Pelvic inflammatory disease (PID), an infection of the upper genital tract, affects more than 1 million women every year in the United States. PID can affect the uterus, ovaries, fallopian tubes, and other reproductive areas; untreated, it may lead to infertility, tubal pregnancy, chronic pelvic pain, and other serious problems.
PID can be either acute or chronic. Acute PID comes on suddenly and is usually more severe than chronic PID. Chronic PID is a low-grade infection that causes only mild pain and a backache. Often, women with PID have no symptoms of the infection and only discover it when they try to become pregnant and find out they are infertile.
PID is caused by bacteria from contaminated semen that spreads from the vagina to the uterus. Many different organisms can cause PID, although most cases are associated with gonorrhea and chlamydia. It can also be caused by bacteria normally present in small amounts in the vagina and cervix.
The risk of PID increases after childbirth, miscarriage, abortion, insertion of an intrauterine device (IUD) for contraception, or operations like dilation and curettage (D and C). Douching also increases risk.
As many as one-third of women who have had PID will have the disease at least one more time. With each episode of reinfection, the risk of infertility increases.
Symptoms of acute PID include:
- Severe pain and tenderness in the lower abdomen
- Vaginal discharge
- Fever
Symptoms of chronic PID include:
- Mild, recurring pain in the lower abdomen
- Backache
- Painful intercourse
- Irregular periods
- Infertility
- Unpleasant-smelling vaginal discharge
A doctor diagnoses PID during a pelvic examination. During the exam, the doctor will probably take a sample of pus from inside the vagina using a cotton swab. The sample will be analyzed to determine if PID is present. If enough symptoms exist to indicate PID, the doctor will use laparoscopy or ultrasound to eliminate other disorders similar to PID.
PID may be preventable. Several precautions can be taken against it:
- Use barrier contraception, like a condom
- Do not put anything in the vagina for two to three weeks after an abortion or a D and C
- Do not put anything in the vagina for six weeks after childbirth, i.e. no douching and no tampons
- Do not use an IUD
- For people with a history of PID, do not have sexual intercourse during menstruation, as the cervix widens to allow blood and uterine tissue to flow out
- Seek treatment for STDs as soon as symptoms appear
PID must be treated as soon as it is discovered, as it can lead to serious complications, including infertility. Oral antibiotics are the traditional method of treatment. Tetracycline, erythromycin, and doxycycline are among the most commonly prescribed antibiotics for PID. If a woman does not respond to oral antibiotics, the doctor may recommend administering them intravenously.
Most women are treated on an outpatient basis, but up to one fourth of women with PID must be hospitalized. If a woman is pregnant, is an adolescent, or has complications, she may be hospitalized and given antibiotics intravenously.
