Pelvic Inflammatory Disease

What is Pelvic Inflammatory Disease?

Pelvic Inflammatory Disease (PID) is a serious infection of the female reproductive organs, including the uterus, fallopian tubes, and ovaries. It is most commonly caused by bacteria, such as chlamydia or gonorrhoea, which enter the body through the cervix and spread to other parts of the reproductive system. Symptoms of PID can include pelvic pain, abnormal vaginal discharge, fever, and irregular periods. If left untreated, PID can cause serious complications such as infertility, chronic pelvic pain, and ectopic pregnancy. Treatment typically involves antibiotics to clear the infection and surgery may be necessary in some cases. It is important to practice safe sex and to get screened regularly for STIs to prevent the development of PID.

Symptoms of Pelvic Inflammatory Disease

Symptoms of pelvic inflammatory disease (PID) can include:

• Pain or tenderness in the lower abdomen or pelvis
• Abnormal vaginal discharge or bleeding
• Pain or bleeding during or after sexual intercourse
• Painful urination
• Fever or chills
• Nausea or vomiting
• Fatigue or general malaise

It’s important to note that some women with PID may not have any symptoms at all. If left untreated, PID can cause serious complications such as infertility, ectopic pregnancy, and chronic pelvic pain. If you suspect you may have PID, it’s important to see a healthcare provider as soon as possible for a diagnosis and treatment.

Causes of Pelvic Inflammatory Disease

Pelvic Inflammatory Disease is itself not a disease, but it is a complication of an untreated sexually transmitted infection. There may be many types of bacterial infections behind PID, but gonorrhoea and chlamydia are the most common STIs which lead to Pelvic Inflammation, if not treated timely. Gonorrhoea and chlamydia are usually acquired by means of unsafe sexual activity. Some of the causes of PID are as under;

1. Sexually transmitted infections (STIs): The most common cause of pelvic inflammatory disease (PID) is an untreated STI, such as chlamydia or gonorrhoea. These infections can spread from the cervix to the uterus, fallopian tubes, and ovaries.
2. Bacterial infection: Bacteria can enter the reproductive system through the cervix and cause an infection. This can happen during childbirth, miscarriage, abortion, or a pelvic exam.
3. IUDs: Women who use intrauterine devices (IUDs) for birth control have a higher risk of developing PID because the device can introduce bacteria into the uterus.
4. Pelvic surgery: Women who have had pelvic surgery, such as a hysterectomy or tubal ligation, are at a higher risk of developing PID because the surgery can create an opening for bacteria to enter the reproductive system.
5. Immune system disorders: Women with compromised immune systems, such as those with HIV or lupus, are at a higher risk of developing PID because their bodies are less able to fight off infections.
6. Multiple sexual partners: Women who have multiple sexual partners are at a higher risk of developing PID because they have a greater chance of coming into contact with an infected partner.
7. Douching: Douching can disrupt the balance of bacteria in the vagina and increase the risk of PID.

Risk Factors of Pelvic Inflammatory Disease

There are a number of factors that can increase one’s risk of being a victim of PID, for example;

• Age Factor: The risk of pelvic inflammatory disease (PID) is higher in sexually active people younger than 25 years. This is because the cervix of young women is not fully developed and is more susceptible to infection. Additionally, young people may be more likely to engage in risky sexual behaviours, such as having multiple partners or not using contraception, which increases the risk of contracting sexually transmitted infections (STIs) that can lead to PID. It is important for young people to practice safe sex and get regular STI screenings to reduce their risk of PID.
• Multiple Sex Partners: PID occurs when bacteria move from the vagina or cervix into the uterus, fallopian tubes, or ovaries. Having multiple sex partners increases the risk of PID because it increases the chances of being exposed to sexually transmitted infections (STIs) such as chlamydia and gonorrhoea, which are common causes of PID. These STIs can cause inflammation and irritation in the reproductive organs, which can lead to PID if left untreated.
• Having Sex with the One who has Multiple Sex Partners: Apart from avoiding having multiple sex partners, it is important to abstain from having sex with a person who has multiple sex partners. Having sex with someone who has multiple sex partners increases the risk of contracting PID because it increases the chances of exposure to sexually transmitted infections (STIs), such as chlamydia and gonorrhoea. These infections can cause inflammation and damage to the reproductive organs, leading to PID.
• Unsafe Sex: Unsafe sex, such as having unprotected intercourse or multiple partners, increases the risk of contracting the bacteria causing STIs and developing PID.
• Frequent Douching: Frequent douching can increase the risk of pelvic inflammatory disease (PID). Douching can disrupt the natural balance of bacteria in the vagina and can push bacteria into the upper reproductive tract, leading to infection and inflammation. Additionally, douching can mask the symptoms of an infection, making it more difficult to diagnose and treat. It is recommended to avoid douching and to maintain good hygiene practices instead.
• Past Infections: Having a history of pelvic inflammatory disease (PID) or a sexually transmitted infection (STI) can increase the risk of developing PID in the future. Women who have had PID or an STI in the past are more likely to develop the condition again because the bacteria that cause these infections can remain in the body and cause recurrent infections. Additionally, if a woman has had multiple sexual partners or engages in unprotected sex, she is at a higher risk of developing PID.

Complications of Pelvic Inflammatory Disease

The untreated pelvic inflammatory disease might cause scar tissue and abscesses (pockets of infected fluid) to develop in the reproductive tract. These can cause permanent damage to the reproductive organs.

1. Infertility: Pelvic Inflammatory Disease (PID) can cause damage to the fallopian tubes, making it difficult for the sperm to reach the egg and fertilize it. This can lead to infertility or difficulty getting pregnant.
2. Ectopic Pregnancy: PID can also cause scarring and blockages in the fallopian tubes, which can lead to an ectopic pregnancy, where the fertilized egg implants outside of the uterus, usually in the fallopian tubes.
3. Chronic Pelvic Pain: PID can lead to chronic pelvic pain, which can be caused by the inflammation and scarring of the pelvic organs.
4. Abscesses: PID can cause abscesses, which are collections of pus, to form in the pelvic area. These abscesses can cause severe pain and may require surgery to remove them.
5. Long-term Health Consequences: PID can cause long-term health consequences such as chronic pelvic pain, infertility, and an increased risk of ectopic pregnancy, which can impact a woman’s overall quality of life.
6. Septicemia: Septicemia is a severe complication of pelvic inflammatory disease caused by the spread of bacteria to the bloodstream. If left untreated, septicemia can lead to sepsis which can be fatal.
7. Peritonitis: This is an inflammation of the peritoneum, the lining of the abdominal cavity and can happen as a complication of pelvic inflammatory disease.
8. Oophoritis: This is the inflammation of one or both ovaries. This can be a complication of pelvic inflammatory disease and can cause pain, fever, and other symptoms.
9. Endometritis: This is the inflammation of the endometrium, the lining of the uterus. This can be a complication of pelvic inflammatory disease and can cause pain, fever, and other symptoms.
10. Salpingitis: This is an inflammation of the fallopian tubes. This can be a complication of pelvic inflammatory disease and can cause pain, fever, and other symptoms.

Diagnosis of Pelvic Inflammatory Disease

Your healthcare provider can easily diagnose the condition by PID symptoms, examining your pelvic fluid, and history of infection.

• Lower abdominal pain and tenderness
• Irregular menstrual bleeding
• Vaginal discharge that is foul smelling or yellowish in colour
• Fever or chills
• Fatigue
• Nausea or vomiting
• Pain during intercourse
• Painful urination

If you have any of these symptoms, it is important to see a healthcare provider as soon as possible. They will perform a physical examination and may also perform tests such as a pelvic exam, urine test, or blood test to confirm the diagnosis of PID. In some cases, imaging tests such as ultrasound may also be used to diagnose PID.

Tests to diagnose PID

Blood and urine tests: 

Blood tests for PID typically include a complete blood count (CBC) to check for anaemia (low red blood cell count) and an elevated white blood cell count, indicating inflammation or infection. Other blood tests that may be done include:

• • C-reactive protein (CRP) to measure inflammation
  • Erythrocyte sedimentation rate (ESR) to measure inflammation
  • Liver function tests (LFTs) to check for liver damage or infection
  • Rheumatoid factor (RF) to check for autoimmune disorders
  • Syphilis serology to check for syphilis infection
  • Toxoplasma serology to check for the toxoplasmosis infection
  • HIV serology to check for HIV infection

Urine Tests

Urine tests for PID typically include a urinalysis to check for signs of infection, such as the presence of white blood cells or bacteria in the urine. Other urine tests that may be done include:

• • Chlamydia and gonorrhoea cultures to check for these specific bacterial infections
  • Trichomonas testing to check for trichomoniasis infection
  • Mycoplasma and ureaplasma cultures to check for these specific bacterial infections
  • Pregnancy tests to check for pregnancy as a potential cause of symptoms.

Ultrasound Test

Ultrasound can be used to diagnose pelvic inflammatory disease (PID) by identifying abnormalities in the pelvic organs such as the uterus, ovaries, and fallopian tubes. The ultrasound technician will look for signs of inflammation, fluid accumulation, and other abnormalities that can indicate PID. Additionally, the technician may also measure the thickness of the endometrium and the size of the ovaries, which can be used to help diagnose PID. However, ultrasound is not always accurate in diagnosing PID, and it should be used in conjunction with other diagnostic methods such as clinical examination and laboratory tests.

Laparoscopy

Laparoscopy can be used to diagnose pelvic inflammatory disease (PID), but it is not typically the first diagnostic tool used. PID is typically diagnosed based on a combination of symptoms, physical examination, and laboratory test results.

If a woman has severe symptoms or has not responded to initial treatment, a laparoscopy may be performed to confirm the diagnosis of PID. During the procedure, a small incision is made in the abdomen, and a laparoscope (a thin, lighted tube with a camera) is inserted to view the pelvic organs. The surgeon can see if there is inflammation, scarring, or other abnormalities in the reproductive organs, which can help confirm the diagnosis of PID.

It’s important to note that laparoscopy carries some risks, including infection, bleeding, and damage to the organs or surrounding tissue. Therefore, it is usually only considered when other diagnostic methods have not provided a clear diagnosis.

Endometrial Biopsy

In the rare case, your healthcare provider may use an endometrial biopsy to diagnose PID. During this procedure, your provider inserts a thin tube into the uterus to remove a small sample of endometrial tissue. The tissue is tested for signs of infection and inflammation. PID is typically diagnosed based on a combination of symptoms (such as abdominal pain, fever, and abnormal vaginal discharge) and laboratory tests (such as a pelvic exam, pelvic ultrasound, and tests for sexually transmitted infections). An endometrial biopsy may be used to diagnose or rule out other conditions, such as endometrial cancer or abnormal growths in the uterus.

Prevention and Treatment of Pelvic Inflammatory Disease

To prevent pelvic inflammatory disease (PID), it is important to practice safe sex by using condoms and limiting the number of sexual partners. It is also important to be tested and treated for sexually transmitted infections, as these can increase the risk of developing PID. Additionally, women should make sure to have regular gynaecological check-ups, and if you have any symptoms of PID such as abnormal vaginal discharge, pain in the lower abdomen or pelvis, or fever, seek medical attention immediately.

1. Practice safe sex: Use condoms and practice safe sexual practices to prevent the spread of sexually transmitted infections, which are common causes of pelvic inflammatory disease.
2. Get regular pelvic exams: Regular check-ups can help detect any signs of infection early on, allowing for prompt treatment.
3. Get tested for STIs: Get tested for sexually transmitted infections regularly and get treated if you test positive.
4. Avoid multiple partners: Having multiple sexual partners increases the risk of contracting an STI, so limit your number of partners.
5. Take antibiotics as prescribed: If you are diagnosed with an STI, take antibiotics as prescribed by your healthcare provider to prevent the spread of the infection.
6. Practice good hygiene: Always clean your genitals before and after sexual activity, and urinate after intercourse to flush out any bacteria.
7. Seek treatment for any symptoms: If you experience symptoms such as pelvic pain, heavy bleeding, or abnormal discharge, seek medical attention immediately.
8. Get vaccinated: Get vaccinated against HPV and Hepatitis B to prevent these infections from leading to pelvic inflammatory disease.

Medications and Treatment

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• Pelvic Inflammatory Disease
• Mycoplasma Genitalium (MGen)
• Human Papillomavirus Infection
• Genital Herpes
• Ramsay Hunt syndrome