Pelvic inflammatory disease (PID)

pelvic inflammatory diseasePelvic inflammatory disease (PID) is a gynecologic disease that affects the womb, Fallopian tubes and ovaries due to the infection.


Description


The pelvis is the part of the abdomen where the uterus, Fallopian tubes and ovaries are found.

Pelvic inflammatory disease is a condition caused by infection of woman’s internal reproductive organs, especially due to sexually transmitted infection. Most commonly, the disease affects the young, sexually active women at the age of 15-29. PID is referred to as the “silent epidemic” as long as the disease remains asymptomatic for the long period of time, many women are not aware of their disease and may infect the others if they are sexually active.


Causes

The inflammation of the uterus, Fallopian tubes and ovaries is mainly caused by the sexually transmitted infections (STI) such as gonorrhoea, chlamydia and mycoplasma. The bacteria enter the vagina and cervix and later spreads to the internal organs causing inflammatory response.


Risk factors


Pelvic inflammatory disease is more common for young women that are at the age of 15-29.

Risk factors for PID include:

  • having a sexually transmitted infection (typically it’s chlamydia or gonorrhoae) and not getting a proper treatment;
  • bacterial vaginosis;
  • having sex and being under the age of 25;
  • having multiple sex partners;
  • having sex without a condom;
  • using an intrauterine device (IUD) to prevent a pregnancy;
  • douching;
  • a history of pelvic inflammatory disease;
  • an endometrial biopsy;
  • a childbirth;
  • an abortion;
  • appendicitis increases the risk of developing PID.

See also: Endometriosis

Symptoms

PID may often cause no symptoms or only slightly affect the woman’s condition by causing non-specific symptoms.

The symptoms of PID may include:

  • dull pain and tenderness in the area of the pelvis/lower abdomen/the rectum;
  • menstrual disorders (painful, long or heavy periods);
  • irregular periods;
  • period cramps;
  • discomfort/deep pain during sexual intercourse;
  • pain/burning feeling during urination or often urination;
  • bleeding in-between the periods or after sex;
  • bad-smelling vaginal discharge (yellow or green);
  • fatigue and tireness;

 

In some cases, women  experience:

  • severe abdominal pain;
  • chills or fever;
  • fainting;
  • nausea/vomiting.

 

Complications

Complications of PID include scarring of the female reproductive organs, ectopic (tubal) pregnancy, chronic pelvic pain, tuboovarian abscess, Fitz-Hugh–Curtis syndrome, cancer and infertility. One episode of PID increases the risk of tubal infertility twice. The more times PID occurs, the greater is the risk of infertility. Three or more episodes of PID, increases the risk of Fallopian tube blockage to 75 percent.

The risk of developing an ectopic pregnancy is in 7 times higher in those who experienced an episode of PID at least once in their lifetime.

The spread of the infection through the bloodstream causes sepsis and may be life-threatening.


Diagnosis

To evaluate the diagnosis medical history should be taken, pelvic examination, cervical cultures (a vaginal/cervical swab) and urine testing should be performed. Several laboratory tests are needed to check for the  signs of infection: C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR) and WBC (White Blood Cells) count.

To assess the damage to the reproductive organs, pelvic ultrasound, culdocentesis, endometrial biopsy and laparoscopy may be necessary. In some cases CT/MRI is recommended.

Treatment


An affected person should drink lots of water, and eat healthy foods. The douching and using tampons should be avoided. It is strongly recommended to avoid sexual intercourse until the infection is gone. Antibiotics and analgetics are commonly prescribed.

 

Applicable medicines

Medicines used to treat PID are the following:

Antibiotics (cefoxitin or cefotetan plus doxycycline, and clindamycin plus gentamicin) are prescribed to treat the infection orally or intravenously in severe cases. It is important that a sexual partner should also be examined and treated. NSAIDs (ibuprofen, acetaminophen) are taken to alleviate the pain.

 

Prevention

To avoid PID a person should:

  • get a proper treatment if the STD is diagnosed;
  • regularly visit gynecologist and seek for medical help if there are some signs of the reproductive system disease;
  • have one stable sexual partner;
  • use of birth control (condoms and/or a diaphragm) and spermicides;