Overview of Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) is an infection of the reproductive organs, occurring when bacteria travels through cervix to the uterus and fallopian tubes. PID can cause infertility, ectopic pregnancy, chronic pelvic pain, tubal or ovarian abscesses, adhesions, peritonitis (infection of a silk-like lining that covers the abdominal organs) and perihepatitis (inflammation of the coating of the liver). In rare, severe cases, untreated PID can lead to death.

Pelvic inflammatory disease can be acute (meaning sudden, severe symptoms), chronic (long-term with less intense symptoms) or silent (no symptoms.)

With PID, the presence or lack of symptoms do not indicate how much damage the reproductive organs sustain. It's possible to have no symptoms and have serious blockages and adhesions, leading to infertility. Some women will only discover they have PID after trying to conceive unsuccessfully or after experiencing an ectopic pregnancy.

According to the U.S. Centers for Disease Control and Prevention, approximately 2.5 million women in the U.S. have been diagnosed with PID at some point in their lives. Because many cases of PID are silent and involve no symptoms, and PID is often missed or undiagnosed, the actual number of cases of PID is likely higher.

Causes

PID is usually caused by sexually transmitted diseases (STDs). Common causes include chlamydia and gonorrhea. Chlamydia is a common cause of silent PID, which means many women do not know they are infected. However, some bacteria that are normally found in the vagina can lead to PID if they're overgrown enough to cause bacterial vaginosis.

If you have an undiagnosed STD, your risk of PID is higher any time the cervix is open and infection can potentially enter the uterus. You have a higher risk of PID if you douche or if you've recently had an IUD inserted or had a miscarriage or abortion.

How Does It Cause Infertility?

According to the CDC, about 1 of 8 women with a history of PID will have trouble getting pregnant.

The most common cause of PID-related infertility is blocked fallopian tubes. The tubes typically become blocked from the adhesions caused by the inflammation, and the blockage is usually found closer to the ovaries than the uterus. When the blockage is near the ovaries, it's more difficult to treat surgically.

PID may also cause hydrosalpinx. This occurs when a tube is blocked near the ovary and then dilates and fills with fluid. The presence of a hydrosalpinx can decrease the chances for successful IVF treatment.

Ectopic pregnancies can also be caused by PID-related damage. If you undergo surgery to repair tubal damage caused by PID, your risk of ectopic pregnancy will also be higher.

In rare cases, an especially acute infection may lead to an emergency hysterectomy.

In the past, some doctors treated chronic PID with hysterectomy, but this is being used less and less. If your doctor suggests a hysterectomy as a cure for chronic PID, you may want to get a second opinion before making a decision that will seriously impact your future reproductive possibility. See more about this below, under Treatments for PID.

Symptoms

Symptoms of pelvic inflammatory disease differ from person to person, depending on whether or not they are experiencing acute, chronic or silent PID.

The most common symptoms of PID is pelvic pain. Other symptoms include pelvic pain during intercourse, lower back pain, irregular menstrual bleeding, unusual vaginal discharge, problems with urination, flu-like symptoms, like fatigue, fever, chills, weakness or swollen lymph nodes; lack of appetite, diarrhea, and vomiting, and infertility.

Many of the symptoms can be mistaken for other diseases, including appendicitis, endometriosis or a urinary tract infection. It is important to be upfront with your doctor if you suspect you may have contracted an STD or you have other risk factors for PID, like a recent miscarriage, childbirth, abortion, or IUD insertion.

It's not usual for chronic PID to go undiagnosed for months or years. If you're experiencing regular pelvic pain or pain during intercourse, and your doctor has not been able to diagnose or treat the problem successfully, you may want to seek a second opinion.

Keep pushing until you find appropriate treatment for your symptoms. Your future fertility and overall health depend on it.

Diagnosis

Doctors diagnose PID by assessing your signs and symptoms, analyzing vaginal and cervical cultures, conducting urine and blood tests, performing a pelvic exam and evaluating vaginal discharge.

While vaginal cultures will usually uncover an STD or other bacterial infection, they will not always detect an infection that has traveled to the uterus and fallopian tubes.

Other tests your doctor may use to help diagnose PID include pelvic ultrasound, falloposcopy, laparoscopy, and endometrial biopsy.

Because some tests can unintentionally push bacteria from the vaginal and cervical area to the uterus and fallopian tubes, it's important that basic STD cultures are taken before invasive testing is done and that any infection found is treated.

Potential Treatments

Oral antibiotics are most often used to treat PID. Determining which organism is causing your PID may be difficult, and sometimes, more than one kind of bacteria may be involved. For this reason, you may be prescribed two or more antibiotics to take at once.

Because of the risk of serious complications and potential damage to your fertility, treatment is often started before all the results are back. The results, however, may indicate that a different antibiotic is necessary for successful treatment, so your doctor may change your treatment midway.

Antibiotics may also be delivered via injection. Acute or difficult-to-treat cases may be treated intravenously, which may require hospitalization.

While it's common to feel better after a few days of antibiotic treatment, it is very important that you complete your antibiotic regime. Not doing so may lead to the bacteria becoming resistant to the antibiotics, making it difficult or impossible to treat.

Your sexual partner or partners must also be treated, even if they have no symptoms. Otherwise, you may keep passing the bacteria responsible for the PID back and forth. You should also use a condom during intercourse during treatment, to avoid reinfection.

In some cases, surgery may be necessary to treat abscesses or particularly painful adhesions. In extremely rare cases, an emergency hysterectomy may be performed.

Prevention

Since PID is caused by a sexually transmitted disease, it is preventable. Unprotected sex with multiple partners increases your risk of getting PID. If you are not in a committed relationship with a partner who has already been tested for STDs, practicing safe sex by using male latex condoms and getting regular STD testing is essential.

IUD insertion can also lead to PID if you already have an STD. Testing and treatment for STDs prior to IUD insertion can greatly reduce your risk of infection.

Also, douching has been found to increase your risk of PID. Douching alters the natural flora and pH of the vagina, increasing your risk of vaginal infection. Douching also negatively impacts cervical mucus, which is important when trying to conceive.

Invasive fertility testing, like HSG and hysteroscopy, and fertility treatments that involve the cervix and uterus like insemination or IVF, can lead to PID if you have an undiagnosed STD. This is one reason why most fertility clinics conduct STD testing and vaginal cultures before conducting fertility testing and treatment.

If you've had unprotected sex that may have exposed you to an STD, and you are in the middle of fertility testing or treatment, be sure to tell your doctor so you can be retested.