Dr. Tariq Jagnarine
Fam Med, Endocrinology/Diabetes
Pelvic inflammatory disease (PID) is an inflammation of the female reproductive organs. Most cases result from an untreated infection in the vagina or cervix that spreads. PID can affect the uterus, or womb, the fallopian tubes, the ovaries, or a combination. It can lead to scar formations with fibrous bands that form between tissues and organs.
Complications include chronic, persistent pelvic pain, ectopic pregnancy, and infertility. According to the Centers for Disease Control and Prevention (CDC), 1 in 8 who have had pelvic inflammatory disease (PID) have difficulty becoming pregnant.
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.
• Sexually transmitted bacteria are the most common cause of PID. Chlamydia is the most common, followed by gonorrhoea.
• The American Family Physician (AFP) estimates that between 80 and 90 percent of women with chlamydia and 10 percent of those with gonorrhoea have no symptoms.
• Some 10 to 15 percent of women with chlamydia or gonorrhoea go on to develop PID as a secondary infection.
RISK FACTORS
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) is 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 tissue sample 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.
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
• They use a douche
It is most common among women aged 15 to 29 years.
SYMPTOMS
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
• Fever
• Fatigue
• Bleeding or spotting between periods
• Irregular menstruation
• Pain in the lower back and the rectum
• Pain during sexual intercourse
• Unusual vaginal discharge
• Frequent urination
• Vomiting
Sometimes the symptoms resemble those of an ovarian cyst, appendicitis, endometriosis, or a urinary tract infection (UTI).
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 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.
DIAGNOSIS
A physician will ask about symptoms, and perform a pelvic exam to check for tenderness.
The physician would also test for chlamydia and gonorrhoea.
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.
An ultrasound scan may be used to check for inflammation in the fallopian tubes.
Sometimes a laparoscope is used to view the area. If necessary, tissue samples can be taken through it.
TREATMENT
Early treatment decreases the likelihood of developing complications such as infertility.
Antibiotic treatment
The first kind of treatment is with antibiotics. It is important to follow the doctor’s instructions and complete all of the prescriptions. A course usually lasts 14 days.
PID often involves more than one type of bacteria, so the patient may take two antibiotics together.
More targeted therapy is possible if tests show which bacteria are causing the disease.
Antibiotics for PID include: cefoxitin, metronidazole, ceftriaxone, doxycycline
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 the 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 reoccurrence if it goes untreated.
The patient should refrain from sex until the treatment is completed.
COMPLICATIONS
Complications that can arise if PID is not treated include:
• Scarring that can lead to fertility problems
• Recurring PID
• Severe pelvic pain
• 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.
PREVENTION
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 practising safe sex
• Not having sex too soon after childbirth or termination or loss of pregnancy
Sex should not be resumed until the cervix closes properly.
