Pelvic Inflammatory Disease: The infection that can leave women infertile

Apr 23, 2017 Dr Zulfikar Bux, Features / Columnists

---

By Dr Zulfikar Bux

Assistant Professor of Emergency Medicine

Pelvic inflammatory disease (PID) is an infection of the uterus, fallopian tubes or ovaries. It is the

most common serious infection among young women, with approximately 4.5% of sexually active women of reproductive age having it at any one time. 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.

PID is the most common preventable cause of infertility. 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.

 

WHAT CAUSES PID? 

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 PID are gonorrhea and chlamydia. Without treatment, the same bacteria that cause these diseases also can cause PID.

PID 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, PID 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.

PID 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 PID, 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.

 

WHAT ARE THE SYMPTOMS OF PID?

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

 

HOW IS PID DIAGNOSED?

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 (vaginal) examination will reveal whether your reproductive organs are tender or swollen. This helps to identify the specific site of infection.

The diagnosis of PID 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 PID is more severe.

If the diagnosis is not certain, your doctor may choose to do an ultrasound or, in rare cases, a computed tomography (CT) scan

 

CAN IT BE PREVENTED?

Other than avoiding sexual intercourse, there is no guaranteed way to prevent PID. 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. Because most cases of PID are linked to STDs, treating a woman’s sex partners is essential to prevent repeat infections. All recent sex partners of a woman with PID should be examined by a doctor and treated as if they had both gonorrhea and chlamydia. A woman with PID should not have sex again until her sex partners have been treated.

 

HOW IS IT TREATED?

The primary treatment for PID 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.

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 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.

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.

---

---