Pelvic inflammatory disease (PID)

What is pelvic inflammatory disease?

Pelvic inflammatory disease is an infection of the uterus, fallopian tubes, or ovaries. It most often affects sexually active women during their reproductive years.

Pelvic inflammatory disease is the most common preventable cause of infertility in the United States. The infection can cause tissue inside the fallopian tubes to become scarred, which can damage the fallopian tubes or block them completely and cause difficulty becoming pregnant. This can also increase the risk of ectopic pregnancy. The more often a woman gets this infection, the greater her risk of complications. In addition, even one episode of PID can lead to persistent pelvic pain.

Pelvic inflammatory disease is a major reason for hospitalization in young women. Most cases develop from sexually transmitted infections. The two types of bacteria most likely to be associated with pelvic inflammatory disease are gonorrhea and chlamydia. Gonorrhea and chlamydia cause damage to the protective mucous barrier that the cervix usually provides, allowing additional harmful bacteria to find their way into the uterus and beyond.

Pelvic inflammatory disease typically develops in a two-stage process. First, the organisms infect the cervix (opening of the uterus). Then, in about 10% of women, bacteria migrate up to the uterus, fallopian tubes, or ovaries. Sometimes pelvic inflammatory disease can develop if bacteria get into the upper portions of the reproductive tract after childbirth. Less commonly, the condition can develop after inserting an intrauterine device (IUD) or after a dilation and curettage of the uterus. While these procedures carry some risk of infection, especially if the patient also has a sexually transmitted infection at the same time, infections can be prevented by taking antibiotics at the time of the procedure.

Pelvic inflammatory disease is most common in women younger than age 25 who have more than one sex partner. Women who have had a sexually transmitted infection have a higher risk of getting pelvic inflammatory disease, as do those who have had a pelvic infection in the past. Any woman whose sex partner has more than one sex partner is also at increased risk of pelvic infection.

Symptoms of pelvic inflammatory disease

Symptoms can be severe, minor or nonexistent. The most common symptoms include:

• pain in the pelvis and lower abdomen
• discharge from the vagina with an unpleasant odor
• fever and chills
• nausea and vomiting
• pain during sexual intercourse.

Diagnosing pelvic inflammatory disease

Your doctor will ask you to detail your symptoms and when they started. Knowing the sexual habits of both you and your partner or partners and what methods you use for birth control and prevention of sexual transmitted infections will help her to make a plan for treatment. Your doctor will perform a pelvic examination, during which she can gently move your cervix to see if it causes an increase in pain and also feel for tender areas in your pelvic region.

The diagnosis of pelvic inflammatory disease is not always easy because the site of infection cannot be examined easily. Also, the symptoms sometimes mimic symptoms of other conditions, such as appendicitis.

During the pelvic examination, your doctor may take a sample of fluid from the inside of your cervix with a sterile, cotton-tipped swab, or may ask you to provide a urine sample. A laboratory will test the sample for gonorrhea and chlamydia. Your doctor may order a blood test to see if your white blood cell count is high, which may indicate that the pelvic inflammatory disease is more severe.

Your doctor will likely order a pelvic ultrasound or computed tomography (CT) scan to provide details of the location of the infection and to see if an abscess has formed.

Expected duration of pelvic inflammatory disease

Most cases of pelvic inflammatory disease clear up after 10 to 14 days of antibiotic treatment. More severe cases may need to be treated in a hospital.

Preventing pelvic inflammatory disease

Other than avoiding unprotected sexual intercourse, there is no guaranteed way to prevent pelvic inflammatory disease. However, women who are in monogamous sexual relationships have very little risk if neither person was infected with an STD from a previous partner. Condoms provide protection against STDs. Although oral contraceptives can prevent pregnancy, women with more than one sex partner also should make sure their partners use condoms every time they have vaginal intercourse.

Because most cases of pelvic inflammatory disease are linked to sexually transmitted infections, treating a woman's sex partners is essential to prevent repeat infections. All recent sex partners of a woman with pelvic inflammatory disease should be treated as if they had both gonorrhea and chlamydia. A woman with pelvic inflammatory disease should not have sex again until her sex partners have been treated.

Treating pelvic inflammatory disease

The primary treatment for pelvic inflammatory disease is antibiotics, and in most cases, antibiotics alone can cure the infection. Because pelvic inflammatory disease often is caused by more than one type of organism, two or more antibiotics may be necessary. Antibiotics can be taken by mouth or intravenously (through a vein). If you use oral antibiotics, it is important to finish all of the medication, even if the symptoms go away. This is because the infection can still be present after the symptoms disappear. In most cases, antibiotics must be taken for 10 to 14 days.

If you are being treated for pelvic inflammatory disease, your doctor may ask you to call two to three days after beginning treatment to report your progress. If your condition is not improving, you will need to visit your doctor again to have another examination.

Some women with a severe infection need to be hospitalized to receive antibiotics intravenously. If fever and pain do not improve after several days, you may need a pelvic ultrasound or computed tomography (CT) scan to see if an abscess has formed. If you have an abscess, you may need surgery or a minor procedure to place a drain in the abscess, in addition to antibiotics to cure the infection.

When to call a professional

If you experience any symptoms of pelvic inflammatory disease, see your doctor promptly.

Prognosis

Getting prompt treatment and follow-up care can cure pelvic inflammatory disease and keep it from causing further problems. Follow your doctor's advice closely, finish all your medication and return to your doctor for all scheduled checkups. To avoid reinfection, your sex partner(s) also should be treated, and you should follow all of the recommendations for prevention.

Additional info

Centers for Disease Control and Prevention (CDC)
http://www.cdc.gov/