Signs And Symptoms:

Women with PID present with a variety of clinical signs and symptoms that range from subtle and mild to severe. PID can go unrecognized by women and their health care providers when the symptoms are mild. Despite a lack of symptoms, histologic evidence of endometritis has been demonstrated in women with subclinical PID.

When present, signs and symptoms of PID are nonspecific, so other reproductive tract illnesses and diseases of both the urinary and the gastrointestinal tracts should be considered when evaluating a sexually active woman with lower abdominal pain. Pregnancy (including ectopic pregnancy) must also be excluded, as PID can occur concurrently with pregnancy.

When,

Symptoms are present, the most common symptoms of PID are:

• Lower abdominal pain.
• Mild pelvic pain.
• Increased vaginal discharge.
• Irregular menstrual bleeding.
• Fever (>38° C).
• Pain with intercourse.
• Painful and frequent urination.
• Abdominal tenderness.
• Pelvic organ tenderness.
• Uterine tenderness.
• Adnexal tenderness.
• Cervical motion tenderness.
• Inflammation.

You Should See A doctor if You Experience:

• Nausea and vomiting, with an inability to keep anything down.
• Severe pain low in your abdomen.
• Fever, with a temperature higher than 101 F (38.3 C).
• Foul vaginal discharge.

Causes OF Pelvic Inflammatory Disease:

Types of Pelvic Inflammatory Disease:

There are three types of PID:

1. Acute PID:

This is when the infection comes on suddenly and violently. There is a high level of infection, and abscesses can form. If the abscesses burst, the infection can spread to the lining of the abdominal cavity, this is a potentially life-threatening condition.

2. Recurrent PID:

If the PID is untreated or is not treated properly, it may clear up of its own accord, but then come back again. Many women are plagued for years with recurrent attacks, especially when they are run down physically or emotionally.

Once the natural protective mechanisms have broken down by the first attack of PID, the body is more susceptible to subsequent attacks. Women can also become re-infected by their partners, which is why it is important for both of you to be treated.

3. Chronic PID:

When PID is untreated or inadequately treated it never clears up and the infection lingers on for long periods, causing discomfort but not acute pain. It is said that antibiotics usually clear up the original infection, the pain they are suffering is the effects of damage to the tissues done by the infection.

The Long-term Effects of PID:

Pelvic Inflammatory Disease can lead to serious, long-term problems:

A. Infertility:

One in 10 women with PID becomes infertile. PID can cause scarring of the fallopian tubes. This scarring can block the tubes and prevent an egg from being fertilized.

B. Ectopic pregnancy:

Scarring from PID also can prevent a fertilized egg from moving into the uterus. Instead, it can begin to grow in the fallopian tube. The tube may rupture (break) and cause life-threatening bleeding into the abdomen and pelvis. Emergency surgery may be needed if the ectopic pregnancy is not diagnosed early.

C. Chronic pelvic pain:

PID may lead to long-lasting pelvic pain.

Risk Factors For Developing Pelvic Inflammatory Disease:

Complications of Pelvic Inflammatory Disease:

Complications of PID include:

If you are treated early in the infection, you are less likely to have complications. The potential complications from PID can include:

• Long-lasting pelvic pain.
• Trouble getting pregnant (infertility).
• Increased chance of an ectopic or tubal pregnancy – where a fertilized egg attaches to the fallopian tube or any other area outside of the uterus.
• Getting PID again.
• Toxic shock syndrome (TSS).
• Fitz-Hugh-Curtis syndrome – a rare complication of the liver The likelihood of having complications from PID increases each time a person has a pelvic infection.

Diagnosis of Pelvic Inflammatory Disease: 

To learn if you have PID, your gynecologist or other health care professional will start by asking about your medical history, including your:

• Sexual habits.
• Birth control method, and symptoms.
• If you have PID symptoms, you will need to have a pelvic exam.
• This exam can show if your reproductive organs are tender.
• A sample of fluid from your cervix will be taken and tested for gonorrhea and chlamydia. Blood tests may be done.
• Your gynecologist or other health care professional may order other tests or procedures.
• They can include ultrasonography, endometrial biopsy, and in some cases, laparoscopy.

Prevention of Pelvic Inflammatory Disease:

Latex condoms may reduce the risk of PID by preventing STDs. Since STDs play a major role in PID, screening of women at risk for infection and treatment of infected women and their sex partners can help to minimize the risk of PID. Screening of young sexually active women for chlamydia has been shown to decrease the incidence of PID.

Important things to remember when using condoms:

Don’t Use,

• A damaged condom.
• A condom after its expiry date.
• 2 condoms at once. Using 2 condoms together may result in a condom breaking.
• Carefully open the package so that the condom does not tear. Do not use a torn condom.
• Keep condoms away from sharp objects such as rings, studs, or piercings.
• Store condoms at room temperature.

Use, 

• A new condom every time you have sex. Do not reuse condoms.
• Only water-based lubricants with external (“male”) latex condoms. Oil-based lubricants, such as petroleum jelly, lotion, or baby oil, can weaken and destroy the latex.
• Only condoms made of latex or polyurethane/nitrile/polyisoprene rubbers.
• Water or oil-based lubricant may be used with polyurethane/nitrile condoms.
• Avoid using condoms with spermicides containing nonoxynol-9 (N-9) as it can irritate tissue and may increase the chance of getting an STI

Latex and polyurethane condoms are the best types of condoms to use to help prevent pregnancy and STIs. (Lambskin and sheepskin condoms can help prevent pregnancy but don’t work as well as latex or polyurethane condoms to prevent STIs)

Treatment:

MANAGEMENT AND INTERVENTIONS:

Goals of Treatment:

• Preserve fertility.
• Treat infection.
• Prevent further complications.
• Alleviate symptoms.
• Prevent the spread of infection.

Criteria for Potential Hospitalization:

The following criteria may indicate the need for hospitalization or parenteral therapy:

• Surgical emergencies, such as appendicitis or ectopic pregnancy.
• Pregnancy.
• Severe nausea, vomiting, or a fever >38.5oC
• underlying illnesses such as diabetes, HIV or active hepatitis infection
• Concerns with the client’s ability to complete oral antibiotic therapy
• Severe abdominal pain.

Patients,

• Cannot tolerate oral treatments.
• Under the age of 19.
• Has abdominal guarding, rigidity, or rebounds tenderness.

Usual Treatment,

The usual treatment for PID is antibiotics. In some cases,

• PID may be severe enough that you need to be admitted to the hospital for intravenous (IV) antibiotic treatment.
• You should return to your health care provider 3 to 7 days after starting treatment if symptoms continue.
• If symptoms worsen, seek urgent medical care (e.g., to a hospital emergency).
• Sexual partners from the last 2 months need to be tested and treated.
• If you have not had a sexual partner in the last 2 months, then your last sexual partner will need to be tested and treated.
• It takes time for the infection to clear from the body, so it is important that you do not have any oral, vaginal or anal sex until after you and your partner(s) complete the antibiotic treatment.

If you or your partners,

Do not finish the treatment miss pills or have unprotected sex before you have finished the medication, there is a chance that the infection will stay in your body or pass back to you or your partner(s), and may cause health problems later on. If that happens, talk with your health care provider to see if you or your partners need more treatment.

Some Women,

may need to be treated in a hospital. A hospital stay may be recommended for women who:

• Do not have a clear diagnosis.
• Are pregnant.
• Must take IV antibiotics.
• Are severely ill.

Have:

• Nausea and vomiting.
• A high fever.
• An abscess in a fallopian tube or ovary.
• In certain situations, such as when an abscess is found, surgery may be needed.

A woman’s sex partners must be treated. Women with PID may have partners who have gonorrhea or chlamydia. A person can have these STIs even if there are no signs of illness.

What Can Happen if PID Isn’t Treated?

If the pelvic inflammatory disease isn’t treated or went on a long time before being treated, girls can have problems such as:

• Ongoing pain in the lower belly.
• Trouble getting pregnant (infertility).
• Pregnancy in the fallopian tube instead of the uterus (an ectopic pregnancy).
• An infection in the ovary and fallopian tube (a tube-ovarian abscess).

The Bottom Line: 

If you are diagnosed with PID, then you will need to immediately begin treatment to stop the infection. Antibiotics are administered to start battling the infection. Further treatments may be necessary if you have significant scarring.

This is especially true if you plan on having a baby. Laparoscopic surgery is usually an option for women of reproductive age. You may wish to go to an experienced and skilled Reproductive Endocrinologist for this procedure to increase your chances of success.

If you are experiencing symptoms of PID,

Have had sex with someone you suspect may be carrying a sexually transmitted disease, or if you or your partner have multiple sexual relationships you should see your doctor immediately. Your life could depend on it.

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