems that can mimic PID.

Laparoscopy is a surgical procedure in which a tube is inserted through a small incision near your navel. This allows your health care provider to view the internal abdominal and pelvic organs and to take specimens to examine in the laboratory.

Treatment

According to CDC, health care providers should start treating sexually active young women and other women at risk for STIs if they have motion tenderness of the uterus, ovaries, fallopian tubes, or cervix. Without adequate treatment, 20 to 40 percent of women with chlamydia and 10 to 40 percent of women with gonorrhea may develop PID.

Many different bacteria may cause an episode of PID. Therefore, your health care provider will prescribe antibiotics (generally two at once, by injection or by mouth) that are effective against a wide range of bacteria, including those causing chlamydia and gonorrhea. You should begin treatment as soon as your health care provider diagnoses PID because complications of the disease may be prevented with taking antibiotics immediately.

Women who douche may have higher risk of developing PID. Douching can change the vaginal flora (organisms that live in the vagina) and can force bacteria from the vagina into the upper reproductive organs.

Even if your symptoms go away, you should finish taking all of the medicine. You also should return to your health care provider 2 to 3 days after beginning the medicine to be sure the antibiotics are working.

Your health care provider may recommend going into the hospital to treat your PID if you

If your symptoms continue or if an abscess does not go away, you may need surgery.

Complications of PID such as chronic pelvic pain and scarring are difficult to treat, but sometimes they improve with surgery.

Many sex partners may be infected with bacteria that cause PID and do not know it because they do not have symptoms. To protect yourself from being re-infected with bacteria that cause PID, you should discuss this with your health care provider.

Prevention

The surest way to avoid getting or transmitting sexually transmitted infections (STIs) is to abstain from sex or to be in a long-term, mutually monogamous relationship with a partner who has been tested and isn’t infected. Condoms, when used consistently and correctly, can reduce your risk of getting chlamydia and gonorrhea.

In addition, you can protect yourself from PID by getting treated quickly if you do get an STI.

The most common preventable cause of PID is an untreated STI, mainly chlamydia or gonorrhea. CDC recommends yearly chlamydia testing of all sexually active women age 25 or younger and of older women with risk factors for chlamydia (those who have a new sex partner or many sex partners). If you have had chlamydia, you also should be re-tested several months after completing treatment so you can be re-treated, if necessary.

Complications

Prompt and appropriate treatment can help prevent complications of PID. Without treatment, PID can cause permanent damage to the female reproductive organs. Infection-causing bacteria can silently invade the fallopian tubes, causing normal tissue to turn into scar tissue. This scar tissue blocks or interrupts the normal movement of eggs into the uterus.

If your fallopian tubes are totally blocked by scar tissue, sperm cannot fertilize an egg and you become infertile. Infertility also can occur if the fallopian tubes are partially blocked or even slightly damaged. About one in five women with PID becomes infertile.

In addition, a partially blocked or slightly damaged fallopian tube may cause a fertilized egg to remain in the fallopian tube. If this fertilized egg begins to grow in the tube as if it were in the uterus, it is called an ectopic or tubal pregnancy. An ectopic pregnancy can rupture the fallopian tube, causing severe pain, internal bleeding, and even death.

Scarring in the fallopian tubes and other pelvic organs can also cause chronic pelvic pain (pain lasting for months or even years). You are more likely to suffer infertility (20 percent of women), ectopic pregnancy (9 percent), or chronic pelvic pain (18 percent) if you have repeated episodes of PID.

Sexual Health

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