Pelvic Inflammatory Disease: Prevention and Treatment

What is pelvic inflammatory disease?

Pelvic inflammatory disease, or PID, is a serious infection of a woman's reproductive system. Every year it's contracted by about a million women in the United States. The disease is most likely to harm your Fallopian tubes, which may be badly scarred; this problem may lead to a life-threatening tubal pregnancy if you conceive. Left untreated, PID can cause sterility or in rare cases, even death.

What causes it?

Two sexually transmitted diseases, chlamydia and gonorrhea, are the most common causes. Other bacteria can trigger the infection as well. The disease may develop over a period of days or even months after you've been infected. Since PID can cause permanent damage without producing any symptoms at all, you should be tested for chlamydia or gonorrhea once a year if you're sexually active and aged 25 or younger, or if you are over 25 and at risk (meaning you have new or multiple partners).

What are the indications that I might have PID?

Acute PID appears suddenly and can be agonizingly painful, while chronic PID comes on more slowly and is harder to detect. Pay attention to any dull pain or tenderness in the lower abdomen, since this is the most common symptom of the disease. Other signs include the following:

• Bleeding between menstrual periods
• Unusually heavy bleeding during periods
• Increased or foul-smelling vaginal discharge
• Frequent or painful urination
• Pain in the lower pelvis during menstruation
• Nausea and vomiting
• Fever and chills
• Pain during sex

Who's at risk?

Any woman can develop PID. You're at higher risk of contracting it if any of the following applies to you:

• You're under 25 and are having sex
• You've had multiple sexual partners
• You douche regularly
• You've had a sexual partner with gonorrhea or an illness called nongonococcal urethritis (an inflammation of the urethra that's usually caused by chlamydia)
• You have an untreated gonorrhea or chlamydia infection
• You've previously had PID
• You've used an intrauterine device (IUD) for contraception (this risk is generally only increased among women who had an STD at the time the IUD was inserted and is greatly reduced if you are tested and treated for STDs before insertion)

How does infection occur?

Chlamydia or gonorrhea may infiltrate your uterus or one of the other reproductive organs during sex. The bacteria can also get into your pelvic area if your cervical opening is larger than usual, which may be the case after childbirth. The presence of blood (especially during menstruation) can also make it easier for you to get infected.

How can I find out whether I have PID?

If you suspect you do, you should make an appointment with your doctor immediately. The doctor will give you a pelvic exam, checking for tenderness in your uterus, Fallopian tubes, or ovaries, and will take a culture to see if bacteria are present. He or she will also take blood and urine samples and may do a rectal exam.

If the exam and the samples don't provide enough information, the doctor may want to do a simple surgical procedure called a laparoscopy. This entails giving you an anesthetic, making a small incision in your abdomen, and using a lighted tube to look inside and check for signs of the disease.

If necessary, your doctor may do other tests to see if you have PID or a different condition that looks like PID. These tests may include an ultrasound -- a procedure that uses sound waves to take pictures of the pelvic area, or an endometrial biopsy, in which a small piece of the inside lining of the womb is removed and tested.

How is PID treated?

Your treatment depends how severe the infection is. If it's mild, you'll be given antibiotics in pill form. (Remember, take all medications till they're entirely used up, even if your symptoms vanish. If you don't, the infection might not go away.) If you have a more severe infection or don't respond to the medication, you may be treated with intravenous injections of antibiotics. Be sure to go to your follow-up appointments, and let your doctor know if the symptoms get worse.

If you're badly infected and the antibiotics aren't doing the trick, you may need to have surgery. That option might also be called for if you have an abscess that needs to be drained or if you're experiencing persistent pain despite another form of treatment. In either of these cases, your doctor may suggest surgical removal or repair of the infected areas.

Your partner should also be seen by a urologist and treated; both of you should avoid sex until you are completely cured. If your partner goes untreated, he or she could reinfect you when you resume having sex.

How can I guard against PID?

The American Sexual Health Association says that the best way to prevent PID is to keep from getting sexually transmitted infections (STIs) and suggests using a latex condom whenever you have sex. For other tips on practicing safe sex, check their web site at https://www.ashasexualhealth.org/. You should also take the following precautions:

• Have regular pelvic exams
• If you're sexually active, get tested once a year for STIs
• Avoid douching
• Get prompt treatment for any sexually transmitted disease
• Avoid having intercourse or putting anything such as tampons in your vagina for two to three weeks following a miscarriage or an abortion and for six weeks following childbirth

Can men help prevent PID?

Definitely. Wearing a condom during intercourse helps prevent the STIs that often cause this disease. Also, your male partner should tell you right away if he's having any symptoms of a sexually transmitted disease; these include a pus-like discharge from the penis and pain or burning during urination. By warning you that you need to be tested, he will help you ward off long-term damage to your reproductive system.

References

Pelvic Inflammatory Disease. Frequently Asked Questions. US Department of Health and Human Services.

Centers for Disease Control. Pelvic Inflammatory Disease CDC Fact Sheet.

Gareen IF et al. Intrauterine devices and pelvic inflammatory disease: meta-analyses of published studies, 1974-1990. Epidemiology 2000 Sep;11(5):589-97.

The Self-Care Advisor:230 The Health Publishing Group 1996.

Brigham Narins, Editor. World of Health:872-74. The Gale Group 2000.