Pelvic Inflammatory Disease

Symptoms and Treatments for Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection that affects a woman's reproductive organs, including the cervix, uterus, fallopian tubes, ovaries, and surrounding structures. When the cervix is infected, it is called cervicitis. With fallopian tube inflammation, it is called salpingitis. Endometritis is inflammation of the tissues that line the uterus. When the membrane that lines the abdominal cavity is infected, it is called peritonitis. Any or all of these conditions could occur with PID. When the fallopian tubes are infected and inflamed, the tissue develops scars and adhesions, resulting in blockage of the normal passage of an egg. This is a main cause of female infertility. When the tubes are only partially blocked, the egg could become fertilized and implant outside the uterus, causing an ectopic pregnancy. If a woman has more than one incidence of PID, she is at greater risk for infertility. PID can be prevented by practicing safe sex and avoiding douching.

Overview of PID

Pelvic inflammatory disease is an infection of any of the female reproductive organs and structures, including the uterus, cervix, fallopian tubes, ovaries, and surrounding tissues. This is a serious sexually transmitted disease (STD) that can damage the reproductive system if left untreated. Common complications include female infertility, ectopic pregnancy, abscess formation, and chronic pelvic pain.

Incidence and Prevalence

PID affects more than 1 million women in the U.S. each year, and of those, as many as 250,000 require hospitalization for treatment. Of those affected, up to 15 percent become infertile as a result of this STD. Many ectopic pregnancies occur as a consequence to PID. Those at risk include sexually active females and women younger than 25 years of age.

Causes and Risk Factors

The two most common causes of PID are the bacteria Chlamydia trachomatis and Neisseria gonorrhoeae. These microorganisms are sexually transmitted. There are also other common infectious pathogens that cause PID. When the bacteria move upward from the vagina through the opening to the uterus (cervix), they infect the reproductive organs.

Risk factors for PID include:

  • Age. A female under the age of 25 is more at risk for this infection.
  • Having multiple sex partners. This is because there is more potential for exposure to infectious microorganisms.
  • Douching. Women who douche are also at increased risk because douching changes the vaginal flora and forces bacteria into the uterus via the cervix.
  • IUD. Another risk factor is the use of an intrauterine device (IUD).

Signs and Symptoms of PID

Most women with PID become very ill, have severe pelvic pain, and develop high fevers, but many do not have any symptoms. Other symptoms of PID include:

  • Abdominal pain.
  • Pelvic tenderness.
  • Back pain.
  • Irregular or abnormal vaginal bleeding.
  • Heavy, unusual vaginal discharge.
  • Pain with sex.
  • Pain with urination.
  • Nausea and/or vomiting.

Complications

There are several conditions that could occur due to PID. These include:

  • Ectopic pregnancy. PID is a major cause of tubal pregnancy, where the fertilized egg cannot make it through the fallopian tube and implants somewhere along this structure. Ectopic pregnancies can cause life-threatening bleeding, and often, emergency surgery is required.
  • Chronic pelvic pain. Many women who have PID end up with chronic pelvic pain from the inflammation to the reproductive structures. Scarring of the fallopian tubes and other organs cause pain that occurs with ovulation, intercourse, and exercise.
  • Infertility. PID damages the various reproductive structures and organs, resulting in infertility. Having PID more than once puts the woman at a greater risk for infertility.

Diagnosis and Treatment

A health care provider typically will diagnose PID by taking a woman's medical history, doing a physical examination, performing a pelvic evaluation, and conducting appropriate tests. Cervical cultures will detect the causative organisms, and a pelvic ultrasound is helpful for ruling out complications, such as ovarian torsion, abscesses, or ectopic pregnancy.

The treatment for PID involves several types of antibiotics, such as doxycycline, ceftriaxone, and metrodiazole, which are given by mouth, injection, or intravenously. Prompt antibiotic therapy can prevent the damage to the reproductive system and maintain fertility. The longer a woman delays treatment for PID, the more likely she is to develop infertility. Most symptoms go away soon after the antibiotic therapy begins, but the woman must finish all of the antibiotics to eradicate the infection. After finishing all antibiotics, it is recommended that the woman be checked by a health care provider. If the woman is severely ill, pregnant, does not respond to treatment, or has an abscess in the fallopian tube or on the ovary, hospitalization may be necessary. For some women, a laproscopic procedure is necessary. Exploratory surgery is done when the doctor needs to evaluate the reproductive organs for infection and inflammation. The gynecologist will use a laparoscope, which is a small tube with a camera on the end. This is inserted into small incisions around the navel in order to view the pelvic cavity.

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