Women’s Health

Pelvic Inflammatory Disease (PID)

Unlike the other sexually transmitted diseases discussed in this chapter, pelvic inflammatory disease (PID) does not refer to a single bacteria or viral infection. Instead, pelvic inflammatory disease is generally caused by a variety of sexually-transmitted bacteria that can cause acute infection of the upper genital tract—the uterus, fallopian tubes and ovaries as well as other intra-abdominal structures. These bacteria include some you may have heard of—chlamydia and gonorrhea—as well as one’s you’re probably unfamiliar with—anaerobic streptococci, enterococcus, Klebsiella and E.coli. When infection is confined to the uterus the condition is called endometritis. Infections that involve the fallopian tubes are called salpingitis and ones that involve the ovaries are called oophoritis. Frequently these infections coexist. PID can also involve neighboring pelvic structures including the bowel or upper abdominal structures such as the liver (perihepatitis). Chronic pelvic infections can result in a tubo-ovarian abscess, which is a serious infection often requiring the surgical removal of the tubes and ovaries and even the uterus. Lastly, not all pelvic inflammatory disease is called by sexually transmitted bacteria—some are the result of severe endometriosis, pelvic surgery or even related to diseases of the bowel such as Crohn’s disease and chronic appendicitis.

How common is pelvic inflammatory disease?

The National Ambulatory Medical Care Survey estimated that the number of cases of PID in women ages 15-44 was nearly 170,000 in 2003. This represented a decrease of nearly 20,000 cases from the previous year. About 70,000 women per year are hospitalized for acute PID. The numbers are decreasing primarily because of more aggressive screening for chlamydia, one of the major culprits in pelvic inflammatory disease.

What can happen if I get pelvic inflammatory disease?

The major problems associated with pelvic inflammatory disease are infertility, tubal pregnancies and chronic pelvic pain. About 8% of women who have had PID once become infertile. Another 20% will develop chronic pelvic pain.

What are the symptoms of acute pelvic inflammatory disease?

Acute pelvic inflammatory disease can happen after sexual intercourse with an infected partner. Your partner may not even be aware that he is carrying the infection. The symptoms often include fever, chills, lower abdominal bilateral (both the right and left sided) pain, headaches and generalized muscle aches that may or may not be associated with a vaginal discharge. The symptoms will generally force you to seek medical attention. In other cases the symptoms may be more subtle. Some women experience pain with intercourse.

Can acute pelvic inflammatory disease be treated? Is it curable?

The answer to both of these questions is yes. If you contact your health care provider he or she will conduct several tests which may include a complete blood count (CBC), cervical cultures and perhaps a pelvic ultrasound examination. The treatment generally involves a course of oral antibiotics. In severe cases you may be admitted to the hospital to receive intravenous antibiotics. If the infection is treated early in its course damage to the fallopian tubes and ovaries can be prevented and the disease will not prevent a threat to your future fertility. If the diagnosis is delayed the disease can progress to a chronic form which will may cause damage to the fallopian tubes and result in infertility and chronic pelvic pain.

Who is at risk for PID?

The risk factors include women who

  • are less than 25 years old
  • are less than 17 years old when they first become sexually active
  • who don’t use condoms
  • who have a new partner
  • have multiple partners
  • have a prior history of PID
  • have tested positive for chlamydia, gonorrhea or bacterial vaginosis

How is the diagnosis of pelvic inflammatory disease made?

In general the diagnosis of pelvic inflammatory disease is what’s known as a “clinical diagnosis”. To be blunt, the diagnosis is in-exact and imperfect. Why? Given the current state of technology the most precise method of diagnosing pelvic inflammatory disease is by a diagnostic laparoscopy. A laparoscopy is a surgical procedure in which a lit fiberoptic telescope is place through a small incision in the abdomen–this requires anesthesia and is not without risks. For that reason we often make the diagnosis of PID when a woman’s medical history, physical exam, blood work, cervical cultures and ultrasound findings are consistent with the diagnosis of pelvic inflammatory disease. This method works out well for uncomplicated cases—particularly those that respond quickly to antibiotics. For more complex cases—such as those that involve a pelvic mass, do not respond quickly to antibiotics or when the symptoms and physical exam are equivocal a laparoscopy may be necessary. Fortunately, laparoscopy is rarely required to establish the diagnosis of PID.

How can I avoid pelvic inflammatory disease?

The methods of avoiding PID are common sense methods:

  • Use condoms to protect yourself.
  • Talk to your partner about STDs before beginning a sexual relationship. Find out whether he or she is at risk for having an STD. Consider getting tested for STDs before you initiate sexual contact with each other. Remember that many STDs such as genital herpes, HPV, chlamydia and even many cases of gonorrhea do not cause symptoms. Even HIV may not show up as a positive blood test for up to 6 months following exposure and infection.
  • If you’re under the age of 25 or have reason to doubt the fidelity of your partner get cervical cultures even if you’re not having symptoms.
  • If you’re having multiple sex partners use condoms, get regular cervical cultures and strongly consider a lifestyle change.
  • Avoid sexual contact with anyone who has symptoms of an STD or who has been exposed to an STD and not been treated.
  • Avoid multiple sex partners.

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