Pelvic Inflammatory Disease (PID): Symptoms, Causes, Treatment & When to See a Doctor

In short: Pelvic inflammatory disease is an infection of the uterus, fallopian tubes and ovaries, usually caused by sexually transmitted bacteria such as chlamydia and gonorrhoea. Symptoms are lower abdominal pain, vaginal discharge, fever, and pain on passing urine or during intercourse. It is treated with antibiotics; see the doctor at once when symptoms appear, because neglect can lead to infertility, ectopic pregnancy and adhesions.

Pelvic inflammatory disease (PID) is an infection that affects the uterus, fallopian tubes, ovaries, surrounding tissues, the peritoneum lining them, and the pelvis.

It occurs when an infection spreads from the vagina and cervix upward into the uterus and pelvis.

In more severe cases, PID can lead to the formation of pus (an abscess) in the pelvis.

Many women with PID do not notice any symptoms at all. When symptoms do appear, they may include lower abdominal pain, vaginal discharge, fever, painful urination, painful intercourse, and irregular menstrual cycles.

If left untreated, pelvic inflammatory disease (PID) can lead to complications such as infertility, ectopic pregnancy, and chronic pelvic inflammation. Early diagnosis and prompt treatment can help protect your reproductive health.

Symptoms and Signs of Pelvic Inflammatory Disease (PID)

If symptoms are present, they may include:

*Lower abdominal and pelvic pain

*Thick vaginal discharge with an unpleasant odor

*Menstrual irregularities

*Pain during intercourse

*Lower back pain

*Fever, fatigue, diarrhea, and nausea

*Pain and difficulty urinating

Other complications include endometritis, salpingitis, tubal and ovarian abscess, pelvic peritonitis, appendicitis, and perihepatitis.

Causes of Pelvic Inflammation:

1. Bacteria such as gonorrhea or chlamydia.

2. Unsafe sexual practices, which increase the likelihood of contracting sexually transmitted infections.

3. Certain types of contraceptives.

4. Bacteria may enter as a result of childbirth, abortion, or an endometrial biopsy.

5. It may be due to the spread of infection from a nearby area, such as appendicitis.

6. It may be due to the spread of infection via the bloodstream from other parts of the body.

7. Douching may disrupt the natural balance of microorganisms in the vagina.

Diagnosis of Pelvic Inflammatory Disease (PID):

1. Clinical examination and review of medical and sexual history.

2. Laparoscopy, including viral culture, intra-abdominal bacterial culture, and biopsy.

Laparoscopy can reveal violin-string adhesions, a characteristic feature of Fitz-Hugh-Curtis syndrome.

3. Blood tests such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels.

4. Ultrasound, CT scan, and MRI.

5. Vaginal and cervical swabs. If the swab result is negative, it means you are unlikely to have an infection, but it does not mean you are completely free of infection.

The patient may also be asked to undergo some additional tests, such as:

Urinalysis

HIV testing

Pregnancy hormone testing, as some pregnancy symptoms may resemble those of pelvic inflammatory disease.

Prevention of Pelvic Inflammatory Disease (PID):

1. Use condoms.

2. If symptoms of PID appear, seek medical advice immediately.

3. Using hormonal birth control pills can reduce the likelihood of developing PID because they thicken the cervical mucus plug, helping prevent bacteria from ascending from the lower reproductive tract.

4. The patient should seek medical advice if their sexual partner has a sexually transmitted infection (STI) or if they themselves are infected.

5. Obtain a history of any STIs the patient’s sexual partner has had and ensure they receive treatment.

6- Avoid factors that increase the risk of vaginal and pelvic inflammation, such as having multiple sexual partners, as well as induced abortion, spontaneous miscarriage, or certain procedures such as placing a cervical stitch during pregnancy.

Treatment of pelvic inflammatory disease

1- Antibiotics: Treatment usually begins with an antibiotic injection, followed by two weeks of oral antibiotics. Antibiotics should be started as soon as PID is diagnosed — treatment should not wait for culture results, as the condition can worsen quickly. The choice of antibiotic may be adjusted once culture results become available.

2- Painkillers to relieve pain and irritation caused by inflammation.

3- In some cases, surgery may be needed to drain an abscess and take a sample of pus and secretions for culture, helping identify the responsible bacteria so treatment can be targeted accordingly. However, any procedure to open fallopian tubes blocked by this inflammation is only carried out after the acute infection or flare-up has been treated.

• If you do not feel better, or your condition worsens within 27 to 84 hours, you should see your doctor again.
• It is advised to avoid sexual contact during the treatment period.

If the patient is pregnant, it is best to admit her to the hospital and prescribe an antibiotic that is safe for the fetus.

Complications of Pelvic Inflammatory Disease (PID):

1. PID can cause scarring of the reproductive organs, leading to chronic pelvic pain, infertility, and ectopic pregnancy.

2. In some cases, the infection can spread to the peritoneal lining near the liver, causing inflammation and scarring — a condition known as Fitz-Hugh-Curtis syndrome.

When should a patient be hospitalized for pelvic inflammatory disease (PID)?

• If the diagnosis is unclear

• If the patient’s condition is very serious
• If the patient is pregnant
• If there is no improvement within 27 to 84 hours of starting antibiotic treatment
• If the patient is unable to take antibiotic tablets
• If there is suspicion of pus or an abscess

How is a patient with pelvic inflammatory disease (PID) treated while having an intrauterine device (IUD)?

In most cases, the IUD can be left in place. If there is no improvement within 48 hours of starting treatment, the IUD may need to be removed. Emergency contraception may be necessary after IUD removal if intercourse occurred within the seven days prior to removal.

Should the sexual partner be tested?

If pelvic inflammatory disease is caused by a sexually transmitted infection, anyone the patient has had sexual relations with in the previous 6 months should be tested.

How is follow-up done after treatment for pelvic inflammatory disease?

• If there is no improvement, follow-up will be after 3 days.
• If the patient feels better, follow-up will be at the clinic after two weeks.

A cervical and vaginal swab may be taken after treatment is completed to confirm the patient’s response to treatment.

What are the long-term effects of pelvic inflammatory disease (PID)?

• Ectopic pregnancy
• Infertility
• Abscess/pus in the fallopian tube or ovary
• Formation of adhesions leading to chronic lower abdominal pain

If you’re experiencing symptoms of PID, or have concerns about your reproductive health and fertility, Dr. Najeeb Layyous and his clinical team are here to help with a careful evaluation and personalized care plan.

Dr. Najeeb Layyous F.R.C.O.G

Consultant in Obstetrics, Gynecology, and Infertility