Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease is an infection of the female reproductive system, including the cervix ^* , uterus ^* , ovaries ^* , and especially the fallopian tubes ^* . It usually is caused by a sexually transmitted disease and can reduce a woman's ability to get pregnant.

Carrie and Reg's Story

Two years after Carrie and Reg got married, they decided to start a family. Carrie began looking at the ads for strollers and baby clothes. But after a year, she had not gotten pregnant. She was sure she did not have a medical problem. After another 6 months of trying, Carrie and Reg decided to see a doctor who had experience with fertility problems.

The doctor asked if Carrie had ever had pelvic inflammatory disease (PID). She said no, she had not even heard of it. But in a series of tests, her body told a different story. Carrie's fallopian tubes (the place where egg meets sperm in conception) had been scarred by PID. After laser surgery removed the scar tissue and opened the blocked passageways, Carrie finally got pregnant.

When healthy young women have difficulty getting pregnant, damage from pelvic inflammatory disease is one of the many possible causes. In most cases, the women do not know they had the disease and never got treated. Quick treatment of PID can reduce the chances that it will cause infertility.

What Causes PID?

Most commonly, women get PID after they have had a sexually transmitted disease (chlamydial [kla-MID-e-al] infection or gonorrhea [gon-o-REE-a]) that was not treated, dften because it was not noticed. The bacteria ^* , named Chlamydia trachomatis and Neisseria gonorrhoeae, then can move up from the vagina ^* to infect other parts of the reproductive system. PID often involves a wide range of other bacteria as well. In many cases, doctors cannot identify the bacteria involved.

PID also can develop after a woman gives birth or has an abortion in unsanitary conditions. In rare cases, certain medical procedures done on reproductive organs, such as injecting dye for special x-rays, can lead to PID.

What Does PID Do in the Body?

First, a quick review of conception. The ovary releases an egg into one of a woman's two fallopian tubes, where it meets with the sperm ^* . The newly formed embryo ^* travels through the tube to the uterus, an expandable sac where it will grow into a fetus ^* .

In PID, the bacteria usually infect the cervix and then travel upward and infect the fallopian tubes, a condition called salpingitis (sal-pin-JY-tis). Doctors sometimes use that name as a synonym for PID. But PID also can involve the uterus and the ovaries. In severe cases, a collection of pus can form in the ovaries and fallopian tubes, called a tuboovarian abscess, or the infection can spread to the membrane ^* around the reproductive organs, a condition called pelvic peritonitis (per-i-to-NY-tis).

The body usually fights off the infection. But in the struggle, tissue can be damaged and scarred, causing blockages in the delicate fallopian tubes. That means the egg and sperm may not be able to meet, or, if they do, the fertilized egg or embryo may not be able to reach the uterus.

Of women who have PID one time, about 10 percent become infertile. After three bouts of the disease, more than half may be infertile. Prompt treatment, within 3 days of symptoms, can help prevent problems.

Women who have had PID also are more likely than other women to have an ectopic (ek-TOP-ik) pregnancy. That means the embryo starts growing outside the uterus, usually in the fallopian tubes. Such a pregnancy cannot produce a baby and, if it is not ended, poses a very serious risk to the woman's safety because the growing embryo will rupture the fallopian tubes and cause life-threatening hemorrhage ^* .

Who Is at Risk for PID?

PID affects only women and is rare unless a woman is sexually active. Sexually active teenagers are at the highest risk by far, followed by women in their early twenties. The risk increases if a woman has many sexual partners, has sexual intercourse very frequently even with a single partner, or uses an IUD (intrauterine [in-tra-YOO-ter-in] device), a birth-control device inserted in the uterus. Frequent douching (inserting fluid into the vagina to "clean" it) may also increase the risk of PID.

What Are the Symptoms of PID?

It has been estimated that 60 percent of all cases of PID have symptoms so mild they go unnoticed. Noticeable symptoms often include:

• Pain in the lower abdomen ^* or pelvis
• Very sharp pain when the doctor performs a pelvic examination
• A fever of over 100 degrees Fahrenheit (38 degrees Celsius)
• A discharge of pus or irregular bleeding from the vagina
• Pain during urination or intercourse

Sometimes, long after an untreated PID infection occurs, women have chronic ^* (persistent) pain in the pelvis. This is sometimes called chronic PID.

How Is PID Diagnosed?

PID can be difficult to diagnose. Many conditions have similar symptoms, and no simple test can tell for sure if a woman has PID. Because it is so important to treat PID quickly, doctors usually start treatment if the symptoms even suggest PID.

To try to confirm the diagnosis, doctors do blood tests to look for general evidence of infection. They test for chlamydial infection and gonorrhea, and they do a pregnancy test to determine whether the symptoms are being caused by an ectopic pregnancy.

Ultrasound, a painless procedure that uses sound waves to create an image of the organs, can help doctors look for a tuboovarian abscess.

The most definitive test for PID is laparoscopy (la-pa-ROS-ko-pee), a surgical procedure in which a narrow device is inserted through a small incision into the abdomen so the doctor can look inside the belly. Laparoscopy usually is done only if treatment is not working or if the doctor suspects the woman may have another condition, such as appendicitis (a-pen-di-SY-tis), that requires emergency surgery.

How Is PID Treated?

Combinations of antibiotics (an-ty-by-OT-iks) that fight a wide range of bacteria are given for at least 2 weeks, usually in pills to be taken at home. If a woman is pregnant or particularly ill, she usually is hospitalized for at least a few days and given antibiotics intravenously ^* .

If a woman has an abscess, it may need to be drained through a tube or catheter (CATH-e-ter) inserted into the abdomen. If an abscess ruptures, or breaks open, immediate surgery is necessary.

If a woman has PID, any man who had sex with her in the previous 2 months should be treated for possible chlamydial infection and gonor-rhea. Even if he has no symptoms, chances are high that he is infected and could reinfect the woman or other partners.

How Can PID Be Prevented?

Like chlamydial infections and gonorrhea, PID most surely is prevented by not having sex. A sexually active woman is most protected if she has sex only with one faithful partner, that is, a partner who has sex only with her. Short of that, a woman should limit her sexual partners. Latex condoms worn by the man during sexual activity can prevent PID if they are used correctly at all times.

A woman should seek immediate treatment if she suspects that she, or a sexual partner, has a sexually transmitted disease. Because these diseases often cause no symptoms, health officials recommend that all sexually active young women, especially teenagers, get tested routinely for chlamydial infections and gonorrhea. When chlamydial infection screening of young women was tried as an experiment, it reduced the number of cases of PID.