The statistics are shocking: One in seven women in the United States will be treated for pelvic inflammatory disease (PID) over the course of her lifetime. That translates into more than a million women diagnosed with PID each year. Worse yet, for every four women who get PID, one will suffer a complication, such as chronic abdominal pain, infertility, or an abnormal pregnancy. But the statistics tell only part of the story. The number of women with unrecognized disease is estimated to be far higher than one in seven. Many women with undiagnosed disease will learn of their infection only when they try to have a baby – and can’t. This situation would be tragic under any circumstance, but it is doubly so when it is the result of a treatable – and largely preventable – disease.
What is PID?
Pelvic inflammatory disease is a term for a variety of infections affecting a woman’s upper reproductive organs, including the uterus, the ovaries, and the two fallopian tubes that serve as passageways between the ovaries and the womb. PID occurs when disease-causing micro-organisms in the lower genital tract rise through the opening in the cervix, which separates the uterus and the vagina (see ‘How PID infects the reproductive organs’).
Most cases of PID are acquired during sexual intercourse with a partner who has a sexually transmitted disease (STD), primarily chlamydia or gonorrhoea. Up to 40% of women who get one of these infections and don’t have it adequately treated will wind up with PID.
PID can occur after a miscarriage, abortion, or any other procedure that opens the cervix or abdomen, allowing disease-causing germs easy entry to the reproductive organs.
The dangers of PID
PID can spread beyond the reproductive tract, causing serious and potentially deadly complications. Each year about 250,000 US women are hospitalized because of PID, and more than 150 die.
Even aside from the immediate dangers, the long-term effects of PID can be devastating. PID can permanently scar and damage the fallopian tubes, causing blockage of the tubes. About 12% of women suffer enough tubal damage from one episode of PID to become infertile. After three episodes of PID, the infertility rate reaches 50 per cent.
PID also increases the risk of an ectopic pregnancy, in which the fertilized egg gets trapped in the tube and begins to grow there. Without treatment, the tube may burst, causing internal bleeding and possibly death. Finally, tissue damage can leave many women with chronic pelvic pain long after the PID infection is gone.
Symptoms
The symptoms of PID can be dramatic or they can be barely noticeable. Symptoms caused by chlamydia are especially likely to be mild. The most common symptom is a dull, constant pain in the lower abdomen. The pain often begins right after menstruation and may be worse during sexual intercourse. Other symptoms include an abnormal vaginal discharge or bleeding, painful urination, fever, nausea, and vomiting.
Because even mild infections can cause extensive tubal damage, don’t hesitate to call a doctor if you think you might have PID or a sexually transmitted disease. Women who have already had PID need to be especially watchful, because any abnormal symptom could signal another infection.
Diagnosis
To make a diagnosis of PID, the doctor will usually ask you about your sexual habits and other risk factors, perform a pelvic examination, and take samples of cervical cells or vaginal discharge to test for chlamydia, gonorrhaea, and other infections. Blood tests, x-rays, or ultrasound imaging may also be needed.
The diagnosis is not always easy, because many other conditions can cause similar symptoms. There isn’t any one test that will tell the doctor for certain that you have PID. Sometimes the questions can be resolved only by doing a laparoscopy, a surgical procedure that allows the doctor to look into the abdominal cavity, check the pelvic organs for signs of infection, and rule out other possible disorders, such as appendicitis and ectopic pregnancy.
Treatment
Antibiotics are the mainstay of PID treatment. If the infection fails to respond to the medications or has become walled off in an abscess, surgery may be needed. Depending on the cause and severity of the problem, the antibiotics may be given by mouth, injection, or intravenously. Some women can be treated at home; others must be cared for in a hospital. For treatment to succeed, it’s essential to follow the doctor’s instructions; not taking the antibiotics as directed or stopping them too soon can lead to a relapse. Since PID is often sexually acquired, sexual partners may need to be examined and treated to prevent a reinfection.
Conclusion
PID is one of those conditions that everyone assumes is not going to happen to them. No matter how clean-cut the other person is and no matter what you’ve said to each other, you have to presume that your partner could be carrying an STD – even if he/she doesn’t know it – and stick by your guns and protect yourself.
