Pelvic inflammatory disease
Pelvic inflammatory disease or PID is an infection of the female reproductive system, including the uterus, ovaries, and Fallopian tubes. Also called pelvic inflammatory disorder, PID is one of the most serious complications of sexually transmitted diseases (STDs), and if untreated, can result in infertility and other irreversible damage to the female reproductive system.
Definition & Facts
Pelvic inflammatory disease is a disease caused by bacteria spreading from the vagina and cervix to the internal reproductive organs. Often symptoms are not present or are mild enough to be dismissed, but possible symptoms include lower abdominal pain, fever, abnormal vaginal discharge, pain during sex, painful urination or a burning sensation while urinating, or irregular periods.
The primary bacteria involved are the gonorrhea and chlamydia bacteria, accounting for 90% of all PID cases, though multiple types of bacteria are often involved. Statistically, 10 percent of untreated chlamydial infections and 40 percent of untreated gonorrheal infections will develop into PID.
The global occurrence of PID is not tracked by the World Health Organization, but estimates place it as affecting 1.5 percent of young women yearly worldwide. In the US, nearly 1 million cases of PID occur annually, and 1 in 8 sexually active females will have PID before age 20.
Symptoms & Complaints
- Vaginal discharge, yellow or green colored with a bad odor
- Pain in the lower abdomen, stomach pain, or lower back pain
- Burning pain during urination or needing to urinate often
- Pain experienced during sex
- Irregular periods or bleeding between periods
- More painful or longer period cramps
- Nausea and vomiting
Additionally, untreated PID causes permanent injury to the female reproductive organs. Long-term complications of PID include:
- Ectopic pregnancy, when an egg grows outside of the uterus
- Chronic pelvic pain
- Various types of cancers
PID without symptoms is more likely to be caused by a chlamydia infection, and women with unexplained infertility or ectopic pregnancies often have chlamydial PID.
Pelvic inflammatory disease is primarily caused by contracting a bacterial STD and leaving the infection untreated. The primary risk group for PID is sexually active females, especially those with multiple partners.
While all sexually transmitted diseases should be immediately treated by a doctor or other health-care provider, vaginal infections are usually prevented from spreading to the inner reproductive system by the cervix. The cervix itself becoming infected can leave the way open for the spread of a bacterial infection into the uterus.
All factors that can increase risk of a sexually transmitted infection also increase risk of PID, including having a male sex partner with gonorrhea or chlamydia, having multiple sex partners, or having a sex partner who has multiple sex partners. In addition, an STD is more likely to result in PID if a female is under 25 years of age, has had PID in the past, or regularly uses a douche.
More rarely, bacteria can also enter the body during a medical procedure, leading to PID or an STD that could lead to PID. Procedures that present this extremely rare risk include all operations that introduce foreign objects into the female reproductive system. The most common such procedures are:
- Getting an intrauterine device (IUD) for birth control
- Having an endometrial biopsy (removal of piece of womb lining for cancer test) performed
Diagnosis & Tests
There is no definitive test for PID, and a diagnosis generally requires a combination of a physical examination and multiple tests looked at in conjunction with medical history. It is suggested that any female under 40 experiencing lower abdominal pain be tested for PID.
A suspected PID infection is first tested for the presence of chlamydia or gonorrhea. If vaginal discharge is present, it is tested for infection, including gonorrhea or chlamydia. If a doctor suspects infection, blood tests may be performed to further test for infections, and an ultrasound or other medical imaging test may be performed to view the reproductive system for late-stage infection or for other causes of abdominal pain.
Other possible medical issues with similar symptoms include appendicitis, ectopic pregnancy, ovarian cysts, gastroenteritis and other lower gastrointestinal tract infections, and many other infections of various organs in the lower abdomen. Tests should be performed if any of these other causes are suspected.
Treatment & Therapy
Treatment should be started without confirmation due to the possible long-term complications of delayed treatment. An antibiotics regimen is the treatment for mild to moderate cases of PID, with the specifics of the regimen depending on the infectious agent (gonorrhea, chlamydia, or other less common infections) causing the infection.
The antibiotics are generally taken by mouth, although a hospital stay for intravenous antibiotics may be used if the infection is severe or if medicine cannot be taken by mouth. If oral antibiotics cause no improvement within two to three days, or intravenous antibiotics within 24 to 48 hours, further treatment is advised. Any recent sexual partners must undergo the same treatment or the infection will reoccur after the next time sexual intercourse occurs.
When an infection like PID causes an abscess (a collection of pus within the body) antibiotics cease to be effective, and surgery is required to remove the abscess before it ruptures. Surgery may be performed by laparoscopy (surgery performed through small incisions with the aid of a camera), or open surgery may be required.
Prevention & Prophylaxis
PID nearly always progresses from an STD infection, and methods of reducing the risk for STDs also reduce the risk of contracting PID. They include: