Pelvic Inflammatory Disease

 
Pelvic inflammatory disease, or PID, is an infection of a woman's reproductive organs. These organs include the uterus, fallopian tubes, and vagina.

What is going on in the body?

PID is usually caused by a sexually transmitted disease. The cervix, or opening to the uterus, may allow bacteria to enter. Then, an infection may begin. This infection can spread to the fallopian tubes and other parts of the body.

What are the signs and symptoms of the infection?

There may not be any symptoms in the early stages of PID. As the infection spreads and grows, however, the symptoms may include: · back pain that spreads down the legs · dyspareunia, or pain with intercourse · pressure in the pelvic area · flu-like symptoms, such as fever, fatigue, backache, or vomiting · heavy, foul-smelling vaginal discharge · irregular or heavy menstrual cycles · pain and tenderness in the lower abdomen

What are the causes and risks of the infection?

Most cases of PID are caused by a sexually transmitted disease, such as chlamydia or gonorrhea. In some cases, bacteria that are normally found in the vagina are responsible for PID. Sometimes the specific cause or type of bacteria cannot be found.

PID may also occur after the pelvic organs have been manipulated in some way. This includes procedures such as: · abortion · biopsy of the lining of the uterus, or endometrial biopsy · dilatation and curettage, or D and C · insertion of an intrauterine device, or IUD

Childbirth puts a woman at risk for developing PID. The following conditions increase this risk: · anemia, or low red blood cell count · being overweight or obese · devices inserted into the uterus to monitor labor, such as fetal heart monitors · eclampsia, a pregnancy complication that causes high blood pressure · having a forceps delivery or cesarean section · a long labor, lasting more than 12 hours · many internal exams during labor · membranes that have been ruptured for more than 24 hours before delivery · preexisting bacterial infection

What can be done to prevent the infection?

Safer sex practices can help prevent sexually transmitted diseases which can lead to PID. If a woman has a sexual partner who has an STD, then she needs to be treated. If a woman thinks she has been exposed to someone with an STD, she should be treated.

How is the infection diagnosed?

Diagnosis of PID begins with a history and physical exam, including a pelvic exam. The healthcare provider may order additional tests, such as: · bacterial cultures of the cervix or vagina · a complete blood count, which may indicate if there is infection in the body · insertion of a needle into the vagina to obtain fluid from the abdomen · sedimentation rate, a blood test that can tell if there is inflammation in the body · an ultrasound or a special X-ray test of the pelvic area

What are the long-term effects of the infection?

The long-term effects of PID depend on several factors. These include the severity and length of the infection as well as the organism that caused the infection. Possible complications include: · abscess, or pus pocket, in the tubes, ovaries, or behind the uterus · arthritis or swelling of the joints due to a gonococcal infection · bowel obstruction · destruction of the ovaries and tubes · increased risk of ectopic pregnancy · infertility · sepsis, a serious blood infection that may lead to septic shock and death

What are the risks to others?

The sexually transmitted disease that caused PID may be passed to the woman's sexual partners.

What are the treatments for the infection?

Treatment of mild cases of PID includes antibiotics, pain medicine, bed rest, and avoiding sexual activity. If a woman has an IUD, it will be removed.

With severe symptoms, the woman may need to be hospitalized. Higher doses of antibiotics and pain medicines can be given intravenously. The woman may need surgery to drain pus through the vagina. Other procedures can include removing the injured ovaries, fallopian tubes, or any scar tissue. If the bowel is blocked, surgery can release the obstruction. A hysterectomy, or removal of the uterus, is sometimes recommended.

What are the side effects of the treatments?

Antibiotics can cause stomach upset, rash, and allergic reactions. Surgery may cause bleeding, infection, or allergic reaction to anesthesia.

What happens after treatment for the infection?

Treating the infection early gives the best results. PID can cause infertility. This happens in roughly 15% of affected women. Each episode of PID increases a woman's risk of infertility. The risk of ectopic pregnancy is also increased. This is because the tubes may be blocked by scar tissue.

How is the infection monitored?

A woman may need to have more frequent cervical tests. A woman's sexual partners should also be checked and treated. Ultrasound exams can check for an abscess that may need to be drained with surgery. Any new or worsening symptoms should be reported to the healthcare provider.

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