Pelvic inflammatory disease

What is Pelvic inflammatory disease?

Pelvic inflammatory disease (PID) is an infection of the ovary, fallopian tube, and/or uterus (oophoritis, salpingitis, and endometritis respectively). It is a common and serious complication of sexually transmitted diseases (STDs) even if the STD is treated promptly.

More than one million women experience an episode of acute pelvic inflammatory disease each year in the US, and more than 100,000 women become infertile each year as a result. Women who use an IUD (a device placed in the uterus for birth control) have the highest rate of PID. Though less common, it can be a complication of a miscarriage, abortion, or childbirth.

Most cases are caused by sexually transmitted infections of chlamydia (the most commonly transmitted STD in women) or gonorrhea, but other bacteria normally found in the vagina and cervix may also be responsible. These organisms travel up the fallopian tubes causing inflammation and scarring.

Symptoms of pelvic inflammatory disease begin immediately after menstruation more often than at any other time during the menstrual cycle. This may indicate that menstrual blood flows backwards from the uterus into the fallopian tubes, carrying the infecting organisms with it. PID can have a sudden, rapid onset or can be a chronic infection. One-quarter of women with PID will have at least one repeat episode of the disease. With each episode, the risk of infertility increases.

How is it diagnosed?

Physical exam The cervix and uterus are usually tender. An enlarged, tender fallopian tube may be felt. An ovary may also be involved in the inflammation, in the case of a tubo-ovarian abscess.

Tests: Swabs from the vagina and cervix are cultured to identify the infecting bacteria. The organism might also be seen microscopically. A complete blood count (CBC) can indicate a high number of white blood cells in acute PID, but the white cell count may remain normal.

A urinalysis and urine culture might be done to rule out a urinary tract infection. A pregnancy test may be done to exclude the possibility of a tubal (ectopic) pregnancy. A blood test may also be done to detect syphilis and HIV the virus responsible for AIDS.

Other tests include an ultrasound and endometrial biopsy (a tissue sample taken from lining of uterus). A laparoscopy may be done to diagnose PID. Laparoscopy is a surgical procedure where a small lighted viewing instrument is inserted through a small incision into the abdomen allowing direct visualization of pelvic organs.

How is PID treated?

Most cases of pelvic inflammatory disease can be effectively treated with antibiotics. At least two antibiotics are usually given because more than one organism is often responsible. About one-quarter of women with PID are hospitalized for intravenous antibiotic treatment. This includes women who are severely ill or pregnant. All sexual partners should be examined for sexually transmitted diseases and promptly treated if infected. If an IUD (intrauterine device) appears to be contributing to the infection, it may need to be removed.

Surgery may be indicated to drain an ovarian or pelvic abscess. Surgical removal or salpingo-oophorectomy may be indicated for chronic pelvic inflammatory disease that is unresponsive to antibiotic treatment.

Medications

Information	Brand	Generic	Label	Rating
	Flagyl	Metronidazole
	Ilosone	Erythromycin
	Principen	Ampicillin
	Adoxa	Doxycycline
	Cleocin	Clindamycin
	Sumycin	Tetracycline

Activity

Avoid sexual intercourse until you are well. Rest in bed until any fever subsides. Sit and lie in different positions until you find one that is comfortable for you. Allow several weeks for recovery.

What might complicate it?

Complications include infertility, tubal pregnancy, spontaneous abortion, and chronic pelvic pain. Infertility occurs in approximately twenty percent of women who have had PID resulting from scarring and blockage of the fallopian tube. Many women with blocked fallopian tubes may never have had symptoms of PID because chlamydial infections can silently invade the fallopian tubes. A woman with pelvic inflammatory disease has a much higher risk of a tubal pregnancy. The fertilized egg cannot pass into the uterus through blocked and scarred fallopian tubes. Untreated, PID can result in chronic pelvic pain in about twenty percent of individuals. PID can also result in abscesses of the ovaries, fallopian tubes, and other sites in the pelvis.

Predicted outcome

A favorable outcome depends on prompt diagnosis and treatment. With chronic or recurring PID, each episode increases the chance of infertility, tubal pregnancy, and abscesses.

Alternatives

Other possibilities are appendicitis (acute or chronic), ectopic pregnancy, urinary tract infection, ovarian cyst, endometriosis, diverticulitis, or ulcerative colitis.

Appropriate specialists

Gynecologist, general surgeon, and infectious disease specialist.

Last updated 17 November 2015