Pelvic Inflammatory Disease (PID)

What Is It?

Pelvic inflammatory disease is an infection of the uterus, fallopian tubes or ovaries. It is the most common serious infection among young women, with approximately 1 million new cases diagnosed in the United States each year. It usually affects sexually active women during their childbearing years. About one in every seven women receives treatment for pelvic inflammatory disease at some point in her life.  

Pelvic inflammatory disease is the most common preventable cause of infertility in the United States. The infection can cause tissue inside the fallopian tubes to become scarred, which can damage the fallopian tubes or block them completely. The more often a woman gets this infection, the greater her risk of becoming infertile. The risk doubles with each bout of the disease.

Pelvic inflammatory disease is a major cause of hospitalization in young women. It leads to thousands of surgeries due to complications from the infection. Researchers believe most cases develop from sexually transmitted diseases (STDs), infections that are spread through sexual contact. The two diseases most likely to lead to pelvic inflammatory disease are gonorrhea and chlamydia. Without treatment, the same bacteria that cause these diseases also can cause pelvic inflammatory disease. 

Pelvic inflammatory disease usually develops in a two-stage process. First, the organisms infect the cervix (opening of the uterus). Then, in about 10% of women, the bacteria migrate up to the uterus, fallopian tubes or ovaries. Less commonly, pelvic inflammatory disease can develop if bacteria get into the upper portions of the reproductive tract after childbirth, after inserting an intrauterine device (IUD) or after an induced abortion. All of these procedures carry some risk of infection, especially if the patient also has an STD.

Pelvic inflammatory disease is most common in women younger than age 25 who have more than one sex partner. Women who have had an STD have a higher risk of getting pelvic inflammatory disease, as do those who have already had a previous pelvic infection. Any woman whose sex partner has more than one sex partner is also at increased risk of pelvic infection.  

Symptoms

Symptoms can be severe, minor or nonexistent. The most common symptoms include:  

• Pain in the pelvis and lower abdomen  
• Discharge from the vagina with an unpleasant odor  
• Fever and chills  
• Nausea and vomiting  
• Pain during sexual intercourse  

Diagnosis

Your doctor will ask about your medical history, including the sexual habits of both you and your partner or partners. Your doctor also will ask about your symptoms and methods of birth control. A pelvic examination will reveal whether your reproductive organs are tender or swollen. This helps to identify the specific site of infection. 

The diagnosis of pelvic inflammatory disease is not always easy because the site of infection cannot be examined easily. Also, the symptoms sometimes mimic symptoms of other conditions, such as appendicitis.  

During the pelvic examination, your doctor may swab the inside of your cervix with a sterile, cotton-tipped swab. A laboratory will test the sample for gonorrhea and chlamydia. Your doctor may order a blood test to see if your white blood cell count is high, which may indicate that the pelvic inflammatory disease is more severe. 

If the diagnosis is not certain, other procedures may be done, including:  

• Laparoscopy — A slender, telescope-like instrument is inserted through a small incision in the navel or just below it. This allows the doctor to view the pelvic organs.  
• Ultrasound — An electronic device is moved over the abdomen or placed in the vagina, creating echoes that are transformed into images of organs for viewing on a screen. Ultrasound can help the doctor see if the fallopian tubes are swollen or there is an abscess, which is a collection of infected fluid.  

Expected Duration

Most cases of pelvic inflammatory disease clear up after 10 to 14 days of antibiotic treatment. More severe cases may need to be treated in a hospital. 

Prevention

Other than avoiding sexual intercourse, there is no guaranteed way to prevent pelvic inflammatory disease. However, women who are in stable sexual relationships with only one partner have very little risk if neither person was infected with an STD from a previous partner. Condoms provide protection against STDs. Although oral contraceptives can prevent pregnancy, women with more than one sex partner also should make sure their partners use condoms every time they have vaginal intercourse. 

Because most cases of pelvic inflammatory disease are linked to STDs, treating a woman's sex partners is essential to prevent repeat infections. All recent sex partners of a woman with pelvic inflammatory disease should be examined by a doctor and treated as if they had both gonorrhea and chlamydia. A woman with pelvic inflammatory disease should not have sex again until her sex partners have been treated. 

Treatment

The primary treatment for pelvic inflammatory disease is antibiotics, and in most cases, antibiotics alone can cure the infection. Because pelvic inflammatory disease often is caused by more than one type of organism, two or more antibiotics may be necessary. Antibiotics can be taken by mouth or intravenously (through a vein). If you use oral antibiotics, it is important to finish all of the medication, even if the symptoms go away. This is because the infection can still be present after the symptoms disappear. In most cases, antibiotics must be taken for 10 to 14 days. 

If you are being treated for pelvic inflammatory disease, call your doctor two to three days after beginning treatment to report your progress. If your condition is not improving, you will need to visit your doctor again to have another examination.  

Some women with a severe infection need to be hospitalized to receive antibiotics intravenously. If fever and pain do not improve after several days, you may need a pelvic ultrasound or computed tomography (CT) scan to see if an abscess has formed. If you have an abscess, you probably will need surgery in addition to antibiotics to cure the infection.  

When To Call A Professional

If you experience any symptoms of pelvic inflammatory disease, see your doctor promptly. 

Prognosis

Getting prompt treatment and follow-up care can cure pelvic inflammatory disease and keep it from causing further problems. Follow your doctor's advice closely, finish all your medication and return to your doctor for all scheduled checkups. To avoid reinfection, your sex partner(s) also should be treated, and you should follow all of the recommendations for prevention. 

Additional Info

Centers for Disease Control and Prevention (CDC)
http://www.cdc.gov/