Pelvic Inflammatory Disease (PID)

What is Pelvic Inflammatory Disease (PID)?

Pelvic inflammatory disease (PID) refers to an infection that affects one or more upper reproductive organs, such as the uterus, fallopian tubes, and ovaries. If untreated, this condition can lead to the formation of scar tissue and abscesses (infected fluid pockets) within the reproductive tract. This could eventually result in irreversible damage. PID symptoms can be mild or subtle, and some women have no symptoms. This means that one may not be aware they have the condition until they experience chronic pelvic pain or difficulty becoming pregnant.

Symptoms

The signs and symptoms of PID can be mild and hard to detect. Sometimes, women might not exhibit any symptoms at all. However, when symptoms do occur, they often include the following:

• Pain in the pelvis and lower abdomen, which ranges from mild to severe
• Abnormal or heavy vaginal discharge, sometimes with an unpleasant smell
• Unusual vaginal bleeding, particularly during or after intercourse or between periods
• Pain during sexual intercourse
• Fever that might be accompanied by chills
• Frequent, painful, or difficult urination

Causes

Various kinds of bacteria can lead to pelvic inflammatory disease. However, the most recognised culprits are gonorrhoea and chlamydia. These bacteria are often transmitted through unprotected intercourse. Less frequently, bacteria can enter the reproductive tract when the cervix's natural barrier is disrupted, such as during menstruation, childbirth, abortion, or miscarriage. Also, bacteria might enter the reproductive system while inserting an intrauterine device (IUD) or during a procedure involving instruments insertion into the uterus. This is, however, rare.

Risk Factors

Some of the risk factors that can contribute to PID are:

• Being sexually active and under the age of 25
• Having more than one sexual partner
• Being in a sexual relationship with a person who has multiple partners
• Not using a condom during intercourse
• Frequently douching, which can disturb the balance of harmful and good bacteria in the vagina and may conceal symptoms
• Having a history of PID or another sexually transmitted infection

There is a slightly elevated risk of pelvic inflammatory disease following IUD insertion, especially within the first three weeks after insertion.

Complications

Untreated PID can lead to the development of scar tissue and abscesses or pockets of infected fluid in the reproductive tract. Eventually, these could result in permanent damage to the reproductive organs. Possible complications include:

• Ectopic pregnancy: PID is a leading cause of ectopic (tubal) pregnancy. Scar tissue from untreated PID can form in the fallopian tubes, preventing a fertilised egg from reaching the uterus. Instead, it implants in the fallopian tube, which can result in severe, life-threatening bleeding and necessitates emergency medical care.
• Infertility: PID can damage the reproductive organs and lead to infertility or the inability to conceive. The possibility of infertility increases with each occurrence of PID. Also, delayed treatment contributes to a higher risk of infertility.
• Chronic pelvic pain: PID can result in pelvic pain that persists for months or even years. Scarring that occurs in the fallopian tubes and other pelvic organs could trigger pain during sex and ovulation.
• Tubo-ovarian abscess: PID can lead to abscesses (buildup of pus) developing in the reproductive tract. While this mostly affects the ovaries and fallopian tubes, abscesses might also form in the uterus or other pelvic organs. Untreated abscesses can cause life-threatening infections.

Diagnosis

No single test can conclusively diagnose PID. Therefore, doctors often depend on a combination of results from the following:

• Medical history: Your doctor is likely to inquire about your history of STIs, sex habits, and birth control methods.
• Signs and symptoms: It's important to share any symptoms you have with your provider, even when they are subtle.
• Pelvic examination: The doctor will perform a pelvic exam to check for tenderness and swelling in the pelvic area. They can also collect fluid samples using cotton swabs from the vagina and cervix. The obtained samples will then be examined in the lab for organisms and infections like gonorrhoea and chlamydia.
• Blood and urine tests: These tests can be used to check for pregnancy, HIV, and other STIs, or to examine white blood cell levels and other infection or inflammation markers.
• Ultrasound: This imaging test uses sound waves to produce pictures of the reproductive organs.

If the diagnosis remains unclear, these additional tests may be ordered:

• Laparoscopy: A thin, illuminated instrument is inserted through a tiny cut in the abdomen to see and examine the pelvic organs.
• Endometrial biopsy: A tiny tube is inserted into the uterus to collect a small endometrial tissue sample, which is then examined for signs of inflammation and infection.

Treatment

Immediate treatment with medication can help eliminate the infection causing PID. However, it cannot reverse the reproductive tract damage and scarring the condition may have caused. Treatment options for PID typically include:

• Antibiotics: The doctor will recommend antibiotic combinations, which you should begin immediately. Once the lab test findings are out, your prescription might be adjusted to better target the exact cause of the infection. After about three days, you will likely have a follow-up appointment to ensure the treatment is effective. It's essential to complete the entire course of medication, even when you start feeling better.
• Treatment for your partner: To avoid reinfection with an STI, it's crucial that your sexual partner (or partners) undergo testing and receive treatment as well. Sometimes, infected partners may not show any symptoms.
• Temporary abstinence: You should refrain from sexual intercourse until your treatment is done, and symptoms resolve.

Hospitalisation might be necessary for those who are severely ill, pregnant, have a suspected abscess, or aren't responsive to oral medicines. In these cases, intravenous antibiotics may be prescribed followed by oral antibiotics. Surgery isn't always required, but the doctor might recommend the procedure to drain the abscess if it ruptures or shows signs of rupture. Additionally, surgery might be an option if antibiotic treatment is not effective or if there is uncertainty in the diagnosis, especially when one or more PID signs or symptoms are unnoticeable.

Prevention

Consider these preventive measures to lower the risk of developing PID:

• Practising safe sex: It's important to always use condoms during sex, minimise the number of sexual partners, and discuss sexual history with potential partners.
• Consult your doctor regarding contraception: While most types of contraception don't usually prevent PID, barrier methods like condoms lower the risk. Despite using birth control pills, you should always use a condom during intercourse with new partners to avoid contracting STIs.
• Undergo tests: You should schedule a testing appointment with your healthcare provider if you have an increased risk of STIs. Establish a frequent screening routine if necessary. Remember that early detection and treatment of STIs can effectively help prevent PID.
• Ask your partner to get tested: If you have PID or an STI, encourage your partner to get tested and receive treatment to avoid the spread of infections and the recurrence of PID.
• Avoid douching: Douching disrupts the normal balance of bacteria in the vagina, which increases the risk of PID.

Coping and Support

Having PID can be challenging and stressful, especially when dealing with STIs, chronic pain, or potential infertility. The following strategies can assist you in coping with the difficulties that come with diagnosis:

• Receive treatment: PID mostly results from an STI. Discovering that you are infected with an STI can be distressing for both you and your partner. However, it is important that both of you seek treatment immediately to reduce the severity of the condition and avoid reinfection.
• Be ready: Experiencing multiple episodes of PID increases the possibility of infertility. So, if you are struggling to conceive, schedule an infertility assessment. Your doctor will inform you of the steps involved in infertility tests and treatment. You can minimise some of your anxiety by understanding the procedure.
• Seek assistance: Problems related to infertility, sexual health, and chronic pain can be very personal. Therefore, it's advisable to seek support from close family members, your partner, friends, or an expert. Several online support groups can also provide a platform to talk about your concerns while maintaining anonymity.

Preparing for Your Appointment

You should schedule an appointment with your doctor if you are experiencing signs of PID. Here's how you can prepare for the visit and what to expect in general.

What to do:

• Be conscious of any pre-appointment limits. When making an appointment, inquire if there are any specific things you should do beforehand.
• Note down the symptoms you are having. This includes anything unrelated to your condition and why you made the appointment.
• List all the medicines, supplements, or vitamins you are currently using.
• Write down all the necessary questions to discuss with your doctor.

The basic questions you should ask your provider are:

• What types of tests do I require?
• Is this an STI?
• Should my partner undergo testing and get treatment?
• Should I abstain from sexual intercourse during treatment? How long do I need to wait?
• How do I prevent PID episodes in the future?
• Will the condition impact my ability to conceive?
• Is a generic alternative to the prescribed medications available?
• Can I receive treatment at home? Or do I need to visit the hospital?
• Are there any printed materials I can take? Which websites would you suggest?
• Do I have to return for a follow-up