What Is Pelvic Inflammatory Disease? What Causes Pelvic Inflammatory Disease?

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Main Category: Women's Health / Gynecology
Also Included In: Fertility;  Sexual Health / STDs
Article Date: 02 Feb 2010 - 0:00 PDT

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Pelvic inflammatory disease or PID is a broad term for inflammation of the uterus (womb), fallopian tubes and/or ovaries - the female reproductive organs or the upper genital tract. PID may progress to scar formations with fibrous bands that form between tissues and organs (adhesions).

In the majority of cases pelvic inflammatory disease is caused by an infection in the vagina or cervix which spreads. PID can refer to bacteria, fungal or parasitic infections - in most cases the infection is bacterial.

Sexually transmitted infections (STIs) are common causes of pelvic inflammatory disease; but it can also be a consequence of childbirth, abortion or miscarriage, using an IUD (intrauterine device, a form of birth control). Other routes, such as lymphatic or hematogenous (derived from the blood) are also possible. A bacterium called Chlamydia is a common cause, followed by gonorrhea.

Pelvic inflammatory disease can lead to complications, including chronic persistent pelvic pain, ectopic pregnancy and infertility.

According to Medilexicon's medical dictionary, Pelvic inflammatory disease (PID) is:

acute or chronic suppurative inflammation of female pelvic structures (endometrium, uterine tubes, pelvic peritoneum) due to infection by Neisseria gonorrhoeae, Chlamydia trachomatis, or other organisms, typically a complication of sexually transmitted infection of the lower genital tract, may be precipitated by menstruation, parturition, or surgical procedures including abortion; complications include tuboovarian abscess, tubal stenosis with resulting infertility or sterility and heightened risk of ectopic pregnancy, and peritoneal adhesions.

According to the CDC (Centers for Disease Control and Prevention), USA, over a million American women have PID each month, with teenagers and first time mothers being the most affected. 100,000 American women become infertile annually because of PID. The National Health Service (NHS), UK says that 1 in every 60 visits to GPs (general practitioners, primary care physicians) in the United Kingdom is because of PID.

What are the signs and symptoms of pelvic inflammatory disease?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

Many women with PID experience no symptoms. Some women without symptoms find out when they seek medical advice for infertility problems. PID due to Chlamydia is often asymptomatic (without symptoms).

If symptoms are presented, they may include:

• Pain - typically in the pelvic (lower abdomen) area. In some cases the pain can be severe.
• Elevated body temperature.
• Fatigue
• Irregular periods (menstruation)
• Lower back pain
• Painful sexual intercourse.
• Rectal pain
• Unusual vaginal discharge.
• Vomiting

What are the causes of pelvic inflammatory disease?

In most cases the PID is caused by an infection which starts in the vagina and then makes it way to the cervix, and can move onto the fallopian tubes and ovaries. Often more than one type of bacteria may be causing the infection.

• Chlamydia and gonorrhea - Chlamydia is the most common cause (50% to 65% of cases in the UK), followed by gonorrhea (14% of cases in the UK). Sometimes PID may be caused by a combined Chlamydia-gonorrhea infection.
• Childbirth, abortion or miscarriage - bacteria can get into the vagina during/after childbirth, abortion or miscarriage; it then multiplies and spreads, causing PID. The infection can spread more easily because the cervix may not have fully closed.
• IUD - the intrauterine device, also known as a coil can increase the risk of infection which may lead to PID.
• Endometrial biopsy - this procedure, during which a sample of tissue is taken for analysis, has a risk of infection and subsequent PID.
• Appendicitis - there is a slight risk of developing PID if a woman has appendicitis.

Women who are sexually active and less than 25 years of age, have several sexual partners, or do not use barrier contraceptives have a higher risk of developing PID.

What are the complications of pelvic inflammatory disease?

In the vast majority of cases, prompt and proper treatment for PID can prevent the complications listed below.

• Recurrence of PID - when a woman has PID again (recurrence), the risk of it coming back again and again is greater. In such cases, the risk of long-term (chronic) pelvic pain is greater.
• Abscess - there is a higher risk of abscesses developing in the fallopian tubes, ovaries and the entrance to the vagina.
• Ectopic pregnancy - the embryo develops outside the uterus (womb), usually in the fallopian tubes.
• Infertility - the National Health Service (NHS), UK estimates that approximately 20% of females with PID become infertile because of scarring in the fallopian tubes.

How is pelvic inflammatory disease diagnosed?

The doctor, usually a GP (general practitioner, primary care physicians) will ask the patient questions about symptoms and carry out a gynecological exam.

The doctor will take a swab from the cervix if PID is suspected; and maybe a swab from the urethra too. The urethra is the tube from the bladder to outside the body from which urine flows (the urine tube). Blood and urine tests may also be ordered. Sometimes the swabs and other tests mentioned above may not detect an infection. The doctor may then order other tests, which may include:

• Imaging scans - such as an ultrasound scan to see whether the fallopian tubes are inflamed. An ultrasound can detect severe inflammation, but may miss mild ones.
• Laparoscopy - a long, thin tube (laparoscope) is pushed through the wall of the abdomen so that the doctor can have a good look at the area. If necessary, tissue samples can be taken.

What is the treatment for pelvic inflammatory disease?

The earlier the patient receives treatment, the less like she is of developing complications, such as infertility.

Antibiotics - treatment for PID depends on the cause, but usually involves administering antibiotics. If the patient does not respond to antibiotic treatment within three days she should go back to her doctor or hospital, who may recommend intravenous antibiotic therapy or a change of medication.

As PID is frequently caused by more than just one type of bacteria at any one time, doctors tend to prescribe two antibiotics, which are taken together. As soon as the doctor knows which bacterium or bacteria are causing the disease, antibiotic therapy may become more targeted. Examples of antibiotics for PID include, ofloxacin, metronidazole, ceftriaxone and doxycycline

A course of antibiotics usually lasts 14 days. Patients with very severe symptoms will be hospitalized and receive their medication intravenously.

Surgery - the fallopian tubes may have scarring, or there may be abscesses that need to be drained. Surgery may be needed, either laparoscopy (keyhole surgery) or salpingectomy (removal of one or both fallopian tubes). Doctors are reluctant to remove both fallopian tubes, because the woman will not be able to get pregnant naturally.

Sexual partner - the doctor may advise the woman to have her sexual partner checked and if necessary, treated for an STD (sexually transmitted disease). If the partner has an STD there is a serious risk of recurrence.

The patient should refrain from sex until the treatment is completed.

Preventing pelvic inflammatory disease

• Use a condom or cervical cap during sex
• Abstinence - people who do not have sex are much less likely to develop PID
• Have regular screening, especially if you have multiple sex partners
• Make sure your partner is tested for infections and STDs
• Douching - regular douching significantly increases the risk of developing PID
• After childbirth, miscarriage or abortion - wait a while before having sex, until the cervix closes properly.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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