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Pelvic Inflammatory Disease (PID)

What is PID?

Pelvic inflammatory disease (PID) is a general term that refers to infection of the fallopian tubes (tubes that carry eggs from the ovary to the womb) and of other internal reproductive organs in women. It is a common and serious complication of some sexually transmitted diseases (STDs). Inside the lower abdominal cavity, PID can damage the fallopian tubes and tissues in and near the uterus and ovaries. Untreated PID can lead to serious consequences including infertility, ectopic pregnancy, abscess formation, and chronic pelvic pain.

How common is PID?

Each year in the United States, more than 1 million women experience an episode of acute PID. More than 100,000 women become infertile each year as a result of PID, and a large proportion of the ectopic pregnancies occurring every year are due to the consequences of PID. More than 150 women die from this infection every year.

What causes PID?

PID occurs when bacteria move upward from a woman's vagina or cervix into the internal reproductive organs. Sexually active women in their childbearing years are most at risk. Many different organisms can cause PID, but most cases are associated with gonorrhea and chlamydia, two very common bacterial STDs. It is estimated that 10% to 80% of women with either of these STDs will develop symptomatic PID.

What are the symptoms of PID?

Symptoms of PID vary from none to severe. Particularly when it is caused by chlamydial infection, PID may produce only mild symptoms or no symptoms at all, even while it is seriously damaging the internal reproductive organs. Because of the vague symptoms, PID goes unrecognized both by women and by their health care providers about two thirds of the time. Women who do have symptoms of PID most commonly have lower abdominal pain. Other signs and symptoms include fever, unusual vaginal discharge that may have a foul odor, painful intercourse, painful urination, irregular menstrual bleeding, and pain in the right upper abdomen (rare).

What are the complications of PID?

Early and complete treatment can help prevent complications of PID. Without treatment, PID can cause permanent damage to the female internal reproductive organs. Infection-causing bacteria can silently invade the fallopian tubes, causing normal tissue to turn into scar tissue. Scar tissue blocks or interrupts the normal movement of eggs into the uterus. If the fallopian tubes are totally blocked by scar tissue, an egg will not be fertilized by sperm or move to the uterus to develop into a baby. Totally blocked fallopian tubes cause a woman to be infertile. Infertility can also occur if the fallopian tubes are partially blocked or even slightly damaged. About one in five women with PID becomes infertile. If a woman has multiple episodes of PID, her chances of becoming infertile are increased.

In addition, a partially blocked or slightly damaged fallopian tube may cause a fertilized egg to get stuck in the tube. This fertilized egg may begin to grow in the tube as if it were in the womb. This is an ectopic pregnancy, which is a pregnancy in the fallopian tube or elsewhere outside the uterus. As it grows, an ectopic pregnancy can rupture the fallopian tube and cause severe pain, internal bleeding, and even death. Scarring in the fallopian tubes and other pelvic structures can also cause chronic pelvic pain (pain that lasts for months or even years). Women with repeated episodes of PID are more likely than women with a single episode to suffer infertility, ectopic pregnancy, or chronic pelvic pain.

How is PID diagnosed?

PID is difficult to diagnose because the symptoms are often subtle and mild. Many episodes of PID go undetected because the woman or her health care provider fails to recognize the implications of mild or nonspecific symptoms. Because there are no precise tests for PID, a diagnosis is usually based on clinical findings. If symptoms such as lower abdominal pain are present, a health care provider should perform a physical examination to determine the nature and location of the pain and check for fever, abnormal vaginal or cervical discharge, and for evidence of gonorrhea or chlamydia infection. If the findings suggest PID, treatment is necessary.

If more information is necessary, the health care provider may order other tests to identify the infection-causing organism or to distinguish between PID and other problems with similar symptoms. A pelvic ultrasound is a procedure that may be helpful in evaluating someone for PID. An ultrasound can view the pelvic area to see whether the fallopian tubes are enlarged or whether an abscess is present. In some cases, a laparoscopy may be necessary to confirm the diagnosis. A laparoscopy is a minor surgical procedure in which a thin, flexible tube with a lighted end (laparoscope) is inserted through a small incision in the lower abdomen. This procedure enables the doctor to view the internal pelvic organs and to take specimens for laboratory studies, if needed.

What is the treatment for PID?

PID can be cured with antibiotics. If women have pelvic pain and other symptoms caused by PID, it is critical that they seek care immediately. Prompt antibiotic treatment can prevent severe damage to pelvic organs. The longer women delay treatment for PID, the more likely they are to be infertile or to have an ectopic pregnancy in the future because of damage to the tubes. However, antibiotic treatment does not reverse any damage that has already occurred to the reproductive organs.

Because of the difficulty in identifying organisms infecting the internal reproductive organs and because more than one organism may be responsible for an episode of PID, PID is usually treated with at least two antibiotics that are effective against a wide range of infectious agents. These antibiotics can be given by mouth or by vein. The symptoms may go away before the infection is cured. Even if symptoms do go away, women should finish taking all of the medicine. This will help prevent the infection from returning. Women on treatment for PID should be re-evaluated by their health care provider two to three days after starting treatment to be sure the antibiotics are working to cure the infection. In addition, women's sex partners should be treated to decrease the risk of re-infection, even if the partners have no symptoms. Many women with PID have sex partners who have no symptoms, although their sex partners may be infected with the organisms that can cause PID.

About one fourth of women with suspected PID must be hospitalized. Hospitalization may be recommended if the woman is severely ill (e.g., high fever) or pregnant; if she cannot take oral medication and needs intravenous antibiotics; if the diagnosis is uncertain; or in some cases, if she is infected with HIV (human immunodeficiency virus, the virus that causes AIDS). If symptoms continue or if an abscess does not resolve, surgery may be needed. Complications of PID, such as chronic pelvic pain and scarring are difficult to treat but are sometimes improved with surgery.

Who is at risk for PID?

How can PID be prevented?

The main cause of PID is an untreated STD. Women can protect themselves from PID by taking action to prevent STDs or by getting early treatment if they do get an STD: