Pelvic Inflammatory Disease (PID)

B.P. Homeier

Pelvic inflammatory disease, sometimes called PID, is a progressive (meaning it becomes worse over time) infection of the fallopian tubes, uterus, cervix, or ovaries. Most women develop PID as a result of sexually transmitted diseases (STDs), such as chlamydia or gonorrhea.
Each year, more than a million women will develop PID, with the highest infection rate amongst teenagers. Women with multiple partners and those who don't use condoms are most likely to get STDs and are at risk for PID. If PID goes untreated, it can lead to internal scarring that can result in chronic pelvic pain, infertility, or a tubal pregnancy.

What Are the Symptoms of PID?
PID can cause severe symptoms or very mild to no symptoms. Women who do have symptoms however, may experience:

• pain and tenderness in the lower abdomen
• large amounts of foul-smelling or abnormally colored discharge
• pain during sexual intercourse
• heavier than normal periods
• more painful periods with more cramps than usual
• spotting between periods
• chills, fever, and vomiting
• increased tiredness
• loss of appetite
• backache and perhaps even difficulty walking
• painful or more frequent urination
  

What Can Happen if You Get PID?
Any women with symptoms of an STD should get medical care as soon as possible. An untreated STD has a greater chance of becoming PID. If it is not treated or goes unrecognized, the PID can continue to spread through a woman's reproductive organs and may lead to long-term reproductive problems:

• PID can cause scarring in a woman's ovaries, fallopian tubes, and uterus, and widespread scarring may lead to infertility (the inability to have a baby). A woman who has had PID three times (or more) has an almost 50% chance of being infertile.
• If someone who has had PID does get pregnant, scarring of the fallopian tubes may cause the fertilized egg to implant in one of the fallopian tubes rather than in the uterus. The fetus would then begin to develop in the tube, where there is no room for it to keep growing. This is called an ectopic pregnancy. An untreated ectopic pregnancy could cause the fallopian tube to burst suddenly, which might lead to life-threatening bleeding in a pregnant woman.
• Untreated PID also puts a woman at risk for a tubo-ovarian abscess (TOA). A TOA is a collection of bacteria, pus, and fluid that occurs in the fallopian tube. A TOA is also more likely to occur in women who use intrauterine devices (IUDs) as birth control. A woman with a TOA often looks sick and has a fever and pain that makes it difficult to walk. The abscess will be treated in the hospital with antibiotics, and surgery may be needed to remove it.
  

How Is PID Diagnosed and Treated?
If you think you may have PID, you need to see your family doctor as soon as possible. He/she will likely do a pelvic exam, which may reveal that you have a painful cervix, abnormal bleeding from the cervix, or pain over one or both ovaries. Your family doctor will also take swabs of fluid from your cervix and vagina, and this fluid will then be tested for STDs. A pregnancy test also will be done. Sometimes blood tests will be taken to look for signs of infection, and newer tests have been developed that can diagnose chlamydia and gonorrhea from checking your urine as well.
Sometimes an ultrasound or CT scan of the lower abdomen is needed to take a three-dimensional picture of the reproductive organs. These are often used to diagnose a TOA or ectopic pregnancy. If your provider diagnoses PID, you will be given antibiotics to take for a couple of weeks. It's very important that you take every dose of the medication to completely treat the infection. It's also important to be rechecked 2-3 days after you have begun treatment to make sure that you are starting to improve because PID can be difficult to treat.
Women who have more severe cases of PID - for instance, if they have a fever or look ill - are often treated in the hospital for a few days with antibiotics given directly into a vein through a straw-like plastic catheter. Surgery is sometimes needed for cases of PID that do not get better with antibiotics or if a woman has an abscess. Ectopic pregnancies can require emergency surgery.
If you're not feeling better even after you take all your medication for PID, it's important to follow up with your gynecological health care provider. Be sure to let your provider know you're still not feeling well. Also, it's very important that anyone with whom you've had sex be checked for STDs right away, so they can get treatment. An untreated partner is likely to give you the same STD again, even after you've been treated.

Can PID Be Prevented?
The best way to prevent STDs or PID is to not have sex. However, for those who choose to be sexually active, it's important to use protection and to have as few sexual partners as possible. Using a latex condom effectively and consistently helps protect against most STDs. However, it's very important to have regular check-ups with your family doctor. So when you're making choices about sex, be smart - and be safe.
[AAFP]