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Pelvic Inflammatory Disease

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Q. What is pelvic inflammatory disease?

A. The most serious and common complication of sexually transmitted diseases (STDs) among women is pelvic inflammatory disease (PID), an infection of the upper genital tract. PID can affect the uterus, ovaries, fallopian tubes, or other related structures. Untreated, PID can lead to infertility, tubal (ectopic) pregnancy, chronic pelvic pain, and other serious consequences.

Q. What causes pelvic inflammatory disease?

A. PID occurs when disease-causing organisms migrate upwards from the vagina and cervix into the upper genital tract. Many different organisms can cause PID, but most cases are associated with gonorrhea and chlamydial infections, two very common STDs. Scientists have found that bacteria normally present in the vagina and cervix may also play a role.

Q. Are there risk factors for PID?

A. Women with sexually transmitted diseases -- especially gonorrhea and chlamydia -- are at greater risk of developing PID than other women; a prior episode of PID increases the risk of another episode because the body’s defenses are often damaged during the initial bout of upper tract infection.

  • Sexually active teenagers are more likely to develop PID than are older women.
  • The more sexual partners a woman has, the greater her risk of developing PID.
  • IUD insertion, induced abortion, and other procedures during which instruments are passed through the cervix into the uterus increase the risk of PID. Recent data indicate that women who douche once or twice a month are more likely to have PID than those who douche less than once a month. Douching may flush bacteria into the upper genital tract. Douching also may ease symptoms of an infection, delaying effective treatment.

Q. What are the symptoms of pelvic inflammatory disease?

A. The major symptoms of PID are lower abdominal pain and abnormal vaginal discharge. Other symptoms such as fever, pain in the right upper abdomen, painful intercourse, and irregular menstrual bleeding can occur as well. PID, particularly when caused by chlamydia, may produce only minor symptoms or no symptoms at all, even though it can seriously damage the reproductive organs. Women with "atypical pelvic inflammatory disease" experience only mild symptoms, unrecognized symptoms, or possibly, in many cases no symptoms ("silent pelvic inflammatory disease"). This more indolent but insidious form of pelvic inflammatory disease is less likely to be detected compared to symptomatic pelvic inflammatory disease, thus placing unsuspecting women at increased risk of disease sequelae.

Q. What is the treatment for pelvic inflammatory disease?

A. Because culture specimens from the upper genital tract are difficult to obtain and because multiple organisms are usually responsible for an episode of PID, at least two antibiotics are given so that they will be effective against a wide range of infectious agents. The infection may still be present after the symptoms are gone, so it is important to finish taking all of the medicine, even if symptoms go away. Patients should be re-evaluated by their physician 2 to 3 days after treatment is begun to be sure the antibiotics are working to cure the infection. About one-fourth of women with suspected PID must be hospitalized.

Many women with PID have sex partners who have no symptoms. Because of the risk of reinfection, however, sex partners should be treated. Even if they do not have symptoms, they may be infected with organisms that can cause PID.