What is pelvic inflammatory disease?

Abdominal inflammatory disease is an infection of the reproductive organs of females. It can lead to patterns of scars, with fibrous bands forming between tissues and organs.

It may impact the uterus, or womb, fallopian tubes, ovaries, or a combination.

Risks include pelvic pain, chronic, recurrent, ectopic pregnancy and infertility. According to the Centers for Disease Control and Prevention (CDC), it’s impossible for 1 in 8 women with pelvic inflammatory disease (PID) to become pregnant.

The majority of cases suffer from a spreading untreated infection in the vagina or cervix.

Sexually transmitted infections (STIs) are a common cause but due to other factors, they can evolve from infections.

The 2013 to 2014 National Health and Nutrition Review Survey (NHANES) found that out of 1,171 women of reproductive age sexually experienced in the United States (U.S.) 4.4 percent reported having ever had PID.

In the U.S. nearly 800,000 people are diagnosed with PID each year.

Fast facts about pelvic inflammatory disease

  • Pelvic inflammatory disease (PID) often stems from an untreated sexually transmitted infection or other gynecological infection.
  • Symptoms may not be noticeable, but they can include pain and fever.
  • Untreated PID can lead to scarring, fertility problems, or an abscess.
  • Treatment is usually with antibiotics, but surgery may be necessary.
  • Prevention strategies include practicing safe sex and not having multiple sexual partners.

Symptoms

A girl with Stomach pain
Pelvic inflammatory disease can cause pain and lead to infertility.

Most women suffering from PID have no symptoms. These can range from mild to severe if symptoms appear. Untreated PID, however, can have serious impacts.

Possible symptoms include:

  • pain, possibly severe, especially in the pelvic area
  • fever
  • fatigue
  • bleeding or spotting between periods
  • irregular menstruation
  • pain in the lower back and the rectum
  • pain during sexual intercourse
  • unusual vaginal discharge
  • frequent urination
  • vomiting

Sometimes the symptoms resemble those of an ovarian cyst, appendicitis, endometriosis, or a urinary tract infection (UTI).

PID can be acute, up to 30 days in length, or chronic if it lasts more than 30 days.

One problem with treating PID is that the symptoms are different and that there may be no symptoms at some patients.

Anyone who has symptoms or believes they might have been exposed to an STI or other source of infection should see a physician.

Complications

Complications that can arise if PID is not treated include:

  • scarring that can lead to fertility problems
  • recurring PID
  • severe pelvic pain
  • a tubo-ovarian abscess

Most women don’t realize they had a PID until they seek medical advice for issues with infertility.

A woman with PID has a 20 percent chance of infertility due to Falopian tube scarring and a 9 per cent risk of a possible ectopic pregnancy. There are 18 per cent chances of experiencing chronic pelvic pain.

Causes and risk factors

PID usually begins with a vaginal infection that spreads to the cervix. It can then move to the tubes and ovaries of Falopia.

Bacterial, fungal, or parasitic may be the cause of infection, but one or more types of bacteria are more likely to be involved.

The most common cause of PID is sexually transmitted bacteria. The most popular is chlamydia, followed by gonorrhea.

The American Family Physicist (AFP) estimates that there are no symptoms for 80 to 90 percent of women with chlamydia and 10 percent of those with gonorrhea.

Some 10 to 15 percent of women with chlamydia or gonorrhea go on to develop PID as a secondary infection.

Risk factors

Apart from an STI, some risk factors increase the risk of developing PID.

Childbirth, abortion or miscarriage, if bacteria enter the vagina. The infection can spread more easily if the cervix is not fully closed.

An intrauterine device (IUD), a form of birth control that is placed into the uterus. This can increase the risk of infection, which may become PID.

An endometrial biopsy, during which a sample of tissue is taken for analysis, increases the risk of infection and subsequent PID.

Appendicitis very slightly increases the risk, if the infection spreads from the appendix to the pelvis.

Who is most likely to be affected?

Women are more likely to develop PID if they:

  • are sexually active and under 25 years of age
  • have several sexual partners
  • do not use barrier contraceptives
  • use a douche

It is most common among women aged 15 to 29 years.

Diagnosis

A doctor will ask about symptoms and conduct a pelvic exam to test for tenderness.

These will also screen for the gonorrhea and chlamydia.

A swab may be taken from the cervix, and perhaps from urethra, the bladder tube through which urine flows. Blood and urine tests may be done.

The ultrasound scan may be used in Fallopian tubes to test for inflammation.

Often, the area is viewed using a laparoscope. Tissue samples may be taken through it where appropriate.

Treatment

Early treatment decreases the likelihood of developing complications, such as infertility.

Antibiotic treatment

First form of antibiotic treatment. It is required to follow the instructions given by the doctor and complete all of the prescription. A course normally runs for 14 days.

PID also includes more than one type of bacteria, so two antibiotics may be taken together.

If tests show which bacteria cause the disease, more oriented therapy may be necessary.

Antibiotics for PID include:

  • cefoxitin
  • metronidazole
  • ceftriaxone
  • doxycycline

If the antibiotics make no difference within 3 days, the patient will seek more assistance. She could get intravenous antibiotic therapy or a drug adjustment.

Hospitalization and surgery

Hospitalization: If a woman with PID is pregnant or has symptoms that are very significant, she may need to stay in hospital. Intravenous medicine may be given at the hospital.

Surgery: This is rarely needed, but it may be necessary if the Falopian tubes have scarring or if an abscess requires drainage. This may include keyhole surgery, or removal of one or both Falopian tubes.

Doctors tend not to cut all Falopian tubes, since obviously the woman will not be able to become pregnant.

The sexual partner of the woman might need to look for help for an STI. If the partner has an STI, then if it goes untreated, there is a serious risk of recurrence.

The patient should refrain from having sex before completion of treatment.

Prevention

PID can be a serious condition but there are some ways of minimizing the risk:

  • having regular screening, especially for those who have multiple sex partners
  • ensuring sexual partners are tested for infections and STIs
  • not douching, because this increases the risk
  • using a condom or cervical cap and practicing safe sex
  • not having sex too soon after childbirth or a termination or loss of pregnancy

Sex should not resume until the cervix closes properly

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