Pelvic Inflammatory Disease

What is pelvic inflammatory disease (PID)?

Strictly speaking, pelvic inflammatory disease (PID) is NOT an STD. However, because many STDs, when left untreated, can cause PID, we thought you would like to know something about it.

Pelvic inflammatory disease (PID) is an infection of a woman’s pelvic organs — her ovaries, fallopian tubes, uterus, cervix and vagina. It is caused by bacteria moving through the vagina to the other reproductive organs. There are many types of bacteria that can cause PID. Bacteria found in two common STDs — Chlamydia and Gonorrhea — are the most common cause of PID. PID can develop anywhere from a few days to a few months after infection with an STD. Some women who have never had an STD also can get PID, but it is unclear how or why this happens. It is estimated that each year over 1 million women experience an acute episode of PID, and more than 100,000 women each year become infertile due to PID.

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What are the signs and symptoms of PID?

Some women never have any symptoms of PID even though the infection may be having a serious affect on the reproductive organs. Symptoms can vary from mild to severe. Because the symptoms of PID can be vague, it often goes undiagnosed until the infection has done serious damage. When symptoms do occur they commonly include lower abdominal pain, sometimes fever, unusual foul-smelling vaginal discharge, pain with sexual intercourse, pain with urination, irregular menstrual bleeding, and (rarely) pain in the right upper abdomen.
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How do women get PID and how is it diagnosed?

PID occurs when bacteria move upward from a woman’s vagina or cervix into her reproductive organs. There are several different bacteria that can cause PID, but most cases are associated with Gonorrhea or Chlamydia. If PID has been treated and resolved once, there is an increase in the risk of having another episode because the organs that were infected may have been damaged during the first infection.

There are several things that can increase risks of getting PID. These include:

• Multiple sex partners
• Douching
• Use of an IUD — this can slightly increase risk, but this risk is greatly reduced if a woman is screened and tested for STDs prior to insertion of the IUD

There is no single test for PID. Diagnosis is made by a health care provider based on clinical findings during a physical examination. Usually tests are done to determine what type of bacteria caused the infection (e.g., Chlamydia or Gonorrhea) or to distinguish between PID and other problems that have similar symptoms. Sometimes other tests are done (e.g., an ultrasound). In other cases, a test called a laparoscopy is done. This test involves inserting a thin tube with tiny a camera through a small incision to view the internal pelvic organs; this makes it possible for the doctor to take specimens to help with diagnosis and treatment.
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What are the complications associated with PID?

Early and appropriate treatment can help prevent complications of PID. Without treatment, PID can cause permanent damage to the female reproductive organs. Damage to the fallopian tubes can cause normal tissue to turn into scar tissue, which blocks the normal movement of eggs. About one in eight women with PID becomes infertile as a result of PID. Fallopian tube blockage also increases a woman’s risk of an ectopic pregnancy (when the fertilized egg grows in the fallopian tube instead of the uterus), which can lead to severe pain, internal bleeding, or even death. Scarring in the fallopian tubes and other pelvic organs can also cause chronic pain.
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What is the treatment for PID?

PID can be cured with several types of antibiotics prescribed by a health care provider. While treatment will not reverse any damage that has already been done to the reproductive organs, early treatment can prevent severe damage. Because more than one type of bacteria may cause an episode of PID, it is usually treated with at least two antibiotics. In some severe cases of PID, hospitalization is necessary and/or surgery is indicated. Because a woman can be re-infected and have a recurrence of PID, her sexual partner should be tested for STDs and treated to decrease the risk of re-infection.
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