PELVIC INFLAMMATORY DISEASE

(PID)
Pelvic inflammatory disease (PID) is an inflammatory condition of the pelvic cavity that
may begin with cervicitis and may involve the uterus (endometritis), fallopian tubes (salpingitis), ovaries
(oophoritis), pelvic peritoneum, or pelvic vascular system.

Pelvic Inflammatory Disease (PID) is a progressive infection and inflammation,

which can result in substantial damage to a woman's reproductive system. Many
different organisms can cause Pelvic Inflammatory Disease, but most cases are
usually caused by the bacteria:

 Neisseria gonorrhoeae
 Chlamydia trachomatis

Both may occur together

It has been shown that:

 Bacteria normally present in small numbers in the vagina and cervix may play
a role
 Various other germs are sometimes involved

 20% of patients with Pelvic Inflammatory Disease (PID) have no definite

cause

Pelvic inflammatory disease (PID) usually occurs in sexually active women

between the ages of 15-25 and the highest rate of infection is among teenagers and
adolescents. More than 750,000 new cases of Pelvic Inflammatory Disease (PID) are
diagnosed every year in the U.S.

The cervix usually prevents bacteria in the vagina from spreading up into the internal
organs but if the cervix is exposed to a sexually transmitted disease (STD), such as
Gonorrhea or Chlamydia, the cervix becomes infected.

The gonococcus, Neisseria gonorrhea

 moves upwards to the fallopian tubes, where it casts out some cells and
invades other cells
 multiplies within and beneath these cells
 spreads to other organs resulting in more inflammation and scarring
Chlamydia trachomatis and other bacteria may behave similarly.

The internal organs can become inflamed and infected if the disease travels, often
damaging the fallopian tubes making it difficult to become pregnant.

Symptoms
Pelvic Inflammatory Disease (PID) occurs:

 in the fallopian tubes

 in the lining of the uterus
 in the ovaries
 in the upper genital tract
 in the uterus
 throughout the pelvic area

Whether treated or untreated, Pelvic Inflammatory Disease (PID) can result in:

 chronic pain
 ectopic pregnancy
 fever
 scarring
 sterility [the more episodes of Pelvic Inflammatory Disease (PID) a woman
has, the greater are her chances of becoming infertile]
 swelling

Symptoms

 abnormal or unusual vaginal discharge (yellow or green color with an unusual

odor)
 abnormal vaginal bleeding
 dull pain and tenderness in the stomach
 lower abdominal or pelvic pain
 pain during urination
 painful intercourse
 pain in the back passage (anus/rectum)
 pain in the lower abdomen and back
 raised temperature and fever
 right upper abdominal pain
 similar signs and symptoms to that caused by a number of different bacteria

Various menstruation problems can occur:

 irregular periods
 spotting or cramps throughout the month
  unusually long or painful periods

The following symptoms occur if the infection has spread to the lining of the
abdomen:

 chills
 high fever
 nausea
 vomiting

Chlamydia Bacteria

Pelvic Inflammatory Disease (PID) when caused by the Chlamydia bacteria may
result in only minor symptoms, sometimes with no symptoms at all, even though it
can seriously damage the reproductive organs

Gonorrhea Bacteria

Symptoms of Pelvic Inflammatory Disease (PID) caused by the Gonorrhea Bacteria

often begin immediately after menstruation rather than at any other time during the
menstrual cycle, although this has not been proved in Chlamydial Pelvic
Inflammatory Disease (PID)

Note

 As the symptoms of Pelvic Inflammatory Disease (PID) can sometimes be

confused with those of appendicitis and other infections, it is VERY
IMPORTANT to see a doctor immediately if you have any of the above
symptoms
 Waiting even 1-2 days can allow the infection to spread farther into your body
and cause more pain and damage

Transmission
The sexually transmitted infections that most commonly cause Pelvic Inflammatory
Disease (PID) are:

 Chlamydia
 Gonorrhea

These diseases are carried in the semen and other body fluids of infected people and
are spread to the woman's cervix during sexual contact.

The disease infects:

  abdomen
 anus
 fallopian tubes
 glands at the opening of the vagina
 ovaries
 urethra (passageway for urine)
 uterus

Other Causes

Pelvic Inflammatory Disease (PID) is not always the result of an STD Infection.

Other causes include:

 a germ (microbe) which is transmitted sexually

 childbirth
 normal bacteria in the vagina sometimes spreads into the uterus, fallopian
tubes and abdomen, causing Pelvic Inflammatory Disease (PID)
 spread of a germ from a nearby organ, as in appendicitis
 spread of an infection in the blood stream from other parts of the body

Certain surgical procedures on the female organs, such as:

 abnormal Pap smear

 after the insertion of an intrauterine device (IUD)
 dilatation and curettage (D & C)
 therapeutic abortion/medical termination of pregnancy

Risk Factors

 A prior episode of Pelvic Inflammatory Disease (PID) because the body’s

immune system is often damaged during the initial bout of upper genital tract
infection
 Multiple sex partners
 Sexually active teenagers are more likely to develop Pelvic Inflammatory
Disease (PID) than older women
 Use of the contraceptive IUD (intrauterine device)
 Women with STDs, in particular gonorrhea and chlamydia, are at greater risk
of developing Pelvic Inflammatory Disease (PID)

Women who douche:

 once or twice a month may be more likely to get Pelvic Inflammatory Disease
(PID) than those who douche less than once a month
 may push bacteria into the upper genital tract
 may ease discharge caused by an infection and therefore delay getting
treatment
 Diagnosis
The doctor or health practitioner will use one or more of the following procedures to
confirm diagnosis:

 Blood Tests
 Culdocentesis

 Culture of vaginal and cervical secretions

 Laparoscopy (endometrial biopsy)

 Microscopic examination

 Pelvic examination

 Ultrasound scan

Culdocentesis

Fluid is removed from behind the vagina with a needle and examined for signs of
bleeding or infection.

Laparoscopy (endometrial biopsy)

A small cut is made in the navel through which an optical instrument with a light is
inserted to look inside the uterus to check for any abnormalities in the reproductive
organs. It is possible to distinguish between Pelvic Inflammatory Disease (PID)
and other serious problems that may have similar symptoms to Pelvic
Inflammatory Disease (PID). Samples for cultures or microscopic studies are also
obtained.

Microscopic examination

A mucus sample is taken from inside the vagina and inside the neck of the womb
with a swab and sent to the laboratory to look for microbes. These will be examined
under a microscope for gonorrhea and chlamydial infection.

Pelvic examination

If a physical examination is carried out, the doctor will require a detailed history of
the woman's health and sexual activity and should also check for:

 abnormal vaginal or cervical discharge

 cervical chlamydial infection or gonorrhea
  fever

 lower abdominal pain

 pain or abdominal tenderness when the cervix is touched or moved

Diagnosis of gonorrhea or Chlamydia with pelvic pain or cervical motion tenderness

sometimes confirms the diagnosis.

Ultrasound Scan

Sound waves are used to form an image of the reproductive organs and the womb,
ovaries and other organs in the pelvis, which enables the doctor to distinguish
between Pelvic Inflammatory Disease (PID) and other serious problems with
similar symptoms.

Screening

Screening and treatment of women who unknowingly had chlamydial infection

reduced cases by more than 60%

Research

New diagnostic tests are being developed, particularly to diagnose the infection in
women with asymptomatic (silent) Pelvic Inflammatory Disease (PID).

Treatment
 Antibiotics (two or more antibiotics may be used together to affect any
possible bacteria that may have caused the condition)
 Bed rest
 Pain killers may be advised
 Sexual abstinence
 Sometimes intravenous (IV) treatment is required

Surgery may be needed to:

 remove abscesses
 remove scar tissue
 repair or remove reproductive organs

Even if the symptoms cease you should finish the full treatment regimen.

Hospitalization may be recommended if the patient:

  cannot take oral medication
 does not respond to treatment after a few days
 has an abdominal emergency, such as appendicitis
 has an uncertain diagnosis
 has a severe initial presentation
 is an adolescent under the age of 18
 is infected with HIV
 is pregnant
 is severely ill
 needs intravenous antibiotics

Research

 Topical microbicides and vaccines to prevent gonorrhea and chlamydial

infection are being developed

 A suppository containing lactobacilli, the normal bacteria found in the vaginas

of healthy women, is being tested as these bacteria colonize the vagina and
may be associated with reduced risk of gonorrhea and Bacterial Vaginosis,
both of which cause Pelvic Inflammatory Disease (PID)

Prevention
Help Factors

 Abstinence from sexual intercourse

 Avoiding multiple sexual partners
 Avoiding sexual contact with people at risk of infection
 Getting early treatment which may prevent the development of Pelvic
Inflammatory Disease (PID)
 Using latex condoms and other barrier contraception can usually protect
against infections associated with Pelvic Inflammatory Disease (PID) and
prevent transmission of the bacteria from one person to the next

Risk Factors

 Birth control pills, injections and implants do not prevent against the
transmission of Pelvic Inflammatory Disease (PID) and other sexually
transmitted diseases (STDs)
 Sexual contact with multiple partners
 Unsafe sexual habits

It is very important for women to:

 Discuss with partner any risk factors

  Notice any signs of discharge with odor or bleeding between cycles, which
could indicate infection

Because men are often silent carriers of these bacteria the male partner of a woman
diagnosed with Pelvic Inflammatory Disease (PID) should see a doctor or health
professional to be examined and checked for a sexually transmitted disease.

In the event of Chlamydia or Gonorrhoea or any other sexually transmitted diseases

being diagnosed it is important to contact any persons with whom you have been
sexually involved so they may be diagnosed and given treatment if required as it is
essential to prevent further unnecessary spread of the bacteria.

Tracing sexual contacts is carried out:

 very professionally
 with discretion
 with sensitivity

Prognosis
After having Pelvic Inflammatory Disease (PID):

 9% of women have ectopic pregnancies

 10-30% of women will lose the ability to become pregnant after just one
episode of Pelvic Inflammatory Disease (PID)
 15% of all infertile women are infertile because of tubal damage caused by
Pelvic Inflammatory Disease (PID)
 18% of women develop chronic pelvic pain
 Scarring will cause approximately 20% of women to become infertile

Ectopic Pregnancy

After having Pelvic Inflammatory Disease (PID) a small percentage of women

develop scarred fallopian tubes, which can cause difficulties with falling pregnant in
the future.

The risk of an ectopic pregnancy increases due to the changes in the normal
anatomy of the woman's genital tract caused by Pelvic Inflammatory Disease (PID).
An ectopic pregnancy is where an embryo grows outside of the uterus.

If not rapidly diagnosed an ectopic pregnancy can cause:

 abscesses
 infertility (an inability to get pregnant)
 internal bleeding
  long-term pelvic pain
 repeat bouts of illness
 rupture of the fallopian tube
 severe pain
 shock and death of the mother (it is the leading cause of pregnancy-related
death in African-American women)

Other Complications

Women with recurrent episodes of Pelvic Inflammatory Disease (PID) are more likely
than women with a single episode to suffer scarring of the tubes that leads to:

 chronic pelvic pain

 infertility
 problems in infants born to affected women
 tubal pregnancy

With each episode of re-infection the risk of infertility is increased.