- Pelvic Inflammatory Disease (PID)
inflammatory disease (PID) is a general term that refers
to infection of the fallopian tubes (tubes that carry
eggs from the ovary to the womb) and of other internal
reproductive organs in women. It is a common and serious
complication of some sexually transmitted diseases (STDs).
Inside the lower abdominal cavity, PID can damage the
fallopian tubes and tissues in and near the uterus and
ovaries. Untreated PID can lead to serious consequences
including infertility, ectopic pregnancy, abscess formation,
and chronic pelvic pain.
How common is PID?
year in the United States, more than 1 million women experience
an episode of acute PID. More than 100,000 women become
infertile each year as a result of PID, and a large proportion
of the ectopic pregnancies occurring every year are due
to the consequences of PID. More than 150 women die from
this infection every year.
occurs when bacteria move upward from a woman's vagina
or cervix into the internal reproductive organs. Sexually
active women in their childbearing years are most at risk.
Many different organisms can cause PID, but most cases
are associated with gonorrhea and chlamydia, two very
common bacterial STDs. It is estimated that 10% to 80%
of women with either of these STDs will develop symptomatic
are the symptoms of PID?
of PID vary from none to severe. Particularly when it
is caused by chlamydial infection,
PID may produce only mild symptoms or no symptoms at all,
even while it is seriously damaging the internal reproductive
organs. Because of the vague symptoms, PID goes unrecognized
both by women and by their health care providers about
two thirds of the time. Women who do have symptoms of
PID most commonly have lower abdominal pain. Other signs
and symptoms include fever, unusual vaginal discharge
that may have a foul odor, painful intercourse, painful
urination, irregular menstrual bleeding, and pain in the
right upper abdomen (rare).
are the complications of PID?
and complete treatment can help prevent complications
of PID. Without treatment, PID can cause permanent damage
to the female internal reproductive organs. Infection-causing
bacteria can silently invade the fallopian tubes, causing
normal tissue to turn into scar tissue. Scar tissue blocks
or interrupts the normal movement of eggs into the uterus.
If the fallopian tubes are totally blocked by scar tissue,
an egg will not be fertilized by sperm or move to the
uterus to develop into a baby. Totally blocked fallopian
tubes cause a woman to be infertile. Infertility can also
occur if the fallopian tubes are partially blocked or
even slightly damaged. About one in five women with PID
become infertile. If a woman has multiple episodes of
PID, her chances of becoming infertile are increased.
addition, a partially blocked or slightly damaged fallopian
tube may cause a fertilized egg to get stuck in the
tube. This fertilized egg may begin to grow in the tube
as if it were in the womb. This is an ectopic pregnancy,
which is a pregnancy in the fallopian tube or elsewhere
outside the uterus. As it grows, an ectopic pregnancy
can rupture the fallopian tube and cause severe pain,
internal bleeding, and even death. Scarring in the fallopian
tubes and other pelvic structures can also cause chronic
pelvic pain (pain that lasts for months or even years).
Women with repeated episodes of PID are more likely
than women with a single episode to suffer infertility,
ectopic pregnancy, or chronic pelvic pain.
is PID diagnosed?
is difficult to diagnose because the symptoms are often
subtle and mild. Many episodes of PID go undetected because
the woman or her health care provider fails to recognize
the implications of mild or nonspecific symptoms. Because
there are no precise tests for PID, a diagnosis is usually
based on clinical findings. If symptoms such as lower
abdominal pain are present, a health care provider should
perform a physical examination to determine the nature
and location of the pain and check for fever, abnormal
vaginal or cervical discharge, and for evidence of gonorrhea
or chlamydia infection. If
the findings suggest PID, treatment is necessary.
more information is necessary, the health care provider
may order other tests to identify the infection-causing
organism or to distinguish between PID and other problems
with similar symptoms. A pelvic ultrasound is a procedure
that may be helpful in evaluating someone for PID. An
ultrasound can view the pelvic area to see whether the
fallopian tubes are enlarged or whether an abscess is
present. In some cases, a laparoscopy may be necessary
to confirm the diagnosis. A laparoscopy is a minor surgical
procedure in which a thin, flexible tube with a lighted
end (laparoscope) is inserted through a small incision
in the lower abdomen. This procedure enables the doctor
to view the internal pelvic organs and to take specimens
for laboratory studies, if needed.
is the treatment for PID?
can be cured with antibiotics. If women have pelvic pain
and other symptoms caused by PID, it is critical that
they seek care immediately. Prompt antibiotic treatment
can prevent severe damage to pelvic organs. The longer
women delay treatment for PID, the more likely they are
to be infertile or to have an ectopic pregnancy in the
future because of damage to the tubes. However, antibiotic
treatment does not reverse any damage that has already
occurred to the reproductive organs.
of the difficulty in identifying organisms infecting
the internal reproductive organs and because more than
one organism may be responsible for an episode of PID,
PID is usually treated with at least two antibiotics
that are effective against a wide range of infectious
agents. These antibiotics can be given by mouth or by
vein. The symptoms may go away before the infection
is cured. Even if symptoms do go away, women should
finish taking all of the medicine. This will help prevent
the infection from returning. Women on treatment for
PID should be re-evaluated by their health care provider
two to three days after starting treatment to be sure
the antibiotics are working to cure the infection. In
addition, women's sex partners should be treated to
decrease the risk of re-infection, even if the partners
have no symptoms. Many women with PID have sex partners
who have no symptoms, although their sex partners may
be infected with the organisms that can cause PID.
one fourth of women with suspected PID must be hospitalized.
Hospitalization may be recommended if the woman is severely
ill (e.g., high fever) or pregnant; if she cannot take
oral medication and needs intravenous antibiotics; if
the diagnosis is uncertain; or in some cases, if she
is infected with HIV (human
immunodeficiency virus, the virus that causes AIDS).
If symptoms continue or if an abscess does not resolve,
surgery may be needed. Complications of PID, such as
chronic pelvic pain and scarring are difficult to treat
but are sometimes improved with surgery.
is at risk for PID?
with STDs--especially gonorrhea
and chlamydia--are at increased
risk for developing PID. A prior episode of PID increases
the risk of another episode because the body's defenses
are often damaged during the initial bout of infection.
active women under age 25 are more likely to develop PID
than are women older than 25.
more sex partners a woman has, the greater her risk of
developing PID. Also, a woman whose partner has more than
one sex partner is at greater risk of getting PID, because
of the potential for more exposures to infectious agents.
who douche have a higher risk of developing PID compared
with women who do not.
who have an intrauterine device (IUD) inserted may have
a slightly increased risk of PID compared with women using
other contraceptives or no contraceptive at all. However,
this risk is greatly reduced in women being screened and
treated for any infections before an IUD is inserted.
In addition, mutual monogamy is encouraged for women who
choose to use this form of contraception to decrease the
risk of getting PID.
can PID be prevented?
main cause of PID is an untreated STD. Women can protect
themselves from PID by taking action to prevent STDs or
by getting early treatment if they do get an STD:
the number of sex partners, and do not go back and forth
sexual abstinence, or limit sexual contact to one uninfected
partner. Do not have sex with anyone who has genital sores.
condoms correctly every time with every sex act.
who choose to engage in sexual behaviors that can place
them at risk for STDs should use latex condoms every time
they have sex. A condom put on the penis before starting
sex and worn until the penis is withdrawn can help protect
both the male and the female partner from STDs. When a
male condom cannot be used appropriately, sex partners
should consider using a female condom.
common methods of birth control as the oral contraceptive
pill or the contraceptive shot or implant do not give
women protection from STDs. Women who use these methods
should also use condoms every time they have sex to prevent
a screening test for STDs.
who are young, sexually active, and who do not use condoms
correctly every time they have sex should be screened
for chlamydia. Screening and
treatment of women with chlamydia
or gonorrhea infection of
the cervix reduces the likelihood of PID.
If you think you have an STD, avoid sexual contact, and
see a health care provider immediately.
Any genital symptoms such as an unusual sore, rash, discharge
with odor, burning during urination, or bleeding between
cycles could mean infection. If you have any of these
symptoms, stop having sex, and consult a health care provider
immediately. Treating STDs early can prevent PID.
If you are told you have an STD, notify all your sex partners
If you are told you have an STD and receive treatment,
you should notify all of your recent sex partners so they
can see a health care provider and be evaluated for STDs.
Sexual activity should not resume until all sex partners
have been examined and, if necessary treated.
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