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Pelvic Inflammatory Disease (PID) Overview

Pelvic inflammatory disease (PID) is an inflammation of the female reproductive organs. Most cases result from an untreated infection in the vagina or cervix that spreads.

PID can affect the uterus, or womb, the fallopian tubes, the ovaries, or a combination. It can lead to scar formations with fibrous bands that form between tissues and organs.

Complications include chronic, persistent, pelvic pain, ectopic pregnancy, and infertility. According to the Centers for Disease Control and Prevention (CDC), 1 in 8 women who have had pelvic inflammatory disease (PID) have difficulty becoming pregnant.

Sexually transmitted infections (STIs) are a common cause for developing PID, but it can develop from infections due to other causes.

According to the National Health and Nutrition Examination Survey (NHANES), 1,171 sexually experienced women of reproductive age in the United States (U.S.), 4.4 percent reported having ever had PID.

Around 800,000 women receive a diagnosis of PID each year in the U.S.

Quick Facts on Pelvic Inflammatory Disease (PID)

Following are quick facts about PID:

  • Pelvic inflammatory disease (PID) often stems from an untreated sexually transmitted infection or other gynecological infection.
  • Symptoms may not be noticeable, but they can include pain and fever.
  • Treatment is usually with antibiotics, but surgery may be necessary.
  • Prevention strategies include practicing safe sex and not having multiple sexual partners.
  • Untreated PID can lead to scarring, fertility problems, or an abscess.Signs and Symptoms of Pelvic Inflammatory Disease (PID)

Many women with PID have no symptoms. If symptoms appear, they can vary from mild to severe. However, untreated PID can have serious consequences.

Possible symptoms include the following:

  • Bleeding or spotting between periods
  • Pain, possibly severe, especially in the pelvic area
  • Fever
  • Pain in the lower back and the rectum
  • Fatigue
  • Irregular menstruation
  • Frequent urination
  • Pain during sexual intercourse
  • Unusual vaginal discharge
  • Vomiting

Sometimes the symptoms resemble those of an ovarian cyst, appendicitis, ovarian cystappendicitisendometriosis, or a urinary tract infections (UTIs).

PID can be acute, lasting up to 30 days, or chronic if it lasts more than 30 days.

One difficulty with treating PID is that the symptoms are varied and that some women may have no symptoms.

Anyone who experiences symptoms or who thinks they may have been exposed to an STI or other cause of infection should see a doctor.

Complications of Pelvic Inflammatory Disease (PID)

If PID is not treated certain complications can arise, which include the following:

  • A tubo-ovarian abscess
  • Scarring that can lead to fertility problems
  • Recurring PID
  • Severe pelvic pain 

Many women do not realize they have had a PID until they seek medical advice for infertility problems.

A woman who has had PID has a 20 percent chance of infertility due to scarring of the fallopian tubes and a 9 percent risk of a future ectopic pregnancy. The odds of developing chronic pelvic pain are 18 percent.

Causes of Pelvic Inflammatory Disease (PID)

PID usually starts with an infection that begins in the vagina and spreads to the cervix. It can then move to the fallopian tubes and the ovaries.

The cause of infection can be bacterial, fungal, or parasitic, but it is more likely to involve one or more types of bacteria.

Sexually transmitted bacteria are the most common cause of PID. Chlamydia is the most common, followed by gonorrhea.

The American Family Physician (AFP) estimates that between 80 and 90 percent of women with chlamydia and 10 percent of those with gonorrhea have no symptoms.

Some 10 to 15 percent of women with chlamydia or gonorrhea go on to develop PID as a secondary infection.

Risk Factors of Pelvic Inflammatory Disease (PID)

Apart from an STI, some risk factors increase the risk of developing PID.

Childbirth, abortion or miscarriage, if bacteria enter the vagina. The infection can spread more easily if the cervix is not fully closed.

An intrauterine device (IUD), a form of birth control that is placed into the uterus. This can increase the risk of infection, which may become PID.

Endometrial biopsy, during which a sample of tissue is taken for analysis, increases the risk of infection and subsequent PID.

Appendicitis very slightly increases the risk, if the infection spreads from the appendix to the pelvis.

Individuals Most Likely to be Affected by PID

Women are more likely to develop PID if they:

  • Are sexually active and under 25 years of age
  • Have several sexual partners
  • Do not use barrier contraceptives
  • Use a douche

It is most common among women aged 15 to 29 years.

 

Diagnosis of Pelvic Inflammatory Disease (PID)

A physician will ask about symptoms and carry out a pelvic exam to check for tenderness.

They will also test for chlamydia and gonorrhea.

A swab may be taken from the cervix, and maybe from the urethra, the tube from the bladder through which urine flows. There may be blood and urine tests.

An ultrasound scan may be used to check for inflammation in the fallopian tubes.

Sometimes, a laparoscope is used to view the area. If necessary, tissue samples can be taken through it.

Treatment of Pelvic Inflammatory Disease (PID)

Early treatment decreases the likelihood of developing complications, such as infertility.

Antibiotic Treatment

The first kind of treatment is with antibiotic. It is important to follow the doctor’s instructions and complete all of the prescription. A course usually lasts 14 days.

PID often involves more than one type of bacteria, so the patient may take two antibiotics together.

If tests show which bacteria are causing the disease, more targeted therapy is possible.

Antibiotics for PID include:

  • Cefoxitin
  • Doxycycline
  • Metronidazole
  • Ceftriaxone

Hospitalization and Surgery

If the antibiotics do not make a difference within 3 days, the patient should seek further help. She may receive intravenous antibiotic therapy or a change of medication.

Hospitalization: If a patient with PID is pregnant or has very severe symptoms, she may need to remain in the hospital. In the hospital, intravenous medication may be given.

Surgery: This is rarely needed, but it may be needed if there is scarring on the fallopian tubes or if an abscess needs draining. This may be keyhole surgery, or it may involve removal of one or both fallopian tubes.

Doctors prefer not to remove both fallopian tubes, because the woman will not be able to become pregnant naturally.

The woman’s sexual partner may need to seek treatment for an STI. If the partner has an STI, there is a serious risk of recurrence if it goes untreated.

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

Prevention of Pelvic Inflammatory Disease (PID)

PID can become a serious condition, but there are some ways to minimize the risk:

  • Ensuring sexual partners are tested for infections and STIs
  • Not having sex too soon after childbirth or a termination or loss of pregnancy
  • Having regular screening, especially for those who have multiple sex partners
  • Not douching, because this increases the risk
  • Using a condom or cervical cap and practicing safe sex

Sex should not resume until the cervix closes properly

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