What is Pelvic Inflammatory Disease?
Pelvic inflammatory disease (PID) is a condition that triggers inflammation, or swelling, in the upper part of a woman’s reproductive system. This includes the uterus (where a baby grows), fallopian tubes (the pathway for eggs to reach the uterus), and/or ovaries (where eggs are produced). Usually, PID begins as an infection in the lower part of the reproductive system and then moves up, causing more widespread inflammation. Most cases of PID are connected to sexually transmitted infections.
Diagnosing PID mostly depends on uncovering specific symptoms, such as abdominal or pelvic pain, and soreness in the genital area. If a woman is experiencing these symptoms, her doctor may investigate other potential causes, like an ectopic pregnancy (when a fertilized egg grows outside the uterus), to ensure they’re not the source of discomfort.
Treatment for PID typically involves using antibiotics that can combat common infections like gonorrhoea and chlamydia. If not treated early or adequately, PID can lead to short-term issues like the formation of abscesses, or pockets of pus, in the fallopian tubes or pelvic area. Long-term complications could include ectopic pregnancy, infertility (difficulty getting pregnant), and chronic pelvic pain. Therefore, it’s crucial to diagnose and treat PID early to prevent potential complications.
What Causes Pelvic Inflammatory Disease?
Pelvic inflammatory disease, or PID, typically occurs due to an infection that moves upwards from the cervix. The cause of this infection in about 85% of cases is sexually transmitted bacteria. The most common culprits are bacteria called Neisseria gonorrhoeae, or gonorrhea, and Chlamydia trachomatis, or chlamydia.
From the women who get an infection caused by these bacteria in their cervix, around 10% to 15% will go on to develop PID. Usually, PID caused by gonorrhea is more severe than PID from other causes. Chlamydia is less likely to cause symptoms, which makes it easier for PID to develop without a woman realizing. This is called subclinical PID and can result in long-term health problems despite a lack of noticeable symptoms.
There are other bacteria that originate from the cervix like Mycoplasma genitalium that are thought to contribute to the disease. PID can also be caused by bacteria responsible for bacterial vaginosis, such as Peptostreptococcus and Bacteroides species, respiratory pathogens like Haemophilus influenza, Streptococcus pneumonia, Staphylococcus aureus, as well as intestinal or ‘enteric’ pathogens including Escherichia coli, Bacteroides fragilis and group B Streptococci. These bacteria are associated with acute PID and account for approximately 15% of all PID cases.
Risk Factors and Frequency for Pelvic Inflammatory Disease
Pelvic Inflammatory Disease (PID) mostly affects women between the ages of 15 and 25. In 2001, over 750,000 cases were reported in the United States. Despite a decrease in the number of cases over the past ten years, PID is still frequently diagnosed in both outpatient clinics and emergency departments.
- PID is most common in women aged 15 to 25 years old.
- In 2001, the United States reported over 750,000 cases of PID.
- Although the rate of PID has been decreasing in the past decade, it is still frequently seen.
- PID is often diagnosed in both outpatient clinics and emergency department settings.
Signs and Symptoms of Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) is a condition that may cause a variety of symptoms in women including lower abdominal or pelvic pain, unusual vaginal discharge, painful intercourse, and abnormal vaginal bleeding. It’s important to be aware of PID if you’re a young woman experiencing these symptoms. If you have a history of multiple sexual partners, are young in age, have previously had PID, use an intrauterine device, or have had tubal ligation, you may have a higher risk for developing it.
PID is normally diagnosed through a patient’s medical history and a physical examination. This includes a discussion about the beginning and nature of the pain and the consideration of possible other medical conditions that could be causing the symptoms.
All women suspected of having PID should have a pelvic exam. This examination checks for things like abnormal vaginal discharge, pain when the cervix is moved, tenderness in the uterus or surrounding areas, or any unusual lumps or masses. PID is a condition characterized by inflammation in the lower genital tract, which could be evidenced by cervical discharge, a high count of white blood cells, or a fragile cervix.
Testing for Pelvic Inflammatory Disease
If you’re experiencing pelvic pain, your doctor may run several tests to determine the cause. One of these tests could be a pregnancy test to rule out the chance that the pain is because of an ectopic pregnancy, which is when a pregnancy occurs outside the womb, usually in the fallopian tube.
Additionally, if there is discharge from the vagina or cervix, your doctor might want to look at it under a microscope. They might also request a specific type of test called a nucleic acid amplification test (NAAT) for two sexually transmitted infections (STIs): Chlamydia trachomatis (the bacteria that causes chlamydia) and Neisseria gonorrhoeae (the bacteria that causes gonorrhea). Your doctor might also suggest testing for other STIs like HIV and syphilis.
Lastly, if your doctor thinks that the pelvic pain could be caused by a tubo-ovarian abscess – a pocket of pus that forms on or near the ovaries and fallopian tubes – they might recommend a pelvic ultrasound. This image helps them closely look at the organs in your pelvic area.
Treatment Options for Pelvic Inflammatory Disease
In simple words, Pelvic Inflammatory Disease (PID) is typically diagnosed through physical symptoms and signs. It’s particularly considered in cases of sexually active young women who experience lower abdominal pain and have signs of infection in the reproductive tract. Even though lab tests like Nucleic Acid Amplification Tests (NAATs), ultrasound or CT scans can provide additional information, the results may not always be immediate. They could even take a couple of days. Also, negative test results don’t necessarily rule out PID. The absence of PID on an ultrasound or CT scan doesn’t ensure you don’t have it. As a result, if PID is suspected based on the clinical evaluation, treatment should be started quickly to manage the condition.
The need to be admitted to the hospital might arise if you are pregnant, have severe symptoms, aren’t responding to the treatment given outside the hospital, you have PID with a pelvic abscess (a swollen area within body tissue, containing an accumulation of pus), or surgery might be needed.
Depending on whether you’re in a hospital or at home, different antibiotics can be used to treat PID. Those in a hospital may receive various combinations of antibiotics like Cefotetan and Doxycycline, or Cefoxitin and Doxycycline, or Clindamycin and Gentamicin. On the other hand, those outside of the hospital setting are typically administered a combination of Doxycycline and Ceftriaxone, or Doxycycline and Cefoxitin in combination with Probenecid, or another similar kind of antibiotic known as a third-generation cephalosporin. If there’s a concern of a particular type of sexually transmitted infection called Trichomonas, or recent vaginal manipulation has been done, Metronidazole can be added to the regimen. All these treatments aim to control and eradicate the infection causing the PID.
What else can Pelvic Inflammatory Disease be?
When a doctor suspects Pelvic Inflammatory Disease (PID), there are several other conditions they need to rule out, as they have similar symptoms. These conditions include:
- Ectopic pregnancy
- Ovarian cyst rupture
- Ovarian torsion (twisting of the ovary)
- Endometriosis
- Cystitis (bladder infection)
- Appendicitis
- Diverticulitis (inflammation of pouches in the wall of the colon)
- Traumatic injury
- Pyelonephritis (kidney infection)
Possible Complications When Diagnosed with Pelvic Inflammatory Disease
Delayed treatment of an illness called PID (Pelvic Inflammatory Disease) can lead to not so great results and long-lasting complications. Even if PID is treated on time, long-term problems may still prevail. According to a research study, around 18% of women between the ages of 20-24 with PID may experience persistent pain. Additionally, 8.5% might have pregnancies that develop outside the womb, known as ectopic pregnancies, and 16.8% may face difficulties in conceiving.
Most women dealing with PID may suffer from chronic pelvic pain that occurs due to inflammation, scarring, and internal tissues sticking together from the infectious process. Frequent occurrences of PID are seen to be the main cause of such chronic pelvic pain.
Problems in getting pregnant can also follow PID, irrespective of whether the patient shows symptoms of the pelvic infection or not. The infection can cause severe damage to the fallopian tubes, which are vital for pregnancy. This can lead to loss of certain cells and blockage in the tube. According to some research studies, there is a 5-fold increase in issues relating to fertility in women who have a history of PID. These fertility issues are more likely to happen if a sexually transmitted bacteria called chlamydia caused PID, if treatment for PID was delayed, if PID occurred multiples times, or if the PID was quite serious.
Damage to fallopian tubes can also increase the risk of having an ectopic pregnancy after having PID. According to a study, there’s a rate of roughly 7.8% ectopic pregnancy following PID, while for those without PID, the rate is around 1.3%.
Long-term PID complications:
- Chronic pain happening in around 18% of women aged 20-24 with PID
- Ectopic pregnancies, or pregnancies outside the womb, for about 8.5% of these women
- Difficulty in getting pregnant or infertility occurring in around 16.8% of these women
- Damage to the fallopian tubes resulting in blockages and loss of essential cells
- Chronic pelvic pain
- Fertility problems including potentially a 5-fold increase in women with a history of PID
- Increased risk of ectopic pregnancy, which is about 7.8% in women with PID and 1.3% in those without PID
