Pelvic inflammatory disease (PID)

Causes and Risks:
The same organisms responsible for bacterial sexually-transmitted diseases (such as Chlamydia , gonorrhea , Mycoplasma, staph, strep) cause 90 to 95% of all cases of pelvic inflammatory disease (PID). Although sexual transmission is most common, bacteria may enter the body after gynecological events or procedures such as IUD insertion ( intrauterine device used for contraception), childbirth, spontaneous abortion ( miscarriage ), therapeutic or elective abortion , and endometrial biopsy .

In the United States, nearly 1 million women develop PID each year. It is estimated that 1 in 8 sexually active adolescent girls will develop PID before reaching age 20. Since PID is frequently underdiagnosed, statistics are probably greatly underestimated.

Risk factors include sexual activity during adolescence, multiple sexual partners, a past history of PID, a past history of any STD (sexually transmitted disease), and the use of non-barrier type contraceptives. Use of an IUD may increase the risk of developing PID 2 to 8 times. Oral contraceptives ("the pill") are thought in some cases to enhance cervical ectropion , a condition that allows easier access to tissue where bacteria may thrive. However, oral contraceptives may in other cases have a protective role against developing PID because they stimulate the body to produce a thicker cervical mucous, which is harder for semen (which may contain bacteria) to penetrate. This makes it harder for semen to gain access to the uterus.

Prevention:
Preventive measure include following safer sex behaviors ; following the health care provider's recommendations after gynecological events or procedures; and getting prompt treatment for sexually transmitted diseases. Sexual partners should also get adequate treatment. (See "Prevention" under gonorrhea ).

Symptoms:



Signs and Tests:
A general examination may reveal enlarged lymph nodes in the groin area (inguinal), fever , and abdominal tenderness . Pelvic examination may reveal cervical discharge, cervical tenderness, a friable cervix (one that bleeds easily), uterine tenderness, or adnexal (ovarian) tenderness.

Tests include:



Treatment:
Uncomplicated PID may be treated on an outpatient basis with antibiotics and close follow-up.

More complicated cases or those involving widespread or well- established infection may require inpatient care (hospitalization). Intravenous antibiotics are used, and usually followed with a course of oral antibiotics. Surgery may be considered for complicated, persistent cases that do not respond to adequate antibiotic treatment. Concurrent treatment of sexual partner(s) and the use of condoms throughout the course of treatment are essential.

Prognosis:
In 15% of the cases, the initial antibiotic therapy fails, and 20% experience a recurrence of PID sometime during the reproductive years.

Complications:
The risk for ectopic pregnancy increases from 1 out of 200 to 1 out of 20 after having PID.

Infertility risks also increase:

  • 15% risk of infertility following the 1st episode of PID
  • 30% risk of infertility following 2 episodes of PID
  • 50% risk of infertility following 3 or more episodes of PID



Call Your Healthcare Provider:
Call for an appointment with your health care provider if symptoms of PID occur. Also call if you suspect that you have been exposed to a sexually transmitted disease, or if treatment of a current STD does not seem to be effective.


Pelvic laparoscopy is a surgical procedure used to view the interior of the lower abdomen without major surgery. Small optical instruments can be inserted through the abdominal wall to directly visualize the interior of the abdomen. Some surgeries can be done using laparoscopic techniques. Recovery from this type of surgery, unlike open surgery, often takes only a day and the patient usually returns home the next morning.



This is an illustration of the female reproductive system. Both internal and external views are shown here.



Gonorrhea is a sexually transmitted disease that causes infection of the genitals. The organisms can spread into the bloodstream (gonococcemia). They frequently lodge in the skin surface, forming a small red infected area. Sometimes a person with severe gonococcemia may have only a few skin lesions.