Pelvic inflammatory disease (PID)

Definition

Pelvic inflammatory disease is a general term for infection of the uterus lining, fallopian tubes, or ovaries.

See also: Endometritis

Alternative Names

PID; Oophoritis; Salpingitis; Salpingo-oophoritis; Salpingo-peritonitis

Causes, incidence, and risk factors

Most cases of pelvic inflammatory disease are caused by bacteria that move from the vagina or cervix into the uterus, fallopian tubes, ovaries, or pelvis.

The most common cause of PID is sexual contact without using a condom or other protection. This is called a sexually transmitted disease (STD). Chlamydia and gonorrhea are the two bacteria that cause most cases of PID.

However, bacteria may also enter the body during some surgical or office procedures, such as:

• Childbirth
• Endometrial biopsy
• Insertion of an intrauterine device (IUD)
• Miscarriage
• Therapeutic or elective abortion

In the United States, nearly 1 million women develop PID each year. About 1 in 8 sexually active adolescent girls will develop PID before age 20.

Risk factors include:

• Male sexual partner with gonorrhea or chlamydia
• Multiple sexual partners
• Past history of any sexually transmitted disease
• Past history of PID
• Recent insertion of an IUD
• Sexual activity during adolescence

Symptoms

The most common symptoms of PID include:

• Fever (not always present; may come and go)
• Pain or tenderness in the pelvis, lower abdomen, or sometimes the lower back
• Vaginal discharge with abnormal color, texture, or smell

Other symptoms that may occur with PID:

• Bleeding after intercourse
• Chills
• Fatigue
• Frequent or painful urination
• Increased menstrual cramping
• Irregular menstrual bleeding or spotting
• Lack of appetite
• Nausea, with or without vomiting
• No menstruation
• Painful sexual intercourse

Note: There may be no symptoms. People who experience an ectopic pregnancy or infertility often have had silent PID, which is usually caused by chlamydia infection.

Signs and tests

You may have a fever and abdominal tenderness. A pelvic examination may show:

• A cervix that bleeds easily
• Cervical discharge
• Pain with movement of the cervix
• Tenderness in the uterus or ovaries

Lab tests that look for signs of infection are:

• C-reactive protein (CRP)
• Erythrocyte sedimentation rate (ESR)
• WBC count

Other tests include:

• Culture of your vagina or cervix to look for gonorrhea, chlamydia, or other causes of PID
• Pelvic ultrasound or CT scan to look for other causes of your symptoms, such as appendicitis or pregnancy, and to look for abscesses or pockets of infection around the tubes and ovaries
• Serum HCG (pregnancy test)

Treatment

Your doctor will often start you on antibiotics while waiting for your test results.

If you are diagnosed with milder PID, you will usually be given an antibiotic injection or shot, and then sent home with antibiotic pills to take for up to 2 weeks. You will need to closely follow-up with your health care provider.

More severe cases of PID may require you to stay in the hospital. Antibiotics are first given by IV, and then later by mouth. Which antibiotic is used depends on the type of infection.

A number of different antibiotics may be used for treating this type of infection. Some are safe in pregnant women. See gonorrhea or chlamydia for specific treatment recommendations.

Sexual partners must be treated to prevent passing the infection back and forth. You and your partner(s) must finish all of the antibiotics. Use condoms until you both have finished taking your antibiotics.

Complicated cases that do not improve with antibiotics may need surgery.

Complications

PID infections can cause scarring of the pelvic organs, possibly leading to:

• Chronic pelvic pain
• Ectopic pregnancy
• Infertility

Calling your health care provider

Call your health care provider if:

• You have symptoms of PID
• You think you have been exposed to a sexually transmitted disease
• Treatment for a current STD does not seem to be working

Prevention

Preventive measures include:

• Get prompt treatment for sexually transmitted diseases.
• Practice safer sex behaviors. The only absolute way to prevent an STD is to not have sex (abstinence). Having a sexual relationship with only one person (monogamous) can reduce the risk. Use a condom every time you have sex. (See: Safe sex)

You can reduce the risk of PID by getting regular STD screening exams. Couples can be tested for STDs before starting to have sex. Testing can detect STDs that may not be producing symptoms yet.

All sexually active women ages 20 - 25 and younger should be screened each year for chlamydia and gonorrhea. All women with new sexual partners or multiple partners should also be screened.

References

Centers for Disease Control and Prevention (CDC). Update to sexually transmitted diseases guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR. 2007;56:332-336.

U.S. Preventive Services Task Force. Screening for Gonorrhea: Recommendation Statement. Am Fam Physician. 2005;72:1783-1786.

Meyers D, Wolff T, Gregory K, et al. USPSTF recommendations for STI screening. Am Fam Physician. 2008;77:819-824.