Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is a broad term used to refer to an infection of the upper reproductive organs, such as the fallopian tubes and ovaries. It is a common and, in some cases, a serious illness. Each year, PID is diagnosed in more than 1 million women, many of them teens.

PID usually can be treated with success, but the infection may cause permanent, long-term problems. Women who know how to protect themselves from PID can decrease their risk of getting it. This pamphlet explains:

Causes of PID

PID is caused by different kinds of germs. Most cases stem from sexually transmitted diseases (STDs). The 2 most common STDs that cause PID are bacterial infections called gonorrhea and chlamydial infection. Without treatment, the bacteria that cause these STDs can cause PID.

PID occurs when the bacteria move upward from the vagina and cervix. The bacteria then find their way to the uterus, ovaries, or fallopian tubes. After exposure to the bacteria, it can take a few days to a few weeks for a woman to develop PID.

Dangers of PID

In the United States, one fourth of women who have PID are hospitalized. Some of these women may need surgery.

PID can lead to serious long-term problems. These include infertility, ectopic pregnancy, and chronic pelvic pain.

One in 5 women with PID become infertile. The more often a woman has PID and the more severe her case is, the greater her risk of infertility. PID can cause scarring of the tissue inside the fallopian tubes. This scarring can damage and block the tubes causing infertility. The scarring also may prevent a fertilized egg from moving normally into the uterus, which can result in an ectopic pregnancy.

In the United States, many of the ectopic pregnancies that occur each year can be linked to PID. An ectopic pregnancy occurs when a fertilized egg attaches outside of the uterus, often to a damaged fallopian tube. The egg may begin to grow in the tube instead of moving into the uterus. This can lead to rupture of the tube and bleeding into the abdomen. Emergency surgery may be needed for this serious problem.

Who Is at Risk?

PID is most common among young women, but can occur at any age in women who are sexually active. Those who are at increased risk of getting PID are:

• Women with STDs, especially gonorrhea and chlamydial infection
• Women who have sex with more than 1 partner—the more sex partners a woman has, the greater her risk of PID
• Women whose sex partners have other sex partners
• Women who have had PID in the past
• Sexually active women who douche frequently

Symptoms

PID may cause severe or minor symptoms. Some women with PID have no symptoms at all. Even with no symptoms, PID can cause severe damage to a woman’s reproductive organs.

If you have any of the following symptoms of PID, you should see your doctor:

• Abnormal vaginal discharge
• Pain in the lower abdomen (often of a mild, aching nature)
• Pain in the right upper abdomen
• Abnormal menstrual bleeding
• Fever and chills
• Painful urination
• Nausea and vomiting
• Painful sexual intercourse

However, having 1 of these symptoms does not mean that you have PID. It could be a sign of another problem.

Diagnosis

PID can be hard to diagnose. One reason is that the affected organs are not easy to examine. Another reason is that PID symptoms may be like those of other problems, such as appendicitis or ectopic pregnancy.

Your doctor will ask you about your medical history, including sexual habits, birth control, and symptoms. Your doctor also may do a pelvic exam to find out if your reproductive organs are tender.

Samples of cells from your cervix may be taken to look for gonorrhea and chlamydial infection. Blood tests also may be done.

If more information is needed, the doctor may order other tests or procedures. These include:

• Ultrasonography—An electronic device is moved over the abdomen or placed into the vagina. The device uses sound waves to create pictures that can be seen on a TV-like screen. This can help find out if the fallopian tubes are filled with fluid or if an abscess is present.
• Endometrial biopsy—A small amount of the tissue lining the uterus is removed and studied under a microscope.
• Laparoscopy—A thin tube device with a lighted end is inserted through a small incision (cut) made through or just below the navel. With this procedure, the doctor can view the pelvic organs and take tissue samples if needed.

Treatment

PID can be treated and often cured. Early treatment of PID is vital to prevent problems such as infertility. However, even when the infection is treated, long-term problems can persist.

PID is first treated with antibiotics. In most cases, antibiotics alone can get rid of the infection. PID often is caused by more than 1 type of bacteria, and no drug kills all the bacteria thought to cause PID. For this reason, 2 or more antibiotics often are prescribed. The antibiotics may be taken orally or given by injection.

Sometimes the symptoms of PID go away before the infection is cured. Even if your symptoms go away, be sure to take all of the medicine prescribed. In some cases, the drugs must be taken for 14 days to make sure the infection is gone.

Your doctor may schedule a visit 2–3 days after treatment begins to check your progress. If your condition hasn’t improved, you may need to be treated in a hospital. Hospitalization also may be needed if you:

• Have appendicitis or ectopic pregnancy instead of PID
• Are pregnant
• Must be given antibiotics intravenously
• Are severely ill, have nausea and vomiting, or have a high fever
• Have an abscess

If your symptoms continue or if an abscess does not go away, surgery may be needed.

A woman’s sex partners also should be treated. Women with PID may have partners who have gonorrhea or chlamydial infection, which can cause PID. A person can have these STDs even if there are no signs of illness. To decrease your risk of getting PID again, your partners need to be checked and treated for STDs.

Prevention

You can take steps to avoid STD infection and prevent PID:

• Have sex only with a partner who does not have an STD and who only has sex with you.
• Limit your number of sex partners and avoid partners who are at increased risk of STDs, such as people who:
  • Have or have had more than 1 sexual partner
  • Have a partner who has or has had more than 1 sexual partner
  • Have sex with someone who has or has had an STD
  • Have a history of STDs
• Use condoms every time you have sex. With correct use, condoms can help prevent STDs. If you use other methods of birth control, also use condoms when having sex to prevent STDs.

See your doctor soon if you think you may have an STD or PID. Early treatment can prevent later problems.

Finally…

Although PID can threaten your health and cause infertility, it can be prevented and treated. If you have symptoms of PID, see your doctor right away. If you are being treated for PID, follow your doctor’s advice closely. Finish all medications and return to your doctor for all scheduled checkups. Also, to avoid re-infection, don’t have sex with partners who may have untreated STDs.

Glossary

Abscess: A build-up of pus that can occur in any part of the body, caused by an infection.

Antibiotics: Drugs used to treat infections.

Cervix: The lower, narrow end of the uterus, which enters into the vagina.

Chlamydial Infection: A sexually transmitted disease caused by bacteria that can lead to pelvic inflammatory disease and infertility.

Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in the fallopian tubes.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Gonorrhea: A sexually transmitted disease that may lead to pelvic inflammatory disease, infertility, and arthritis.

Ovaries: Two glands, located on either side of the uterus, that contain the eggs and that produce hormones.

Sexually Transmitted Diseases (STD): Diseases that are spread by sexual contact.

Uterus: A muscular organ that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.