Pelvic Inflammatory Disease (PID)
What is PID?
Pelvic Inflammatory Disease (PID) is a general term that refers to an acute infection involving the upper female genital tract. This may include the uterus, fallopian tubes and/or the ovaries.
What causes PID?
PID is most commonly caused by Sexually Transmitted Infections (STIs), specifically chlamydia and gonorrhea. However, other microorganisms that are normally found in the vagina have also been associated with PID.
What are the symptoms of PID?
PID may be difficult to diagnose because it can cause a wide variety of symptoms, and these symptoms are often mild or subtle. Symptoms may include:
- Lower abdominal pain (most common)
- Pain with intercourse
- Abnormal menstrual bleeding
- New vaginal discharge, possibly a foul odor
- Painful urination or bowel movements
- Fevers and chills
How is PID diagnosed?
PID is often diagnosed using a combination of different factors, including a history of symptoms, physical examination findings, or the results of laboratory tests, ultrasound and laparoscopy (an operation that uses a scope to look inside the abdomen).
If PID is suspected, a physical exam will include a speculum examination to look for cervical discharge and cervical swabs to test for chlamydia and gonorrhea. An abdominal and pelvic examination is also included to look for any areas of tenderness. Blood tests are done to rule out pregnancy and to identify potential infection. Finally, an ultrasound is usually done to rule out other causes of pelvic pain such as ovarian torsion (a twisting of the ovaries), or to identify severe cases of PID such as a tubal abscess that may require urgent surgical treatment.
While the above investigations are relatively simple and non-invasive, they can only help give a presumptive diagnosis. A diagnosis of PID can only be completely confirmed by using laparoscopy.
How is PID treated?
PID is considered to be infection caused by different kinds of bacteria at the same time. Therefore, the treatment of PID usually involves 2 or 3 different antibiotics. The exact treatment depends on the severity of the disease as determined by your health care practitioner. Mild cases are usually treated with a 2 week course of oral antibiotics.
However, more severe cases require admission to the hospital for at least a few days to administer intravenous (IV) antibiotics. Some patients may require surgery (usually a laparoscopy) to help diagnose and/or treat PID. In some centers, a laparoscopy is routinely performed on patients with pelvic pain before the diagnosis of PID is made and before treatment with IV antibiotics is started. Otherwise, the diagnosis of PID is often wrong.
Impact if not treated
It is very important to seek treatment as soon as possible. Without treatment, PID can lead to permanent damage of the reproductive organs. The complications from this damage can include infertility, chronic pelvic pain and an increased risk of ectopic pregnancy (a serious condition in which a pregnancy develops outside of the uterus, typically in the fallopian tube).
What to tell your partner
You should inform any male partner you have had sexual contact with during the 60 days before your symptoms started. This is important because, even though your partner may not have any symptoms, the infection may still be present and you can be re-infected. Your partner should also seek health-care to be treated for chlamydia and gonorrhea.
When can I have sex again?
Ask your health care provider. It can depend on the severity of your infection and the type of treatment you receive. Generally it will be safe to have sex 1-2 weeks after both you and your partner have completed antibiotic treatment, provided all of your symptoms have disappeared. Some specialists may recommend that you get re-tested for chlamydia and gonorrhea 4-6 weeks after treatment to make sure that both you and your partner have been completely cured.
As always, you should use condoms to prevent sexually transmitted infections. This is particularly important following treatment of PID to prevent re-infection.
Women who have an Intra-Uterine Device (IUD) inserted are at a slightly increased risk of developing PID within the first 3 weeks after insertion, but PID is uncommon after this period. This risk can be decreased by getting tested for chlamydia and gonorrhea, and treated if necessary, before the IUD is inserted.