Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (PID)

What is PID?

PID know as Pelvic Inflammatory Disease is a general term that refers to a sexually transmitted infection of the female reproductive system: uterus (womb), fallopian tubes, ovaries or oviduct. It is the most common and serious complication of sexually transmitted diseases, aside from AIDS, among women. PID can damage the fallopian tubes and tissues in and near the uterus and ovaries.  Poor diagnosis and incorrect treatment can be very dangerous, as a consequence. It can lead to serious consequences including infertility, ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere outside of the womb), abscess formation, and continual pelvic pain.

How do women get PID?

Many different organisms can cause PID, but most cases are associated with gonorrhea and genital chlamydial infections, two very common STDs. PID occurs when bacteria move upward from a woman's vagina or cervix into her reproductive organs. The gonococcus, which causes gonorrhea, probably travels up into the fallopian tubes, where it causes sloughing of some cells and invades others. It multiplies within and beneath these cells. The infection then spreads to other organs, resulting in more inflammation and scarring.  
Worth to remember is that the presence of a cervical mucus helps to prevent spreading microorganisms to the upper genital tract, however it is less effective during ovulation and period. The gonococcus may gain access more easily during menses, if menstrual blood flows backward from the uterus into the fallopian tubes, carrying the organisms with it.

Most at risk are sexually active women in their childbearing years, especially those under age of 25. This is partly because the cervix of teenage girls and young women is not fully matured.

The more sex partners a woman has, the greater her risk of developing PID. Also, a woman whose partner has more than one sex partner is at greater risk of developing PID, because of the potential for more exposure to infectious agents. The sexual partners of women with PID often have no symptoms, although they may be infected. They should therefore be treated even if they do not have symptoms to prevent reinfection and another bout of PID.
Women who douche once or twice a month are also more likely to have PID. Douching changes the vaginal flora, thus may push the microorganisms up into the upper genital tract and ease the discharge, masking the infection.

What are the signs and symptoms of PID?

Symptoms and signs of PID are various, from none to severe. Infection caused by Chlamydia has mild symptoms or no symptoms at all. Unclear symptoms might be unrecognized by women and their health care providers. Usually it happens about two thirds of the time.

Most common signs are:
  • lower abdominal pain fever,
  • foul-smelling vaginal discharge
  • painful intercourse,
  • painful urination,
  • irregular menstrual bleeding,
  • pain in the right upper abdomen (rare)
  • infertility,
  • chronic pelvic pain
  • pain when having sex

What are the complication of PID?

Without any treatment PID can cause permanent damage to the female reproductive organs. Rapid and appropriate treatment, however, can help prevent complications of this infection. Invasion of the fallopian tubes by bacteria turns normal tissue into scar tissue, which blocks or interrupts the normal movement of eggs into the uterus. When fallopian tubes are blocked by scar tissue, sperm cannot fertilize an egg, and the woman becomes infertile. This state may also occur if the fallopian tubes are partially blocked or even slightly damaged.
Sometimes, a partially blocked fallopian tube may cause a fertilized egg to remain in the fallopian tube. Fertilized egg begins to grow in the tube as if it were in the uterus. This situation is called an ectopic pregnancy. As it grows, it can rupture the fallopian tube causing severe pain, internal bleeding or even death.

What is the PID treatment?

Luckily, if you treat it early, PID can be cured with antibiotics. If you have had the disease for a long time before you find it, you may have to be hospitalized in order to get the necessary treatment.

A health care provider will decide and prescribe the best therapy. You must remember that antibiotic treatment does not reverse any damage that has already occurred to the reproductive organs. If a woman has pelvic pain and other symptoms of PID, it is critical to find care immediately. The longer a woman delays treatment for PID, the more likely she is to become infertile or to have an ectopic pregnancy in the future.

The symptoms may go away before the infection is cured. Nevertheless, the woman should finish taking all of the prescribed medication. This will help prevent disease from returning. In addition, a woman’s sex partner should be treated as well to decrease the risk of re-infection. Although sex partners may have no symptoms, they may still be infected with the organism that can cause PID.

If symptoms continue or if an abscess does not go away, surgery may be needed. About a quarter of women with suspected PID must be hospitalized.

Hospitalization to treat PID may be necessary if the patient:
1. is severely ill (e.g., nausea, vomiting, and high fever);
2. is pregnant;
3. does not respond to or cannot take oral medication;
4. has a tubo-ovarian abscess;
5. if the diagnosis is uncertain and may include an abdominal emergency such as appendicitis;
6. if she has HIV.

How can I prevent and reduce risk of getting PID?

  • Get Tested - It is recommended to take part in yearly chlamydia testing, especially for all sexually active women age 25 or younger, older women with risk factors for chlamydial infections and all pregnant women.
  • Limit the Number of Partners You Have -The best way to avoid transmission of STDs is to abstain from sexual intercourse. The fewer partners you have who are known to be uninfected, the less chance you will get a PID.
  • React immediately - Genital symptoms such as an abnormal sore, discharge with odor, pain during urination, or bleeding between menstrual cycles could mean an STD infection. If a woman has any of these, she should stop having sex and consult a health care provider immediately.
  • Protect Yourself - Use a condom or any barrier to prevent skin to skin contact with the infected area. Latex condoms, when used consistently and correctly, may reduce the possibility of transmission of chlamydia and gonorrhea.
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