The Facts

Pelvic inflammatory disease (PID) is the most serious complication of sexually transmitted infections (STIs, also known by the older name of sexually transmitted diseases or STDs) such as chlamydia and gonorrhea.

PID affects the upper female genital tract including the cervix, uterus, ovaries, and fallopian tubes.  Each year, there are approximately 100, 000 cases of symptomatic PID in Canada, and up to two-thirds of cases go unrecognized. It's the leading cause of tubal infertility in young women, but it can usually be prevented if STIs are detected and treated early. One of the long-term consequences of PID is chronic pelvic pain.

Causes

PID is caused by a bacterial infection in parts of the upper reproductive tract. The most commonly affected organs include the fallopian tubes, ovaries, and uterus. The bacteria most commonly associated with PID are Neisseria gonorrheae and Chlamydia trachomatis, but bacteria normally present in the vagina and cervix may also be involved. The cervix produces mucus that normally prevents bacteria from spreading to the upper reproductive tract.

Researchers believe that the bacteria migrate upwards when this normal body defense is not working at its strongest (i.e., during ovulation and menses). It rarely develops before onset of first menses, after menopause, or during pregnancy.

Risk factors for PID include:

• being sexually active
• being under age 25
• number of sexual partners (the more partners, the greater the risk)
• current or past STIs
• douching
• previous diagnosis of PID
• use of an intrauterine device (IUD) for birth control - it may slightly increase the risk of PID only within the first 20 days of getting it placed (this risk is lowered when women are tested and treated for infections before getting an IUD)

Symptoms and Complications



Symptoms of PID can vary widely, from none at all to severe.

The most common symptoms of PID are:

• lower abdominal pain
• abnormal vaginal discharge that may be foul-smelling
• fever
• pain during intercourse
• irregular menstrual bleeding

Complications of PID can be prevented with early treatment. Without treatment, PID can cause infertility, ectopic (tubal) pregnancy, chronic pelvic pain, and abscesses. Infertility occurs in up to 20% of women with PID and is caused by the development of scar tissue that partially or totally blocks the fallopian tubes.

Ectopic pregnancies occur when a fertilized egg attaches outside of the uterus (usually in the fallopian tube) instead of inside the uterus. If not caught and treated early, ectopic pregnancies can be fatal. Scarring can also lead to chronic pelvic pain.

The most serious complication of PID is the rupture of either an abscess or of the walls of one of the infected organs. This requires immediate medical attention. This may cause bacteria to pour out into the abdominal cavity, causing a general abdominal infection, known as peritonitis. Bacteria can also get into the bloodstream (a condition known as sepsis). Rupture of an abscess will cause a sharp increase in symptoms. Intense lower abdominal pain will be followed by nausea, then weakness and possibly fainting.

Making the Diagnosis



PID can be hard to diagnose because symptoms are often unnoticed. If a doctor suspects PID after a physical exam (including an internal pelvic exam), treatment is started immediately.

Additional tests such as blood tests, a pregnancy test, tests for STIs, ultrasound, biopsy, or laparoscopy (a fibre-optic tube is inserted through the abdominal wall allowing the doctor to see the internal pelvic organs) may be performed if more information is needed.

Treatment and Prevention



PID can be cured with antibiotics, but it's important to start treatment as early as possible. Most women are treated at home, but some women will be treated in the hospital. Hospitalization may be needed for women who:

• are very ill
• are pregnant
• did not respond to or cannot take oral antibiotics
• have an abscess (collection of pus)
• have severe symptoms or a high fever

Treatment usually consists of at least two antibiotics. More than one antibiotic is used because it can be difficult to identify the bacteria causing PID. To avoid reinfection, sexual partners should also be treated even if they don't have symptoms.

PID can be prevented by:

• abstaining from sexual intercourse or only having intercourse in a mutually monogamous relationship (where neither of you has sex with anyone else and both of you have tested negative for STIs)
• using condoms to prevent STIs
• getting frequent testing and early treatment for STIs


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