Pelvic Inflammatory Disease
What is it?
Pelvic inflammatory disease (PID), a condition marked by acute, persistent, or recurrent infection of the internal female reproductive organs, is one of the most frequent causes of pelvic pain in women. Infection usually begins in the cervix, extends into the uterus and fallopian tubes, and then involves the pelvic cavity. In most cases proper treatment leads to full recovery within a week, although recurrence is common. If untreated, however, PID may lead to serious complications, including life-threatening abdominal abscess, infection of the abdominal cavity (peritonitis), and blood poisoning. In addition, PID may scar the fallopian tube, significantly increasing the risks of infertility and ectopic pregnancy (which occurs when a fertilized egg becomes trapped in the fallopian tube before it can settle in the uterus).
What Causes It?
- Various infectious agents, especially chlamydia and gonorrhea, can be transmitted by a sexual partner to cause PID.
- Less often, PID is caused by using an intrauterine contraceptive device (IUD), or may occur in the aftermath of a miscarriage, full-term pregnancy, or a gynecological procedure such as endometrial biopsy or dilatation and curettage (D&C).
- Risk factors include sexual activity at a young age and multiple sexual partners. Use of condoms will reduce risk.
- Occasionally, infection may spread from other organs (for example, as a complication of appendicitis).
Prevention
- Monogamy, abstinence, or the use of condoms helps protect against sexually transmitted infections.
- After minor gynecologic procedures such as D&C, avoid douching, tampons, tub baths, and intercourse for at least seven days. Report any fever, increased vaginal discharge, or pain after such procedures.
Diagnosis
- A gynecologic pelvic exam is needed. PID can be difficult to diagnose, as it may be hard to distinguish from other types of infection, such as appendicitis.
- Analysis of swab samples of vaginal discharge may identify underlying infectious agents. However, a patient may be infected with gonorrhea or chlamydia even though the culture does not show growth.
- Inspection of the pelvic organs with a small, slender scope passed through a small abdominal incision (laparoscopy) may be carried out to confirm diagnosis or to drain an abscess.
How to Treat It
- If PID appears likely, antibiotics are often prescribed immediately because delaying treatment is risky. Therapy can be adjusted after lab results are known.
- An abscess may be drained using interventional radiology techniques.
- Hospitalization may be advised for more serious cases, if the diagnosis is uncertain, if the patient is pregnant or an adolescent, or if the infection fails to respond to outpatient treatment. Treatment may include intravenous antibiotics and surgical drainage of the abscess. A ruptured abscess is life-threatening and may require a complete hysterectomy with removal of the ovaries.
- Surgery may also be considered for complicated or persistent cases that do not respond to antibiotics.
- A successfully treated woman may become reinfected by an infected partner and so sexual partners— even asymptomatic ones—should be treated for gonorrhea and chlamydia.
When to Call a Doctor
- If you have PID symptoms, especially high fever with severe pain in the lower abdomen, see your physician or gynecologist immediately.
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Copyright © 2008 Medletter Associates, LLC
Content excerpted from Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference.