An Overview of Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) is a type of inflammatory infection that affects a woman's reproductive organs in the pelvis. It is usually caused by the spread of a vaginal or cervical infection. Having an untreated sexually transmitted disease (STD) is one of the most common risk factors.

PID can cause vaginal discharge or pelvic discomfort, but it does not always cause noticeable effects. However, it increases the risk of infertility and ectopic pregnancy (a tubal pregnancy). A PID can be detected with clinical examination, and it is usually treated with antibiotics.

Not all women with PID have noticeable symptoms. In fact, it can go undetected for years, eventually causing health or reproductive complications. Sometimes symptoms can occur, but they are often mild or nonspecific—and because of this, many women do not seek medical attention for the chronic effects of PID until complications occur.

That is why it is important to recognize the signs of this condition and to seek medical attention as soon as you begin to experience effects.

Symptoms of PID can include:

• Aching in the lower abdomen and pelvis
• Excess vaginal discharge with a foul odor
• Pain or bleeding during or shortly after sex
• Discomfort during urination
• Lower back pain
• Irregular periods

Acute complications include the development of a pelvic abscess (enclosed infection) or a major pelvic infection. Symptoms may include fever, chills, nausea, vomiting, or severe pelvic pain.

An infection can spread to the bloodstream, potentially causes sepsis.

Longstanding untreated PID can result in serious health effects that affect a woman's reproductive health.

Women who have PID may be prone to ectopic pregnancy, which is a nonviable pregnancy in which a fertilized egg in the fallopian tube causes severe abdominal pain. An ectopic pregnancy can become a life-threatening medical emergency.

Women who have had PID can also experience difficulty conceiving or carrying a child to term due to scarring and inflammation of the reproductive tract.

PID is an infection of the uterus, ovaries, and fallopian tubes. It can happen as a consequence of STDs, bacterial vaginosis (BV), or as a complication of pelvic surgery or gynecologic procedures. Chlamydia and gonorrhea are the most common infections associated with PID.

Risk factors for developing PID include:

• Unprotected/unsafe sex: Having multiple sexual partners increases the risk of vaginal and cervical infections, particularly if barrier methods of protection are not used every time.
• Untreated vaginal or cervical infections: Lingering infections can allow the spread of the infectious organism from the vagina up to the uterus, fallopian tubes, or ovaries.
• Younger age: Teenagers who are sexually active are more prone to PID than women who are in their 20's or older.
• Douching: Experts warn that douching can alter the protective flora (normal bacteria) and pH of a woman's reproductive tract. This alteration allows infections to thrive.
• Intrauterine devices (IUD): There is an increased risk of PID within the first few weeks after IUD insertion.

An infection can spread within a woman's reproductive system, causing inflammation and scarring. The scarring can narrow or block the fallopian tube, which prevents sperm from reaching the egg for fertilization. Infertility results when sperm cannot reach the egg.

If fertilization occurs in the fallopian tube (which is where it normally takes place), the narrowing may prevent the egg from reaching the uterus (which is where the fertilized egg needs to attach and grow for the remainder of pregnancy). The resulting effect, an ectopic pregnancy, occurs when the fertilized egg remains trapped in the fallopian tube.

The diagnosis of PID generally involves a medical history, gynecologic exam, and diagnostic tests, such as ultrasound. Often, because most women have no symptoms or few symptoms, diagnosis is made at a late stage, when scarring has already occurred.

If you have PID, your doctor will also evaluate you to identify the infectious organism.

Several tests are used in the evaluation of PID. The first is a gynecologic examination (also called a pelvic examination), in which your doctor will examine your vagina and cervix, typically with a light that helps in visualizing the area.

During your examination, you may have a Pap smear and/or a fluid sample. A Pap smear is sent to a laboratory so that the cells sampled from your cervix can be examined under a microscope. A fluid sample may be sent to a laboratory for a culture, which is a test that is used to grow and identify a bacterial infection.

Specialized diagnostic tests can help your doctor visualize the structure of your reproductive organs, identifying areas of scarring throughout your reproductive tract (vagina, cervix, uterus, fallopian tubes, and ovaries).

• Transvaginal ultrasound: This exam involves the insertion of a camera into the vaginal opening. It can identify areas of inflammation or an abscess.
• Laparoscopy: This is a more invasive examination in which a camera is surgically inserted to identify structural changes, such as inflammation or scarring inside the reproductive tract and/or abdominal cavity.

There are several approaches used for the treatment of PID, including antibiotics and surgery. Antibiotics can be used to treat STDs and bacterial vaginitis before PID develops. And if infectious PID is detected, antibiotics can be used to target the infection. Typically the antibiotic is selected based on the organism grown in culture.

If you have an STD, your partner will need to be treated as well so that the infection will not be transmitted back and forth.

A severe infection that affects the bloodstream will need to be treated with intravenous (IV, directly in the vein) antibiotic treatment.

Inflammation and scarring can cause infertility and the risk of ectopic pregnancy. Sometimes scars can be surgically treated, but surgery can increase the risk of adhesions, which is a type of scar that can cause even further problems.

An abscess may require surgical removal, and the procedure is typically followed by oral (by mouth) or IV antibiotics.

An ectopic pregnancy may resolve without treatment, which means that you would have a miscarriage, typically with bleeding abdominal cramps. But because it can cause a life-threatening emergency, you will need to be monitored as the condition resolves.

If the ectopic pregnancy does not resolve on its own or if you develop a fever or signs of an emergency, you may be given medication to stop the pregnancy. Sometimes the fertilized egg must be surgically removed before it causes life-threatening problems, and this may require the removal of one of the ovaries or fallopian tubes as well.

Worldwide, PID is one of the leading causes of ectopic pregnancy and preventable infertility in women. Strategies for prevention include safe sex and screening and prompt treatment for STDs. Unless your doctor instructs you to douche, you should avoid this practice because it can be harmful to your health and increase the risk of developing PID.