What is pelvic inflammatory disease?
It can affect the uterus, or womb, the fallopian tubes, the ovaries, or a combination.
Complications include chronic, persistent, pelvic pain, ectopic pregnancy, and infertility. According to the Centers for Disease Control and Prevention (CDC), 1 in 8 women who have had pelvic inflammatory disease (PID) have difficulty becoming pregnant.
Most cases result from an untreated infection in the vagina or cervix that spreads.
Sexually transmitted infections (STIs) are a common cause, but it can develop from infections due to other causes.
The National Health and Nutrition Examination Survey (NHANES) 2013 to 2014 found that, out of 1,171 sexually experienced women of reproductive age in the United States (U.S.), 4.4 percent reported having ever had PID.
Around 800,000 women receive a diagnosis of PID each year in the U.S.
- Pelvic inflammatory disease (PID) often stems from an untreated sexually transmitted infection or other gynecological infection.
- Symptoms may not be noticeable, but they can include pain and fever.
- Untreated PID can lead to scarring, fertility problems, or an abscess.
- Treatment is usually with antibiotics, but surgery may be necessary.
- Prevention strategies include practicing safe sex and not having multiple sexual partners.
Pelvic inflammatory disease can cause pain and lead to infertility.
Many women with PID have no symptoms. If symptoms appear, they can vary from mild to severe. However, untreated PID can have serious consequences.
Possible symptoms include:
- pain, possibly severe, especially in the pelvic area
- bleeding or spotting between periods
- irregular menstruation
- pain in the lower back and the rectum
- pain during sexual intercourse
- unusual vaginal discharge
- frequent urination
PID can be acute, lasting up to 30 days, or chronic if it lasts more than 30 days.
One difficulty with treating PID is that the symptoms are varied and that some women may have no symptoms.
Anyone who experiences symptoms or who thinks they may have been exposed to an STI or other cause of infection should see a doctor.
Complications that can arise if PID is not treated include:
- scarring that can lead to fertility problems
- recurring PID
- severe pelvic pain
- a tubo-ovarian abscess
Many women do not realize they have had a PID until they seek medical advice for infertility problems.
A woman who has had PID has a 20 percent chance of infertility due to scarring of the fallopian tubes and a 9 percent risk of a future ectopic pregnancy. The odds of developing chronic pelvic pain are 18 percent.
Causes and risk factors
PID usually starts with an infection that begins in the vagina and spreads to the cervix. It can then move to the fallopian tubes and the ovaries.
The cause of infection can be bacterial, fungal, or parasitic, but it is more likely to involve one or more types of bacteria.
The American Family Physician (AFP) estimates that between 80 and 90 percent of women with chlamydia and 10 percent of those with gonorrhea have no symptoms.
Some 10 to 15 percent of women with chlamydia or gonorrhea go on to develop PID as a secondary infection.
Apart from an STI, some risk factors increase the risk of developing PID.
Childbirth, abortion or miscarriage, if bacteria enter the vagina. The infection can spread more easily if the cervix is not fully closed.
An intrauterine device (IUD), a form of birth control that is placed into the uterus. This can increase the risk of infection, which may become PID.
An endometrial biopsy, during which a sample of tissue is taken for analysis, increases the risk of infection and subsequent PID.
Appendicitis very slightly increases the risk, if the infection spreads from the appendix to the pelvis.
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Who is most likely to be affected?
Women are more likely to develop PID if they:
- are sexually active and under 25 years of age
- have several sexual partners
- do not use barrier contraceptives
- use a douche
It is most common among women aged 15 to 29 years.
A physician will ask about symptoms and carry out a pelvic exam to check for tenderness.
They will also test for chlamydia and gonorrhea.
A swab may be taken from the cervix, and maybe from the urethra, the tube from the bladder through which urine flows. There may be blood and urine tests.
Sometimes, a laparoscope is used to view the area. If necessary, tissue samples can be taken through it.
Early treatment decreases the likelihood of developing complications, such as infertility.
The first kind of treatment is with antibiotic. It is important to follow the doctor's instructions and complete all of the prescription. A course usually lasts 14 days.
PID often involves more than one type of bacteria, so the patient may take two antibiotics together.
If tests show which bacteria are causing the disease, more targeted therapy is possible.
Antibiotics for PID include:
If the antibiotics do not make a difference within 3 days, the patient should seek further help. She may receive intravenous antibiotic therapy or a change of medication.
Hospitalization and surgery
Hospitalization: If a woman with PID is pregnant or has very severe symptoms, she may need to remain in the hospital. In the hospital, intravenous medication may be given.
Surgery: This is rarely needed, but it may be needed if there is scarring on the fallopian tubes or if an abscess needs draining. This may be keyhole surgery, or it may involve removal of one or both fallopian tubes.
Doctors prefer not to remove both fallopian tubes, because the woman will not be able to become pregnant naturally.
The woman's sexual partner may need to seek treatment for an STI. If the partner has an STI, there is a serious risk of recurrence if it goes untreated.
The patient should refrain from sex until the treatment is completed.
PID can become a serious condition, but there are some ways to minimize the risk:
- having regular screening, especially for those who have multiple sex partners
- ensuring sexual partners are tested for infections and STIs
- not douching, because this increases the risk
- using a condom or cervical cap and practicing safe sex
- not having sex too soon after childbirth or a termination or loss of pregnancy
Sex should not resume until the cervix closes properly