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PELVIC INFLAMMATORY DISEASE (PID)

WHAT IS PELVIC INFLAMMATORY DISEASE?

Pelvic inflammatory disease (PID) is an infectious and inflammatory disorder of the female reproductive organs, including the womb, Fallopian tubes, and ovaries. It can lead to the formation of scars in these tissues or organs.

Most cases result from an untreated vaginal or cervical infection which is often sexually transmitted. But it can also develop from infections from other causes.

If PID is left untreated, it may result in long-term complications such as infertility.

Female reproduce system

WHAT ARE THE SIGNS AND SYMPTOMS OF PID?

The presentations of PID vary widely. Many females show little or no symptoms, whereas others have severe symptoms. Some of the most common symptoms are:

  1. Pain especially in the lower abdomen 
  2. Fever
  3. An abnormal discharge with a foul from the vagina
  4. Pain and/or bleeding during sexual intercourse
  5. Burning sensation when you urinate
  6. Bleeding between periods.
  7. Nausea and vomiting 
Lower abdominal pain in pelvic inflammatory disease
A patient experiencing lower abdominal pain

CAUSES OF PELVIC INFLAMMATORY DISEASE

PID is caused by an infection that spread upward from your vagina and cervix into the upper part of the female reproductive system (womb, fallopian tubes, and ovaries). 

Chlamydia trachomatis (the cause of chlamydia) and Neisseria gonorrhea (which causes gonorrhea) are the most common sexually transmitted organisms associated with Pelvic inflammatory disease. About 10-20% of untreated chlamydial or gonorrheal infections progress to PID.

Other organisms that may cause PID include;

  1. G. vaginalis (which causes bacterial vaginosis (BV), 
  2. H. influenzae, and 
  3. Other anaerobic bacteria.  

However, studies have shown that in 30-40% of cases, PID is caused by multiple micro-organisms.

HOW DOES PID OCCUR?

Pelvic inflammatory disease may cause reproduction organs to be inflammed
The upward spread results in inflammation of the womb, fallopian tubes, and ovaries.

Most cases of PID can occur in 2 phases. 

First, there is an infection of the vagina or cervix. This infection is often sexually transmitted and may not show symptoms.

Then, an upward spread of the infection from the vagina or cervix to the womb, fallopian tubes, or ovaries, causing infection and inflammation in these structures. The infection can cause scarring of tissues in the fallopian tubes, which can damage the fallopian tubes or block them completely.

Less commonly, pelvic inflammatory disease can develop if bacteria get into the upper parts of the reproductive tract after childbirth, after inserting an intrauterine device (IUD), or after an induced abortion.

Although the mucus from the cervix protects against the upward spread, the strength of this protection may be decreased by vaginal inflammation and hormonal changes that occur during ovulation and menses.

Also, the use of antibiotics to treat sexually transmitted infections can disrupt the balance of the normal bacteria in the vagina or cervix, causing these organisms to overgrow and ascend.

WHAT ARE THE FACTORS THAT INCREASE YOUR RISK?

Factors that may increase the risk for PID include;

  1. A menstruating woman younger than 25 years-  It is most common in women 15 to 24 years old
  2. Young age at first sexual intercourse
  3. having multiple sex partners
  4. no use of contraception
  5. Frequent vaginal douching (the act of washing or flushing the vagina with water or other fluids) – Can push the infection into the reproductive organs and cause PID. Douching can also hide PID signs.
  6. Prior history of STIs
  7. A prior history of pelvic inflammatory disease
  8. Recently inserted IUD
  9. Abortion
  10. Miscarriage 

COMPLICATIONS OF PELVIC INFLAMMATORY DISEASE 

Untreated PID can cause scar tissue and abscesses (a collection of pus) to develop in the reproductive organs, which may result in permanent damage to these organs.

PID has four major complications

  1. Chronic pain in the pelvis
  2. Infertility 
  3. Ectopic pregnancy
  4. Tubo-ovarian abscess

Chronic pelvic pain occurs in approximately 25% of women who have a history of PID. The pain can last for months or years. Scarring in your fallopian tubes and other organs can cause pain during sexual intercourse and ovulation.

Infertility ( the inability to become pregnant) can result from damage to your reproductive organs. The more times you have had PID, the higher your risk of infertility. Delaying treatment for PID also increases your risk of infertility.

The risk of ectopic pregnancy is heightened 15-50% in women with a history of PID. Ectopic pregnancy is a direct result of damage to the fallopian tube (due to the scar tissues). The scar tissue prevents the fertilized egg from making its way through the fallopian tube to implant in the womb. Instead, the egg implants in the fallopian tube. Ectopic pregnancies massive, life-threatening bleeding and require urgent medical attention.

Tubo-ovarian abscess. Pelvic inflammatory disease can cause an abscess to form in the Fallopian tubes, ovaries, or the womb. If an abscess is not treated, you could develop a life-threatening infection.

HOW IS PID DIAGNOSED

Pelvic inflammatory disease laparoscopy
A view of the inflamed organs with a laparoscope

To diagnose PID, physicians usually do a physical exam to check for signs of PID and test for STIs. If you think that you may have PID, see a physician or nurse as soon as possible.

If you have pain in your lower abdomen, your doctor or nurse will check for:

  1. Abnormal discharge from your vagina or cervix
  2. An abscess (collection of pus) near your ovaries or fallopian tubes
  3. Tenderness or pain in your reproductive organs

Your physician may do tests to find out whether you have PID or a different problem that looks like PID. These can include:

  1. Tests for STIs, especially gonorrhea and chlamydia. These infections can cause PID.
  2. A test for a urinary tract infection or other conditions that can cause pelvic pain
  3. Ultrasound or another imaging test so your physician can look at your internal organs for signs of PID

CAN PELVIC INFLAMMATORY DISEASE BE TREATED?

Early treatment decreases the chance of developing complications, such as infertility.

The main treatment for PID is antibiotics, and in most cases, antibiotics alone can cure the infection. Because the pelvic inflammatory disease is sometimes caused by multiple organisms, two or more antibiotics may be necessary. 

Antibiotics can be taken orally or through a vein. If you use oral antibiotics, it is important to complete the medication, even if the symptoms go away. This is because the infection can persist after the symptoms disappear. In most cases, antibiotics must be taken for ten to 14 days.

Some women with a severe infection need to be hospitalized to receive antibiotics through a vein. If fever and pain do not improve after several days, you may need a pelvic ultrasound or computed tomography (CT) scan to see if an abscess has formed. If you have an abscess, you probably will need surgery in addition to antibiotics to cure the infection.

HOW TO PREVENT PID

Aside from sexual abstinence, there is no guaranteed way to prevent PID. However, women who are in safe sexual relationships with only one partner have very little risk if neither person was infected with an STI from a previous partner. Condoms protect against STIs. Although oral contraceptives can prevent pregnancy, women with more than one sex partner also should make sure their partners use condoms every time they have vaginal intercourse.

Because most cases of pelvic inflammatory disease are linked to STIs, treating a woman’s sex partners is essential to prevent recurrent infections. All recent sexual partners of a woman with PID should be examined by a doctor and treated as if they had both chlamydia and gonorrhea. A woman the pelvic inflammatory disease should abstain from sex until her sex partners have been treated.

Furthermore, douching, drug or alcohol abuse, and other factors that may increase the risk of getting PID should be avoided.

F.O. Adagbonyin, MB.BS in view, certified content creator at Medblog180 and MedicWord, licensed google writer and contributing writer at WikiMedia Foundation.

REFERENCES

  1. https://www.medicalnewstoday.com/articles/177923#prevention
  2. https://www.womenshealth.gov/a-z-topics/pelvic-inflammatory-disease
  3. https://emedicine.medscape.com/article/256448-overview

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