Pelvic inflammatory disease is an infection involving the mouth of the womb (cervix), the womb it self (uterus), one or both fallopian tubes and the ovaries. The infection may even spread beyond the female reproductive organs to involve other organs and tissues in the abdomen like the intestines.
It is commonly known by the abbreviation PID. It is a common cause of lower abdominal pain or pelvic pain in women between 15 and 50 years of age.
This infection often starts from the vagina and or the cervix and spreads up to the womb and the other organs as mentioned above. It may lead to the formation of pus in the womb or the tubes or even in the abdomen.
PID is the leading cause of infertility in women due to repeated infection or one single chronic infection not detected or properly treated on time. The infection blocks and destroys the fallopian tubes, or causes the womb’s surface to gum together and preventing the sperm to be able to swim upwards to meet the eggs in the tube close to the ovary, or prevent a fertilized egg finding space in the womb to grow.
Pelvic inflammatory disease is also a leading cause of ectopic pregnancy . It is also a cause of chronic pelvic pain and abdominal pain during sex in women of child bearing age.
A Common Disease
Pelvic infection is so common that the true estimate of women with this disease can not be reliably assessed. The disease is often diagnosed late, as signs and symptoms of PID take a while to show up.
In the US, over 1 million women are diagnosed with PID yearly, with over 50,000 becoming infertile as a result annually and about a quarter of a million needing hospitalization.
In the UK, thousands of women require hospitalization due to serious infections causing pelvic inflammatory disease.
All sexually active women are at risk of developing PID. It is important to mention here that even though sexually transmitted diseases (STD’s) are the commonest cause of Pelvic inflammatory disease, PID can be caused by other non-sexual means. Apart from being a sexually active woman, other factors that could increase your risk of developing pelvic inflammatory disease includes:
Who is at Risk of Developing PID
- Multiple Sexual Partners
If you or your partner have more than one person with whom sexual intimacy is enjoyed, this increase the likelihood of you contracting a sexually transmitted disease, which could progress to PID. Gonnorrhea and Chlamydia are the leading sexually transmitted disease causing PID in women, and are almost exclusively acquired through multiple sexual partners and practices of unsafe sexual acts, including non-use of the condom and other protective sexual devices.
- Sex During Menses
Having sex during menses or sex during menstruation has been reported to increase the likelihood of developing PID (Barrett and Taylor, 2005). This has been linked to the fact that during menstruation, the uterus fails to produce the normal slime (mucus) that protects it from invasion by external bugs, thus its raw surface can easily be infected by almost any bug. So, avoid sex during menstruation if you can.
- Cigarette Smoking
Yes. Cigarette smoking increases the risk of developing pelvic inflammatory disease by damaging the ability of the little hair-like structures called cilia to move secretions and germs off the reproductive tract, the same way it affects the lungs. It also reduces your general immunity or ability to fight infection.
- Use of Intrauterine Contraceptive Device
Are you using an IUCD also called uterine coils or Intra Uterine Contraceptive Device for pregnancy prevention? Because this is a foreign object, bacteria and other bugs that causes PID can easily cling to it once in the womb and use it as a platform to spread. Generally, PID is one of the risk associated with the use of these coils, but having new sexual partners, or worse still, multiple sexual partners with the use of these coils substantially increases ones chances of developing pelvic inflammatory disease.
- Termination of Pregnancy
This is the second leading route of acquiring PID in the developing world. Termination of pregnancy under non sterile environment and use of unsterilized instruments albeit by quacks puts a woman’s life in grave danger, both from immediate post abortal sepsis (infection of the womb after abortion) and if it spreads and linger, pelvic inflammatory disease.
Some may want to know if there is a relationship between PID and the pills. No. The use of oral contraceptive pills does not increase the risk of developing Pelvic inflammatory disease.
How Do I know If I Have PIDIt is difficult to know at an early stage if one has PID. It usually starts with a sexually transmitted disease that is not well treated.
If one has a sexually transmitted disease in the past, and now develops lower abdominal pain around the bikini line, or just above there, with the pain always there like a dull ache, then take steps to see your physician.
There may be associated vaginal discharge which may be foul smelling.
A common symptom of pelvic inflammatory disease is pain during sex. Some women with PID bleed too after sex or have prolonged menses.
In very serious cases of PID, there may be fever, rigors, feeling unwell, vomiting, with this cramping lower abdominal pain along with the above symptoms.For more detailed discussion of these symptoms, see the page on symptoms of Pelvic inflammatory disease.
Test Available For Pelvic Inflammatory DiseaseBecause there are so many other illness that mimics pelvic inflammatory disease (see below), there is the need to carry out test to confirm the diagnosis of PID.
Test Available includes:
- Laparoscopy or Keyhole Camera Test. If your doctor thinks that you have pelvic inflammatory disease, the single most important test he or she will want to offer is the keyhole camera test called laparoscopy. Some may not find this to be necessary though… depending on local or regional policy. This involves a mini operation, where a nick, the size of a key hole is made in your tummy, and a camera with a very powerful telescope and light source attached is used to look into your pelvic cavity and see your womb tubes and ovaries directly. If you have PID, these may be red, with or without pus collection see. A swab is taken of this free from contamination, and sent to the lab. If it grows any organism, then it confirms that you have PID.
Swabs from the vaginal and cervix are often not too good at confirming diagnosis, as these may become contaminated.
- Ultrasound Scan. This is often requested in the investigation of pelvic inflammatory disease. It itself can not confirm the diagnosis, but some changes in the pelvic organs caused by PID can be seen on Ultra sound scan, like pus collection in the pelvic, or adhesions joining the surface of the womb together, or ballooning of a tube due to collection of pus in it.
- Blood Test. Several blood test would normally be requested in the course of investigating a woman for pelvic inflammatory disease. These includes Full Blood Count(FBC) also called complete blood count (CBC) in the USA. This is a very crude indicator of the presence of inflammation anywhere in the body, including the pelvis. Where infection or inflammation exists, the white blood cells count which is a component of the FBC will rise above 10,000.
Another important blood test is pregnancy test. This is perhaps the most important initial test, as ectopic pregnancy remains the commonest mimicker of pelvic inflammatory disease. Many women have died needlessly from a delayed or mistaken diagnosis of ectopic pregnancy!
Other blood tests include CRP, ESR, blood biochemistry and the VDRL (Venereal Disease Research laboratory) test to ascertain the presence of venereal diseases like syphilis, and gonorrhoea.
- Urine Test. This is an important test to perform in all case of suspected PID, to rule out bladder infection or cystitis and kidney infections both which can also mimic pelvic inflammatory disease.
Do not just take it that you have pelvic inflammatory disease. You may be having other disease conditions that causes lower abdominal pain in women or even men. These include :
Disease Conditions That Mimics PID
Mittleschmerz or Mid-Cycle Pain
Urinary tract infection
TreatmentPelvic inflammatory disease treatment is basically centered around prompt diagnosis, use of high dose antibiotics, bed rest and effective pain relieve with suitable pain killers.
The choice of antibiotics is informed by the type of organism suspected or confirmed after testing.
For complicated PID, treatment may include surgical operations.
Please see the section on treatment of Pelvic inflammatory disease for more comprehensive information on treatment of pelvic inflammatory disease, as well as the section on chronic pelvic inflammatory disease .
All information provided here are from latest medical articles on pelvic inflammatory disease, a few of the references listed below.
If you want further information directly from medical articles on pelvic inflammatory disease, please see the medical articles on PID here.
1. Barrett, S. and Taylor, C. (2005) A review on pelvic inflammatory disease. International Journal of STD & AIDS 16(11), 715-720
2. Undergraduate Obtretricks and Gynaecology by M G R Hull, D N Joyce and Gillian Turner
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