Pelvic inflammatory disease (PID)

What is it? Pelvic inflammatory disease (PID) is an infection or inflammation of the female upper reproductive organs, including the uterus (womb), fallopian tubes, ovaries, and the tissue surrounding these organs. Sometimes an infection of the fallopian tubes is also called salpingitis. How do you get it? There are 3 main ways to get PID: through sexually transmitted diseases, from infections in the vagina, or through medical procedures. PID can be spread sexually. Some STDs are caused by bacteria that infect the cervix (the opening to the uterus). If these bacteria pass through the cervix into the uterus or fallopian tubes, PID can occur. Chlamydia and gonorrhea are 2 common STDs that cause PID. Other bacteria normally found in the vagina that cause bacterial vaginosis can also cause PID this way. Any medical procedure that opens a woman's cervix can allow bacteria to pass through the cervix into the uterus and fallopian tubes. These procedures can include: abortion, D&C (dilatation and curettage), and IUD (intrauterine device) insertion. What are the symptoms? The symptoms of PID can vary widely, from no changes noticed in the body, to very mild symptoms, to severe pain. If a woman experiences no or few symptoms, long term harm can still occur in the upper reproductive tract (see below). Symptoms can include: Pain or cramping in the lower belly or abdomen Deep pain during intercourse Fever and/or chills Unusual or abnormal bleeding from the vagina Nausea and/or vomiting A feeling of fullness, bloating, or pressure in the abdomen Unusual discharge or fluid coming from the vagina Lower back pain Irregular urination A general feeling of illness or tiredness If you have any of these symptoms or believe you are at risk for PID, you should be examined by a health care provider as soon as possible. If you are feeling very ill with any of these symptoms, you can also go to your local hospital emergency. What's the test like? Unfortunately, there is no simple test for PID. That, combined with the wide range of symptoms, makes PID difficult to diagnose. Investigation for PID begins with a vaginal exam with a speculum, with swabs taken from the cervix to test for chlamydia and gonorrhea. Negative chlamydia or gonorrhea tests do not mean a woman doesn't have PID, since the bacteria could be higher in the reproductive organs than the swab can indicate. Swabs may also be taken from the vagina. An exam feeling the internal organs should also be performed. The health care provider puts 2 gloved fingers inside the vagina and the other hand on the belly, to feel for any abnormalities and to check for pain and/or tenderness. A procedure called a laparoscopy can help clarify if a woman has PID. It is a surgical procedure that allows a doctor to examine the woman's upper reproductive organs by putting a scope into the belly and looking directly at the organs. This is done under anesthetic (asleep). A woman would need a referral from her health care provider to a specialist. What is the treatment? PID is treated with 2 or more types of antibiotics to make sure that all the bacteria are killed. While many women are treated with pills by mouth (oral antibiotics), some may have to be hospitalized for intravenous (IV) antibiotics. This may happen if: She is an adolescent (teen) She is pregnant She is severely ill She cannot take antibiotics by mouth The doctor is unsure about the diagnosis A pocket of pus (an abscess) is suspected The oral antibiotics don't work It is extremely important that a woman on oral antibiotics follow up with her health care provider within 3 days of starting treatment as well as after the medication is finished. All pills should be taken as prescribed, even if she is feeling much better. A woman with PID must have all sexual partners she has been with in the 2 months before symptoms started, treated with antibiotics to cure chlamydia and gonorrhea (even if they haven't noticed any symptoms). She should also abstain from sex until 7 days after treatment of herself and her partner(s). If not treated? There are some serious possible consequences to PID, including chronic pain in the pelvis, ectopic (tubal) pregnancy, and/or infertility. Women who have had an episode of PID are 10 times more at risk of the PID returning and/or experiencing infertility, and are 8 times more likely to experience ectopic pregnancy. Infertility can result from the damage caused by the infection or from scar tissue produced during the healing process. This tissue can block the fallopian tubes, preventing ova (eggs) from travelling from the ovary to the uterus. PID can increase one's chance of having an ectopic (tubal) pregnancy. Scar tissue in the fallopian tubes can partially block the tube, resulting in the fertilized egg growing in the tube instead of the uterus. This condition can be life threatening and requires immediate medical attention. Pain can continue after an episode of PID. One in 5 women may experience ongoing pain after an episode of PID. Recurring infection is common and increases the risk of long-term health problems. They can be caused by: Inadequate treatment of the first infection Failure to treat sexual partner(s) Increased vulnerability to infection How common is PID? According to the Canadian PID Society, almost 100,000 Canadian women get PID each year, though the exact number is difficult to measure. And while all sexually active women are at risk, some are considered more likely to contract PID. These include women: with more than one sexual partner under 25 years of age who have previously had an episode of PID who have had a recent procedure in the upper genital tract (i.e. abortion, D&C, IUD inserted) Special consideration for pregnant women PID is rare after the first trimester. It can be treated with antibiotics safe for use during pregnancy. This would usually occur in a hospital with intravenous antibiotics, which would be followed by 2 weeks of oral antibiotics. Prevention Abstaining (not having sex) is the most reliable way of not getting any STD. Since chlamydia and gonorrhea are common causes for PID, the ways to help reduce the chances of PID are similar to the ways to prevent chlamydia or gonorrhea. PID can be transmitted even if the penis or tongue does not completely enter the vagina, so using latex or polyurethane condoms before the genitals touch a partner's body until there is no longer skin contact is the best form of prevention. Since having multiple sex partners can increase a woman's risk for getting any STD and developing PID, having one, uninfected partner will decrease a woman's chance of getting PID. If you are sexually active, having regular check-ups for STDs and PID is important. If you are experiencing any of the symptoms mentioned in the Symptoms section (link), you should seek medical attention as soon as possible. Links Other sites you may find interesting include: NIAID - Further information on Pelvic Inflammatory Disease from the (US) National Institute of Allergy and Infectious Diseases. ASHA- Further information on Pelvic Inflammatory Disease from the American Social Health Association.