Pelvic inflammatory disease (PID)

Pelvic inflammatory disease is a general term for infection of the lining of the uterus, the fallopian tubes, or the ovaries.

See also: Endometritis

The majority of pelvic inflammatory disease cases are caused by the same bacteria that lead to sexually transmitted diseases (such as chlamydia, gonorrhea, mycoplasma, staph, strep).

Although the cause of PID most commonly spreads through sex, bacteria may also enter the body after gynecological procedures such as the insertion of an intrauterine device (IUD), childbirth, miscarriage, therapeutic or elective abortion, and endometrial biopsy.

In the United States, nearly 1 million women develop PID each year. It is estimated that 1 in 8 sexually active adolescent girls will develop PID before reaching age 20. Since PID is frequently underdiagnosed, statistics are probably greatly underestimated.

Risk factors include:

• Sexual activity during adolescence
• Multiple sexual partners
• Past history of PID
• Past history of any sexually transmitted disease
• Insertion of an IUD

Birth control pills are thought in some cases to lead to cervical ectropion, a condition that allows easier access to tissue where bacteria may grow. However, birth control pills may protect against PID by stimulating the body to produce a thicker cervical mucous, which makes it harder for semen to carry bacteria to the uterus.

The most common symptoms of PID include:

• Vaginal discharge with abnormal color, consistency or odor
• Abdominal pain
• Fever (not always present; may come and go)

Other nonspecific symptoms that may be seen with PID include:

• Chills
• Irregular menstrual bleeding or spotting
• Increased menstrual cramping
• Menstruation, absent
• Increased pain during ovulation
• Sexual intercourse, painful
• Bleeding after intercourse
• Low back pain
• Fatigue
• Lack of appetite
• Nausea, with or without vomiting
• Frequent urination
• Pain with urination
• Tenderness

Note: There may be no symptoms. People who experience ectopic pregnancies (pregnancies where the embryo implants in the fallopian tubes instead of the uterus) or infertility are often found to have silent PID, which is usually caused by chlamydia infection.

You may have a fever and abdominal tenderness. A pelvic examination may show that you have cervical discharge, pain with movement of the cervix during the exam, a cervix that bleeds easily, or uterine or ovarian tenderness.

Tests and procedures may include:

• WBC
• ESR (sed rate)
• Wet prep or wet mount microscopic examination
• Serum HCG (pregnancy test)
• Endocervical culture for gonorrhea, chlamydia, or other organisms
• Laparoscopy
• Pelvic ultrasound or CT scan

If you are diagnosed with mild PID, you may be given antibiotics and told to closely follow-up with your health care provider.

More severe cases may require you to stay in the hospital. Antibiotics are first given by IV, and then later by mouth. Surgery may be considered for complicated, persistent cases that do not respond to antibiotics. Any sexual partner(s) must also be treated. The use of condoms during treatment is essential.

PID infections can cause scarring and adhesions of the pelvic organs, possibly leading to infertility, ectopic pregnancy, and chronic pelvic pain.

Call your health care provider if you have symptoms of PID. Also call if you think you have been exposed to a sexually transmitted disease or if treatment of a current STD does not seem to be working.

Preventive measure include:

• Practicing safer sex behaviors
• Following your doctor's recommendations after gynecological procedures
• Getting prompt treatment for sexually transmitted diseases

The risk of PID can be reduced by getting regular STD screening exams. Couple can be tested for STDs before beginning sexual relations. Testing can detect STDs that may not be producing symptoms yet.