Pelvic inflammatory disease (PID)

Definition

Pelvic inflammatory disease is a general term for infection of the uterus lining, fallopian tubes, or ovaries.

See also: Endometritis

Alternative Names

PID; Oophoritis; Salpingitis; Salpingo-oophoritis; Salpingo-peritonitis

Causes

Most cases of pelvic inflammatory disease are caused by the same bacteria that lead to sexually transmitted diseases (such as chlamydia, gonorrhea, mycoplasma, staph, and strep).

The most common cause of pelvic inflammatory disease is through sexual contact. However, bacteria may also enter the body after gynecological procedures such as:

• Childbirth
• Endometrial biopsy
• Insertion of an intrauterine device (IUD)
• Miscarriage
• Therapeutic or elective abortion

In the United States, nearly 1 million women develop PID each year. About 1 in 8 sexually active adolescent girls will develop PID before age 20. Since PID is often undiagnosed, statistics are probably greatly underestimated.

Risk factors include:

• Insertion of an IUD
• Multiple sexual partners
• Past history of any sexually transmitted disease
• Past history of PID
• Sexual activity during adolescence

Birth control pills are thought in some cases to lead to cervical ectropion, a condition that allows easier access to tissue where bacteria may grow. However, birth control pills may protect against PID by stimulating the body to produce a thicker cervical mucus. This makes it harder for semen to carry bacteria to the uterus.

Symptoms

The most common symptoms of PID include:

• Fever (not always present; may come and go)
• Pain in the abdomen or pelvis
• Vaginal discharge with abnormal color, texture, or smell

Other symptoms that may occur with PID:

• Bleeding after intercourse
• Chills
• Fatigue
• Frequent urination
• Increased menstrual cramping
• Increased pain during ovulation
• Irregular menstrual bleeding or spotting
• Lack of appetite
• Low back pain
• Nausea, with or without vomiting
• No menstruation
• Painful sexual intercourse
• Pain with urination
• Tenderness

Note: There may be no symptoms. People who experience an ectopic pregnancy or infertility often have silent PID, which is usually caused by chlamydia infection.

Exams and Tests

You may have a fever and abdominal tenderness. A pelvic examination may show:

• A cervix that bleeds easily
• Cervical discharge
• Pain with movement of the cervix
• Tenderness in the uterus or ovaries

Tests and procedures may include:

• Endocervical culture for gonorrhea, chlamydia, or other infections
• Erythrocyte sedimentation rate (ESR)
• Laparoscopy
• Pelvic ultrasound or CT scan
• Serum HCG (pregnancy test)
• WBC count
• Wet prep or wet mount microscopic examination

Treatment

If you are diagnosed with mild PID, you may be given antibiotics and told to closely follow-up with your health care provider.

More severe cases may require you to stay in the hospital. Antibiotics are first given by IV, and then later by mouth. Which antibiotic is used depends on the type of infection.

• A number of different antibiotics may be used for treating infections that occur after gynecological procedures.
• Chlamydia can be treated with a variety of antibiotics, including azithromycin, tetracyclines, quinolones, and erythromycin. Erythromycin and azithromycin are safe in pregnant women.
• See gonorrhea for its specific treatment recommendations.

Surgery may be considered for complicated cases that do not improve with antibiotics. Any sexual partner(s) must also be treated. It is essential that you use condoms during treatment.

Possible Complications

PID infections can cause scarring of the pelvic organs, possibly leading to:

• Chronic pelvic pain
• Ectopic pregnancy
• Infertility

When to Contact a Medical Professional

Call your health care provider if you have symptoms of PID. Also call if you think you have been exposed to a sexually transmitted disease or if treatment of a current STD does not seem to be working.

Prevention

Preventive measure include:

• Get prompt treatment for sexually transmitted diseases.
• Practice safer sex behaviors. The only absolute way to prevent an STD is to not have sex (abstinence). Having a sexual relationship with only one person (monogamous) can reduce the risk. Use a condom every time you have sex. (See: Safe sex.)

You can reduce the risk of PID by getting regular STD screening exams. Couples can be tested for STDs before starting to have sex. Testing can detect STDs that may not be producing symptoms yet.

All sexually active women ages 20 - 25 and younger should be screened each year for chlamydia and gonorrhea. All women with new sexual partners or multiple partners should also be screened.

References

Centers for Disease Control and Prevention (CDC). Update to sexually transmitted diseases guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. 2007;56:332-336.

U.S. Preventive Services Task Force. Screening for Gonorrhea: Recommendation Statement. Am Fam Physician. 2005;72:1783-1786.

Meyers D, Wolff T, Gregory K, et al. USPSTF recommendations for STI screening. Am Fam Physician. 2008;77:819-824.

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