Pelvic inflammatory disease (PID) is
a general term that refers to
infection of the uterus (womb),
fallopian tubes (tubes that carry
eggs from the ovaries to the uterus)
and other reproductive organs. It is
a common and serious complication of
some sexually transmitted diseases
(STDs), especially chlamydia and
gonorrhea. PID can damage the
fallopian tubes and tissues in and
near the uterus and ovaries.
Untreated PID can lead to serious
consequences including infertility,
ectopic pregnancy (a pregnancy in
the fallopian tube or elsewhere
outside of the womb), abscess
formation, and chronic pelvic pain.
How common is PID?
Each year in the United States,
it is estimated that more than 1
million women experience an episode
of acute PID. More than 100,000
women become infertile each year as
a result of PID, and a large
proportion of the ectopic
pregnancies occurring every year are
due to the consequences of PID.
Annually more than 150 women die
from PID or its complications.
How do women get PID?
PID occurs when bacteria move
upward from a woman's vagina or
cervix (opening to the uterus) into
her reproductive organs. Many
different organisms can cause PID,
but many cases are associated with
gonorrhea and chlamydia, two very
common bacterial STDs. A prior
episode of PID increases the risk of
another episode because the
reproductive organs may be damaged
during the initial bout of
infection.
Sexually active women in their
childbearing years are most at risk,
and those under age 25 are more
likely to develop PID than those
older than 25. This is because the
cervix of teenage girls and young
women is not fully matured,
increasing their susceptibility to
the STDs that are linked to PID.
The more sex partners a woman
has, the greater her risk of
developing PID. Also, a woman whose
partner has more than one sex
partner is at greater risk of
developing PID, because of the
potential for more exposure to
infectious agents.
Women who douche may have a
higher risk of developing PID
compared with women who do not
douche. Research has shown that
douching changes the vaginal flora
(organisms that live in the vagina)
in harmful ways, and can force
bacteria into the upper reproductive
organs from the vagina.
Women who have an intrauterine
device (IUD) inserted may have a
slightly increased risk of PID near
the time of insertion compared with
women using other contraceptives or
no contraceptive at all. However,
this risk is greatly reduced if a
woman is tested and, if necessary,
treated for STDs before an IUD is
inserted.
What are the signs and symptoms
of PID?
Symptoms of PID vary from none to
severe. When PID is caused by
chlamydial infection, a woman may
experience mild symptoms or no
symptoms at all, while serious
damage is being done to her
reproductive organs. Because of
vague symptoms, PID goes
unrecognized by women and their
health care providers about two
thirds of the time. Women who have
symptoms of PID most commonly have
lower abdominal pain. Other signs
and symptoms include fever, unusual
vaginal discharge that may have a
foul odor, painful intercourse,
painful urination, irregular
menstrual bleeding, and pain in the
right upper abdomen (rare).
What are the complications of
PID?
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 the
fallopian tubes are totally blocked
by scar tissue, sperm cannot
fertilize an egg, and the woman
becomes infertile. Infertility also
can occur if the fallopian tubes are
partially blocked or even slightly
damaged. About one in eight women
with PID becomes infertile, and if a
woman has multiple episodes of PID,
her chances of becoming infertile
increase.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 pregnancy. As it grows,
an ectopic pregnancy can rupture the
fallopian tube causing severe pain,
internal bleeding, and even death.
Scarring in the fallopian tubes
and other pelvic structures can also
cause chronic pelvic pain (pain that
lasts for months or even years).
Women with repeated episodes of PID
are more likely to suffer
infertility, ectopic pregnancy, or
chronic pelvic pain.
How is PID diagnosed?
PID is difficult to diagnose because
the symptoms are often subtle and
mild. Many episodes of PID go
undetected because the woman or her
health care provider fails to
recognize the implications of mild
or nonspecific symptoms. Because
there are no precise tests for PID,
a diagnosis is usually based on
clinical findings. If symptoms such
as lower abdominal pain are present,
a health care provider should
perform a physical examination to
determine the nature and location of
the pain and check for fever,
abnormal vaginal or cervical
discharge, and for evidence of
gonorrheal or chlamydial infection.
If the findings suggest PID,
treatment is necessary.
The health care provider may also
order tests to identify the
infection-causing organism (e.g.,
chlamydial or gonorrheal infection)
or to distinguish between PID and
other problems with similar
symptoms. A pelvic ultrasound is a
helpful procedure for diagnosing
PID. An ultrasound can view the
pelvic area to see whether the
fallopian tubes are enlarged or
whether an abscess is present. In
some cases, a laparoscopy may be
necessary to confirm the diagnosis.
A laparoscopy is a minor surgical
procedure in which a thin, flexible
tube with a lighted end
(laparoscope) is inserted through a
small incision in the lower abdomen.
This procedure enables the doctor to
view the internal pelvic organs and
to take specimens for laboratory
studies, if needed.
What is the treatment for PID?
PID can be cured with several types
of antibiotics. A health care
provider will determine and
prescribe the best therapy. However,
antibiotic treatment does not
reverse any damage that has already
occurred to the reproductive organs.
If a woman has pelvic pain and other
symptoms of PID, it is critical that
she seek care immediately. Prompt
antibiotic treatment can prevent
severe damage to reproductive
organs. The longer a woman delays
treatment for PID, the more likely
she is to become infertile or to
have a future ectopic pregnancy
because of damage to the fallopian
tubes.
Because of the difficulty in
identifying organisms infecting the
internal reproductive organs and
because more than one organism may
be responsible for an episode of
PID, PID is usually treated with at
least two antibiotics that are
effective against a wide range of
infectious agents. These antibiotics
can be given by mouth or by
injection. The symptoms may go away
before the infection is cured. Even
if symptoms go away, the woman
should finish taking all of the
prescribed medicine. This will help
prevent the infection from
returning. Women being treated for
PID should be re-evaluated by their
health care provider two to three
days after starting treatment to be
sure the antibiotics are working to
cure the infection. In addition, a
woman's sex partner(s) should be
treated to decrease the risk of
re-infection, even if the partner(s)
has no symptoms. Although sex
partners may have no symptoms, they
may still be infected with the
organisms that can cause PID.
Hospitalization to treat PID may
be recommended if the woman (1) is
severely ill (e.g., nausea,
vomiting, and high fever); (2) is
pregnant; (3) does not respond to or
cannot take oral medication and
needs intravenous antibiotics; or
(4) has an abscess in the fallopian
tube or ovary (tubo-ovarian
abscess). If symptoms continue or if
an abscess does not go away, surgery
may be needed. Complications of PID,
such as chronic pelvic pain and
scarring are difficult to treat, but
sometimes they improve with surgery.
How can PID be prevented?
STD (mainly untreated Chlamydia or
gonorrhea) is the main preventable
cause of PID. Women can protect
themselves from PID by taking action
to prevent STDs or by getting early
treatment if they do get an STD.
The surest way to avoid
transmission of STDs is to abstain
from sexual intercourse, or to be in
a long-term mutually monogamous
relationship with a partner who has
been tested and is known to be
uninfected.
Latex male condoms, when used
consistently and correctly, can
reduce the risk of transmission of
chlamydia and gonorrhea.
CDC recommends yearly chlamydia
testing of all sexually active women
age 25 or younger and of older women
with risk factors for chlamydial
infections (those who have a new sex
partner or multiple sex partners).
An appropriate sexual risk
assessment by a health care provider
should always be conducted and may
indicate more frequent screening for
some women.
Any genital symptoms such as an
unusual sore, discharge with odor,
burning during urination, or
bleeding between menstrual cycles
could mean an STD infection. If a
woman has any of these symptoms, she
should stop having sex and consult a
health care provider immediately.
Treating STDs early can prevent PID.
Women who are told they have an STD
and are treated for it should notify
all of their recent sex partners so
they can see a health care provider
and be evaluated for STDs. Sexual
activity should not resume until all
sex partners have been examined and,
if necessary, treated.
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