Pelvic inflammatory disease (PID) is an infection of the internal female reproductive organs Figure 01. Pelvic inflammatory disease (PID) is an umbrella term for infection of various portions of the female internal reproductive system. It generally occurs when an infection invades the uterus (endometritis). Infection may then spread to the fallopian tubes (salpingitis), ovaries (oophoritis), and even the surrounding tissues.
Figure 01. Pathways of PID Progression
PID is a potentially serious illnesses, that can cause tubal scarring and lead to infertility and ectopic pregnancies. The National Institutes of Health estimates that 20% of women who have PID become infertile. Additionally, a history of PID can increase the likelihood ectopic pregnancies, a situation in which a fertilized egg lodges in the fallopian tubes rather than implanting in the uterus. Women with ectopic pregnancies are at risk for heavy bleeding, and emergency surgery is generally needed.
Unprotected sexual activity is the main cause of PID. PID occurs when a bacterial organism enters the cervix and travels to any portion or all of the internal reproductive system. Bacterial transmission most commonly occurs during unprotected vaginal sex.
Two of the most common infections that cause PID are the sexually transmitted diseases gonorrhea (caused by the bacterium Neisseria gonorrhoeae) and chlamydiosis (caused by the bacterium Chlamydia trachomatis).
Any activity or procedure that injures the cervical opening, thus giving bacteria better access to the reproductive organs, can lead to PID. In addition to unprotected sexual activity, other activities or procedures can predispose the female reproductive system to infection, including:
- Delivering a child through the vagina (whether it's a normal delivery, a miscarriage, or an abortion)
- Medical procedures that use tubes (such as injection of a dye for certain tests)
- Douching, which can wash bacteria from the outer vaginal area up and into the reproductive system.
- Using an intrauterine device (IUD), a birth control method that has been known to carry infection into the reproductive system.
- Delivering a child by caesarean section—a procedure that has been shown to carry an increased risk of postpartum (after childbirth) uterine infection
Various non-sexually-transmitted diseases can also cause PID. Some examples of non-sexually-transmitted diseases that can cause PID include actinomycosis, which is a relatively rare bacterial infection that generally enters through the mouth; schistosomiasis (also relatively rare in the U.S.), an infection caused by a parasite; and tuberculosis.
PID is often difficult to diagnose, and sometimes exists without symptoms Table 01 Table 02. PID is often difficult to diagnose because even when symptoms do appear, they can be mistaken for symptoms of a number of other problems, ranging from reproductive organ-related illnesses, such as endometriosis, to other abdominal conditions such as appendicitis.
Women may experience different symptoms of varying intensity, depending on where the infection is located and whether the disease is chronic or acute. Symptoms such as abdominal pain, fever, fatigue, vaginal discharge, and irregular menstrual bleeding may indicate PID.
One of the dangers of PID is that by the time symptoms appear or seem significant enough for you to seek treatment, the disease will often have progressed to a more severe stage.
Table 1. General Symptoms of PID
Vaginal discharge (may begin light, and become more puslike) Abdominal pain Back pain Pain during intercourse Irregular menstrual bleeding Fever Fatigue Diarrhea Vomiting
Table 2. Possible Symptoms of Chronic vs. Acute PID
Symptom Chronic PID Acute PID Abdominal pain None to a moderate, dull ache Generally severe Fever Low, if any High Nausea Moderate, if any Severe Vomiting Rarely Usually Vaginal discharge Yes, particularly if infection is IUD-related Yes, and may increase, have a stronger odor Irregular menstrual bleeding Not usually Sometimes Backache Mild, if any Severe Abdominal tenderness None to moderate Generally severe
Prevention and Screening
Using simple sanitary precautions can help to prevent PID. Using good bathroom hygiene can prevent some of the infections that lead to PID. Wipe from front to back after urinating, and especially after a bowel movement. Reversing the motion increases the risk of sweeping bacteria into the vagina.
Do not douche, as douching can force the bacteria up the cervix to infect the internal reproductive organs.
Practice safer sex precautions, and, if appropriate, make sure your sexual partner(s) has been tested or treated for sexually transmitted diseases. Unless you want to get pregnant or have a long-term relationship with just one monogamous sexual partner, always use a condom when engaging in sexual activity. Even if it is certain that the man has no infections, it is possible that you could pass an infection to him, and then end up passing it back and forth with continued unprotected sex. Remember that even an easily treated condition like chlamydia can progress into PID, especially if infection constantly recurs.
If you find that you are experiencing recurrent infections, it is critical that you find out if your partner is infected, even if he does not display any symptoms. If your partner is infected and remains untreated, then it is likely that you will continue to be reinfected with the same, or possibly multiple infections.
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