PELVIC INFLAMMATORY DISEASE
Pelvic inflammatory disease is an infection of the uterus, fallopian tubes or ovaries. It is the most common serious infection among especially young women. It usually affects sexually active women during their childbearing years. About one in every seven women receives treatment for pelvic inflammatory disease at some point in her life.
Pelvic inflammatory disease is the most common preventable cause of infertility. The infection can cause tissue inside the fallopian tubes to become scarred, which can damage the fallopian tubes or block them completely. The more often a woman gets this infection, the greater her risk of becoming infertile, and the risk doubles with each bout of the disease.
PID is a major cause of hospitalization in young women. It leads to thousands of surgeries due to complications from the infection. A lot of researchers believe most cases develop from STDs (sexually transmitted diseases), infections that are spread through sexual contact. The two diseases that are most likely to lead to pelvic inflammatory disease are gonorrhea and chlamydia. If the disease is left without treatment, the same bacteria that cause these diseases also can cause pelvic inflammatory disease.
Pelvic inflammatory disease usually develops in a two-staged process. First, the organisms infect the opening of the uterus (the cervix). Then, in about ten out of a hundred women, the bacteria migrate up to the uterus, fallopian tubes or ovaries.
Less commonly, if bacteria get into the upper portions of the reproductive tract in times such as;
- After childbirth
- After inserting an intrauterine device (IUD)
- After an induced abortion
Pelvic inflammatory disease can develop. All of these procedures carry some risk of infection, especially if the patient also has an STD.
Pelvic inflammatory disease is most commonly found in women who are younger than age 25 and who have more than one sex partner. Women who have had an STD have a higher risk of getting pelvic inflammatory disease, as do those who have already had a previous pelvic infection. Any woman whose sex partner also has more than one sex partner is also at increased risk of pelvic infection.
CAUSES
Pelvic inflammatory disease (PID) is caused by an infection that develops in the female upper genital tract.
In most of the cases, the condition is caused by a bacterial infection spreading from the vagina or the entrance to the womb (cervix) into the womb, the fallopian tubes and or the ovaries.
PID is often caused by more than one type of bacterium and it can sometimes make it difficult for doctors to pinpoint which are responsible.
This would mean that a combination of antibiotics will be prescribed so that a variety of bacteria can be treated.
Sexually transmitted infections (STIs)
In about a quarter of all cases, PID is caused by sexually transmitted infection (STI) such as chlamydia, gonorrhea or mycoplasma genitalium.
These bacteria usually only infect the cervix, where they can be easily treated with a single dose of an antibiotic.
However, there's a risk that the bacteria could travel into the upper genital tract if they're not treated.
Other causes
In many cases, the cause of the infection that leads to PID is not known.
Sometimes bacteria that are normally harmless, and found in the vagina can get past the cervix and into the reproductive organs.
Although harmless in the vagina, these types of bacteria can cause infection in other parts of the body.
This is most likely to happen if:
- The woman had a procedure that involves opening the cervix (e.g. abortion, inspection of the womb, or insertion of an intrauterine contraceptive device)
- The woman has had PID in the past
- There's been damage to the cervix following childbirth or a miscarriage
SYMPTOMS
What are the signs and symptoms of pelvic inflammatory disease?
Many women do not know that they have PID, because they do not have any signs or symptoms. When symptoms do happen, they can be mild or more serious.
Signs and symptoms include:
- Pain in the upper right abdomen
- Pain in the lower abdomen
- Fever (38° C or higher)
- Foul smelling vaginal discharge
- Painful sex
- Painful urination
- Irregular periods
RISK FACTORS
A number of factors might increase your risk of pelvic inflammatory disease, including:
- Being a sexually active woman younger than 25 years old
- Having multiple sexual partners
- Having multiple sexual partners who may also have multiple sexual partners
- Having sex without a condom
- Regular douching, which upsets the balance of good versus harmful bacteria in the vagina and might cover up symptoms
- Having a history of pelvic inflammatory disease or a sexually transmitted infection
There is a small increased risk of PID after the insertion of an intrauterine device (IUD). However, this risk is generally confined to the first three weeks after insertion.
REDUCING THE RISK OF GETTING PID
The only way to avoid STDs is to not have vaginal, anal, or oral sex. However, if one is sexually active, the following things can be done to lower the chances of getting PID;
- Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
- Using latex condoms the right way every time for sexual intercourse.
COMPLICATIONS
Untreated pelvic inflammatory disease might cause scar tissue and abscesses (pockets of infected fluid) to develop in the reproductive tract. These can cause permanent damage to the reproductive organs.
Complications from this damage might include:
Ectopic pregnancy. PID is a major cause of ectopic (tubal) pregnancy. An ectopic pregnancy can occur if PID that is not treated causes scar tissue to develop in the fallopian tubes. The scar tissue prevents the fertilized egg from making its way through the fallopian tube to implant in the uterus. Instead, the egg implants in the fallopian tube. Ectopic pregnancies can cause massive, life-threatening bleeding and require emergency medical attention.
Infertility. Damage to the reproductive organs may cause infertility (i.e. The inability to become pregnant). The more times a woman has PID, the greater her risk of infertility. Delaying treatment for PID also dramatically increases the risk of infertility.
Chronic pelvic pain. Pelvic inflammatory disease can cause pelvic pain that might last for months or years. Scarring in the fallopian tubes and other pelvic organs can cause pain during intercourse and ovulation.
Tubo-ovarian abscess. PID might cause a collection of pus (an abscess) to form in the reproductive tract. Most commonly, abscesses affect the fallopian tubes and ovaries, but they can also develop in the uterus or in other pelvic organs. If an abscess is left untreated, a life-threatening infection could develop.
LONG-TERM COMPLICATIONS OF PELVIC INFLAMMATORY DISEASE
Make a doctor's appointment if you think that you have PID. Other conditions, such as a UTI, can feel like pelvic inflammatory disease. However, your doctor can test for PID and rule out other conditions.
If you don't treat your PID, your symptoms can worsen and lead to problems, such as:
- Infertility, an inability to conceive a child
- Ectopic pregnancy, a pregnancy that occurs outside the womb
- Chronic pelvic pain, pain in the lower abdomen caused by scarring of the fallopian tubes and other pelvic organs
The infection can also spread to other parts of your body. If it spreads to your blood, it can become life-threatening.
WHEN TO SEE A DOCTOR
- Women should endeavor to see their doctor or seek urgent medical care if they experience:
- Severe pain low in the abdomen
- Nausea and vomiting, with an inability to keep anything down
- Fever, with a temperature higher than 101 F (38.3 C)
- Foul vaginal discharge
If one has signs and symptoms of PID that aren't severe, still see a doctor as soon as possible. Vaginal discharge with an unpleasant odor, painful urination or bleeding between menstrual cycles can also be symptoms of a sexually transmitted infection (STI). If these signs and symptoms occur, stop having sex and see your doctor soonest.
Prompt treatment of an STI can help prevent PID.
DIAGNOSIS
The doctor will ask about the patient's medical history, including the sexual habits of both the patient and her partner or partners. The doctor also will also want to know about the patient's symptoms and methods of birth control. A pelvic examination will reveal whether the reproductive organs are tender or swollen. This will help to identify the specific site of infection.
The diagnosis of pelvic inflammatory disease is not always easy because the site of infection cannot be examined easily. Also, the symptoms sometimes mimic symptoms of other conditions, such as appendicitis.
During the pelvic examination, the doctor may swab the inside of the cervix with a sterile, cotton-tipped swab. A laboratory will test the sample for gonorrhea and chlamydia. The doctor may order a blood test to see if the white blood cell count is high, which may indicate that the pelvic inflammatory disease is more severe.
If the diagnosis is not certain, other procedures may be done, including:
A laparoscopy — A slender, telescope-like instrument is inserted through a small incision in the navel or just below it. This allows the doctor to view the pelvic organs.
An ultrasound — An electronic device is moved over the abdomen or placed in the vagina, creating echoes that are transformed into images of organs for viewing on a screen. Ultrasound can help the doctor see if the fallopian tubes are swollen or there is an abscess, which is a collection of infected fluid.
TREATMENT
If the diagnosis is made at an early stage, pelvic inflammatory disease (PID) can be treated easily and effectively with antibiotics. These can be prescribed by the doctor at a sexual health clinic.
Left untreated, it can lead to more serious long-term complications.
Antibiotics
Treatment with antibiotics needs to be started quickly, before the results of the swabs are available.
PID is usually caused by a variety of different bacteria, even in cases where chlamydia, gonorrhea or mycoplasma genitalium is identified.
This means patients will be given a mixture of antibiotics to cover the most likely infections.
If you think you may be pregnant before starting antibiotic treatment, tell the doctor as some antibiotics should be avoided during pregnancy.
Usually, the antibiotic tablets will have to be taken for 14 days, sometimes beginning with a single antibiotic injection.
It's very important to complete the entire course of antibiotics, even if one feels better, to help ensure the infection is properly cleared.
In particularly severe cases of PID, patients may have to be admitted to hospital to receive antibiotics intravenously (through a drip in the arm).
Should there be pain around the pelvis or tummy, painkillers such as Paracetamol or ibuprofen can help while you're being treated with antibiotics.
Follow-up
In some cases, patients may be advised to have a follow-up appointment 3 days after beginning the treatment so the doctor can check if the antibiotics are working.
If the antibiotics seem to be working, another follow-up appointment at the end of the course will have to be scheduled to check if treatment has been overly successful.
If the symptoms does not begin to improve within 3 days, one may be advised to attend hospital for further tests and treatment.
If the patient has an intrauterine device (IUD) fitted, she may be advised to have it removed if the symptoms does not improve within a few days, as it may be the cause of the infection.
Treating sexual partners
All sexual partners that the patient has been with in the 6 months before the symptoms began should be tested and treated to stop the infection recurring or being spread to others, even if no specific cause is identified.
- PID can occur in long-term relationships where both partners have been faithful to each other.
- PID is more likely to return if both partners are not treated at the same time.
- Patient should avoid having sex until both she and her partner have completed the course of treatment.
- If the patient has not had a sexual partner in the previous 6 months, her most recent partner should be tested and treated.
- The doctor or sexual health clinic can help to contact previous partners. This can be done anonymously if it is preferred.
WHAT HAPPENS IF IT IS NOT TREATED
If diagnosed and treated early, the complications of PID can be prevented. Some of the complications of PID are
- Long-term pelvic/abdominal pain.
- The formation of scar tissue both outside and inside the fallopian tubes that can lead to tubal blockage
- Ectopic pregnancies (pregnancy outside the womb)
- Infertility (inability to get pregnant)
PREVENTION
The risks of PID can be lowered by:
- The practice of safe sex
- Getting tested for sexually transmitted infections
- The avoidance of douches
- Wiping from front to back after using the bathroom to stop bacteria from entering the vagina
LONG-TERM OUTLOOK FOR PID
Pelvic inflammatory disease is a very treatable condition and most women make a full recovery.
