Pelvic Inflammatory Disease: Don't Let It Sneak Up on You

The statistics are shocking: One in seven US women 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 microorganisms 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 gonorrhea. 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.

PID's DANGERS

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%.

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.

Anyone can get PID, but the risk is highest for women who:

WHO CAN GET PID?

Although anyone can get PID, the disorder is especially common in women under 25 years old (see "Who's at Risk for PID?"). As with STDs in general, the more sexual partners a woman has, the more likely she is to get PID. Even if you have only one sexual partner, you can still get PID if your partner is having intercourse with other people. A woman who has only one partner (who is also sexually exclusive) has a very low risk of PID.

Using an intrauterine device (IUD) for birth control increases the risk of PID somewhat, especially for the first few months after the device is inserted. Douching has also been linked to PID, perhaps because it pushes vaginal organisms up through the cervical opening.

Once you've had one bout of PID, you're more likely to have another, regardless of your behavior. These later infections are not always caused by a new STD. Instead, they commonly result from bacteria that were not completely wiped out by earlier therapy. PID also seems to leave the reproductive tract more sensitive to vaginal organisms that wouldn't ordinarily cause a problem. "In a sense, it's like you catch the infection from yourself," observes Dr Paul Feldman, an adult and adolescent obstetrician-gynecologist and infertility specialist in Saranac, New York.

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, gonorrhea, 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," says Dr Cynda Johnson, a professor in the departments of Family Medicine and Obstetrics and Gynecology and Vice Chairman of the department of Family Medicine at the University of Kansas.

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.

Reduce Your Risk

While it may be impossible to eliminiate the risk of PID completely, there are things women can do to protect themselves.

PREVENTION

You can reduce your risk of getting PID by reducing your risk of acquiring a sexually transmitted infection in the first place (see "Reduce Your Risk"). Short of refraining from sex altogether, the best way to do that is by remaining in a monogamous relationship or using a latex condom and a spermicide for every sexual encounter. Using a diaphragm and spermicide also reduces the risk, though not to the same degree as using a condom. "PID is one of those conditions that everyone assumes is not going to happen to them," warns Dr Feldman. "No matter how clean-cut the other person is and no matter what you've said to each other, you have to presume that he could be carrying an STD--even if he doesn't know it--and stick by your guns and protect yourself."

Having regular gynecologic checkups and screenings is also important, because cervical infections can be identified and treated before they have time to spread. Experts estimate that regular chlamydia screenings could reduce the number of PID cases by half. "Don't wait until you have symptoms," Dr Feldman advises. "If you have more than one sexual partner, if you've had sex without a condom, or if you're concerned that you may have been exposed to an STD, go for a screening." Your future health and well-being may depend on it.

References:

Deborah Breeding is a registered nurse and a freelance medical writer.

Originally published in The Female Patient -- November, 1997

© Copyright, 1997 Quadrant Publishing, All Rights Reserved

Reprints are not allowed without the expressed written consent of Quadrant Publishing.