Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection of the internal female reproductive organs, the uterus and ovaries, and surrounding tissue within the abdomen. This frequently occurs secondary to a sexually transmitted infection (STI) of the vagina which has not been appropriately treated. If PID is left unattended, there is potential for severe complications.

The most common organisms causing PID are Chlamydia trachomatis and Neisseria gonorrhea. Around 10% of women with untreated chlamydia tend to progress to PID. According to a recent CDC report, 88000 women in the US, between the ages of 15 -44 years were diagnosed with PID.

Risk Factors for PID

• Prior STI
• Prior PID
• Age below 25 years
• Lack of usage of barrier contraception
• Multiple sexual partners
• Douching, as this can push the microbes deep into the cervix and uterus
• Recent Intra-Uterine Device (IUD) Insertion. The risk is increased only in the initial 3 weeks surrounding insertion, following which the risk decreases

Symptoms of PID

• Lower abdominal pain and cramping
• Vaginal discharge with foul odor
• Painful menstruation
• Irregular menses
• Fever
• Pain during sexual intercourse
• Pain upon urination

Diagnosis of PID

The diagnosis is made by your physician after a complete physical examination including your pelvic region and a few laboratory tests

• Pelvic exam: This is done to look for pain and discharge from the cervix and vagina and also assess for tenderness around the uterus and ovaries
• Tests for STI: A swab of the discharge is taken to examine for chlamydia, gonorrhea and other microorganisms.
• Urine routine and culture: This is done to evaluate for and rule out a urinary tract infection (UTI).
• Ultrasound of the Pelvis: This is done to visualize the uterus and the ovaries in the pelvis to look for an abscess.

COMPLICATIONS OF PID

• Acute complications
  • Spread of infection in the pelvis with an abscess requiring surgery to remove
  • Systemic spread leading to sepsis
• Long term complications
  • Damage to the fallopian tubes, which are tubes transmitting the egg from the ovary to the uterus
  • Infertility due to the tube blockage
  • Ectopic pregnancy resulting from the inability of the fertilized embryo to reach the uterus
  • Chronic pelvic pain which does not subside to any treatment

TREATMENT OF PID

• Uncomplicated PID is effectively treated with antibiotics. A combination of two antibiotics covering a broad spectrum is generally prescribed.
• Avoiding sexual activity until the infection clears
• Safe sex practices and usage of condoms during future sexual encounters
• Treating any male partners from the preceding 60 days to prevent further transmission and reinfection

PREVENTION OF PID

• Identifying and treating STIs of the vagina
• Limiting the number of sexual partners
• Usage of condoms during intercourse
• Avoiding douching
• Getting yourself and your partner tested prior to initiating sexual activity

REFERENCES

1. Pelvic inflammatory disease fact sheet. Centers for Disease Control and Prevention. Accessed March 29, 2019
2. Centers for Disease Control and Prevention. Sexually Transmitted Diseases. Accessed March 29, 2019
3. Livengood CH, et al. Clinical features and diagnosis of pelvic inflammatory disease. http://www.uptodate.com/home. Accessed March 29, 2019.