What is Pelvic Inflammatory Disease?

Pelvic inflammatory disease (PID) is a general term for a condition that involves infection and inflammation of the upper female genital tract, including the uterus, fallopian tubes, and ovaries. Any or all of these parts may be affected. It usually results from an infection in the vagina and the neck of the womb passing to the internal reproductive organs. Some of the infections causing PID are caught through sexual contact.

Pelvic inflammatory disease can result from infection by the bacteria Chlamydia trachomatis, which can be passed through sexual contact. When chlamydial infection spreads from the cervix and along the Fallopian tubes, it causes inflammation (salpingitis). This causes the lining of the tubes to become red and swollen, and makes the already narrow canals even narrower. Fertilised eggs may not be able to move along normally, thus increasing the risk of ectopic pregnancy and infertility.

As the infection develops within the pelvis and becomes more widespread, PID may be diagnosed. If the infection remains untreated, the inflammation eventually spreads to involve the whole wall of the tubes, with pus coming from the open ends reaching the ovaries. The outer surfaces of the tubes may begin to stick to those of other organs such as the bladder and rectum.

Further infection with other bacteria is common. After a first episode of PID, 20 per cent of women have further episodes, mostly within two years.

It is estimated that 2 per cent of women have PID. This is almost certainly an underestimate, because many women are unaware of having contracted a sexually transmitted disease and are either free of symptoms or unaware of the cause of their symptoms.

Signs & Symptoms

The early symptoms are usually irritation and unusual discharges from the vagina and urethra, occurring 7 to 21 days after infection in the case of chlamydia, and 2 to 5 days in the case of gonorrhoea. Many women have a vaginal discharge unconnected with STI. But if there is a change in the character of the discharge (e.g. it becomes smelly or itchy), especially a few days after a new sexual contact, one of these conditions should be suspected.

Pelvic inflammatory disease features a distressingly constant, dragging abdominal pain, tenderness on pressure and occasional bouts of fever. In addition, there is likely to be discomfort, or even pain, on sexual intercourse. Another effect of these bacteria is abscess in the lips at the entrance to the vagina.

If the infection involves the womb lining (endometrium) there may be vaginal bleeding between periods.

What is the causes of Pelvic Inflammatory Disease?

At least sixty per cent of cases of PID are caused by a sexually transmitted infection (STI). The bacteria Chlamydia trachomatis is the cause in almost half the cases of PID in western countries. Gonococcal infection(caused by the bacteria Neisseria gonorrhoeae) is responsible for most cases in Malaysia. About 10% of women with PID are infected with both types of bacteria.

Rarely, pelvic inflammatory disease originates in the bowel or may spread to the pelvic organs by way of the bloodstream.

Chlamydia trachomatis is now the most common sexually transmitted bacterial disease in the Western world. Up to 80 per cent of infected women are unaware of the fact that they are infected, as only some people show symptoms of the disease, which contributes to the spread of chlamydia.

The Diagnosis of Pelvic Inflammatory Disease

PID is diagnosed by the symptoms and by a gynaecological examination. Moving the cervix causes pain. There may be fever. Vaginal and cervical swabs will reveal the causal germs. One sure way of making the diagnosis is to perform an internal visual examination by laparoscopy.

The Complications

The main complications of PID are ectopic pregnancy and infertility. In cases of advanced PID, surgery is likely to be required to release areas of adhesions (where the inflammation has caused the surfaces of some internal organs to stick together).

Ectopic pregnancy is a serious and potentially fatal condition that may lead to severe internal bleeding, a burst fallopian tube, and (rarely) an abdominal pregnancy.

The Treatment

Chlamydia and gonococci bacteria can be eradicated with antibiotics. An intensive course using drugs to which the germs are known to be sensitive will usually clear up PID. Damage to the fallopian tubes and other organs may however remain.

It is essential that all sexual partners are treated, to prevent any damage due to infection and a recurrence of the condition in the individuals. This is particularly important as some of the most common infections causing PID do not have any symptoms.

For women at risk of pelvic infection who are using an IUD or IUS for contraception may be advised to select an alternative contraceptive method to reduce their risk of PID.

Preventions

Using condoms will minimise the risk of developing PID. A person should be enquired if there has been a sexual contact with someone whom they think may be infected. Avoid sexual activities with multiple partners.