Dr Tariq Jagnarine
Fam Medicine, Endocrinology/Diabetes
Pelvic inflammatory disease (PID) is an infection of a woman’s reproductive organs. PID is often caused by a sexually transmitted infection (STI). If left untreated, it can cause problems getting pregnant, problems during pregnancy, and long-term pelvic pain. PID can also be caused by many different types of bacteria inclusive of normal bacteria found in the vagina.
RISK FACTORS
• Known cases of PID affect about 5% of women worldwide.
• Previous STI
• PID before
• PID is most common in women 15 to 24 years old.
• Have more than one sex partner or have a partner who has multiple sexual partners
• Douche. Douching can push bacteria into the reproductive organs and cause PID. Douching can also hide the signs of PID.
• Recent insertion of an intrauterine device (IUD) . The risk of PID is higher for the first few weeks only after insertion of an IUD, but PID is rare after that.
CAUSES
A woman can get PID if bacteria move up from the vagina or cervix and into thier reproductive organs. Many different types of bacteria can cause PID. Most often, PID is caused by infection from two common STIs: gonorrhea and chlamydia. It can also be contracted without having an STI. Normal bacteria in the vagina can travel into a woman’s reproductive organs and can sometimes cause PID. Sometimes the bacteria travel up to a woman’s reproductive organs because of douching, masturbating using poorly kept sex toys and other unhygienic practices.
SIGNS AND SYMPTOMS
Many women do not know they have PID because they do not have any signs or symptoms. When symptoms do happen, they can be mild or more serious.
Signs and symptoms include:
• Pain in the lower abdomen (this is the most common symptom)
• Fever (100.4° F or higher)
• Vaginal discharge that may smell foul
• Painful sex
• Pain when urinating
• Irregular menstrual periods
• Pain in the upper right abdomen (this is rare)
• PID can come on fast, with extreme pain and fever, especially if it is caused by gonorrhea.
DIAGNOSIS
To diagnose PID, a physical exam is done to check for signs of PID and test for STIs. These include:
• Checking for unusual discharge from the vagina or cervix
• An abscess (collection of pus) near the ovaries or fallopian tubes
• Tenderness or pain in the reproductive organs especially with motion
• Tests for STIs, especially gonorrhea and chlamydia.
• Test for a urinary tract infection or other conditions that can cause pelvic pain
• Ultrasound or another imaging test for signs of PID
TREATMENT
Multiple Antibiotics are used to treat PID. Most of the time, at least two antibiotics are used that work against many different types of bacteria. Persons may need to be hospitalized if:
• Sick and in an unstable condition
• Pregnant
• Symptoms do not resolve after taking antibiotics in this case, IV antibiotics are needed.
• An abscess in a fallopian tube or ovary is present
If the symptoms persist or if the abscess does not go away after treatment, surgery is needed. Problems caused by PID, such as chronic pelvic pain and scarring, are often harder to treat. But sometimes they get better after surgery.
COMPLICATIONS
Without treatment, PID can lead to serious problems like infertility, ectopic pregnancy, and chronic pelvic pain (pain that does not go away). Antibiotics will treat PID, but they will not fix any permanent damage done to internal organs.
Other conditions, such as a UTI, can feel like pelvic inflammatory disease. However, tests for PID are needed to rule out other conditions.
The infection can also spread to other parts of the body becoming life-threatening.
PREVENTION
PID is not always preventable since it is not always caused by an STI. Sometimes, normal bacteria in the vagina can travel up to your reproductive organs and cause PID.
• But, the risk can be lower by not douching.
• Prevent STIs by not having unprotected vaginal, oral, or anal sex.
• Use condoms. Condoms are the best way to prevent STIs from sex. Because a man does not need to ejaculate (come) to give or get STIs, it important to use a condom before having sex via the – vagina, mouth, or anus. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.
• Get tested with one’s partner (spouse) for STIs. Talk to each other about the test results before having sex.
• Be monogamous. Having sex with just one partner can lower the risk for STIs. After being tested for STIs, be faithful to each other.
• Limit the number of sexual partners. The risk of getting STIs goes up with multiple numbers of partners.
• Avoid Douching
Douching removes some of the normal bacteria in the vagina that protect women from infection. Douching may also increase one’s risk for PID by helping bacteria travel to other areas, like the uterus, ovaries, and fallopian tubes.
• Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put persons at risk of sexual assault and possible exposure to STIs.
The steps work best when used together. No single step can protect from every single type of STI.
Pelvic inflammatory disease is a very treatable condition and most women make a full recovery. However, according to the Centers for Disease Control and Prevention, about 1 in 8 women with a history of PID will have difficulty getting pregnant but pregnancy is still possible for most women.
