Pelvic Inflammatory Disease

Pelvic Inflammatory Disease (PID) is a disease of the young:  the majority of women with PID are younger than 25.  It's also a common disease:  almost 15% of women will suffer from pelvic inflammatory disease at some point in their lives - a shocking statistic, as PID is a serious infection of the lining of the wall of the uterus, the fallopian tubes, or the ovaries, and can result in long-term pelvic pain and permanent damage to the reproductive organs.

Causes of PID
PID most often affects sexually active women during their childbearing years.  Most cases of PID are thought to stem from sexually transmitted diseases (STD's).  The most common STD's are gonorrhea and chlamydia infection.  Without treatment, the same organisms that cause these diseases can also cause PID.  PID often forms in a two-stage process.  First, the organisms infect the cervix (opening of the uterus).  Then, about 1 of 10 women with an infection of the cervix, the organisms find their way to the uterus, fallopian tubes, or ovaries.  It is not known just how these organisms travel from the cervix to these other sites.

Dangers of PID
PID is a major cause of illness in young women.  One quarter of those who contract PID each year in the United States are hospitalized.  Many of these women require surgery because of severe infection.  More than 150 women in the United States die from this infection each year.  PID is the most common preventable cause of infertility in the United States.  The infection can cause scarring of the tissue inside the fallopian tubes.  The scarring can damage or block the tubes.  The more a woman has PID, the greater her chances are of being infertile.  The risk doubles with each episode of the disease.

PID is also the leading cause of ectopic pregnancy.  Damage to a fallopian tube can cause a fertilized egg to attach to the inside of the tube and begin to grow there instead of inside the uterus.  This can lead to bursting of the tube and bleeding into the abdomen, which requires emergency surgery and may result in death.

Symptoms
PID may cause severe symptoms, minor symptoms, or no symptoms at all.  Symptoms that may occur include:

•  Vaginal discharge with a bad odor
• Painful urination
• Pain in the lower abdomen (often of a mild, aching nature)
• Abnormal uterine bleeding
• Fever and chills
• Nausea and vomiting

Any of these symptoms should prompt you to see your provider.

Diagnosis
The diagnosis of PID is sometimes hard because the site of infection is not easy to examine. Also, the symptoms of PID may be like those of other conditions, such as appendicitis or ectopic pregnancy.  Questions asked of you may include your sexual habits, use of birth control, and symptoms.

Your provider will perform a pelvic exam & may take samples of cells from your cervix. Blood tests may also be done.  Culdocentesis, a process in which a needle is inserted into the area behind the vagina, may help the doctor find out if there is pus in the abdominal cavity.  If the diagnosis is not certain, other methods may be used:

•  Laparoscopy - a slender, telescope-like device is used to view the pelvic organs through a small incision (cut) made through or just below the navel.
•  Ultrasound - an electronic device is moved over the stomach or placed in the vagina.  The device creates echoes that are transformed into pictures that can be viewed on a TV-like screen.  This can help find out if the tubes are swollen or if an abscess is present.

Treatment
PID is first treated with antibiotics.  In most cases, antibiotics alone can get rid of the infection.  PID is often caused by more than one type of organism, and no one antibiotic kills all the organisms thought to cause PID.  Two antibiotics often used to treat PID are ampicillin and tetracyclin.  In most cases, the drugs must be taken from 10-14 days to make sure that the infection is cleared up.  This will help prevent it from coming back.

Hospitalization also may be needed if the diagnosis is unknown and appendicitis or ectopic pregnancy cannot be ruled out.  Patients with a very high fever or severe stomach problems may require hospitalization so antibiotics can be given intraveinously.  If antibiotic treatment fails or if our doctor suspects a burst abcess, surgery may be needed. As with any serious infection, getting rest is the best way to get better fast.  Hot baths and heating pads applied to the lower back and stomach may help to relieve pain and discomfort.

Prevention
Because PID can affect a woman's health and fertility, prevention of this disease is the key.  Not having sex is the only sure way to prevent PID.  However, women who are in sexual relationships with only one partner have very little risk of PID (if neither person was infected with an STD from a partner they had before).  Using barrier methods of birth control can also help prevent STD's.  Using spermicide with another barrier method like condoms help even more.  Birth control pills may reduce a woman's risk of being hospitalized with PID by about 50%. A woman who is taking birth control pills should also use foam and condoms to further reduce her risk of PID if she has more than one
sex partner.

Because most cases of PID are linked to STDs, treatment of a woman's sex partners is vital to prevent repeat infection.  All recent sex partners should be checked and treated by their provider.  A woman with PID should not have sex again until her sex partners have been treated.