Pelvic Inflammatory Disease (PID) is a term used to describe inflammation or infection of the uterus, fallopian tubes, or ovaries (female pelvic organs). PID is usually caused by the bacterial infection such as Tuberculosis, Gonorrhea, Chlamydia etc. Scarring from PID is a common cause of chronic pelvic pain and infertility.
CAUSE FOR THE PID
PID develops when bacteria (germs) get into a woman’s internal reproductive organs. There are a number of ways this can happen. The internal organs are usually protected by the cervix, which blocks bacteria in the vagina from moving up into the womb. But when the cervix is open (e.g. during menstruation or at ovulation) or if the cervix itself becomes infected, bacteria have a greater chance of getting through and causing infection.
Bacteria may also get into the reproductive organs during pelvic surgery or invasive procedures that disrupt the cervix, such as D & C, Induced abortion, Hystero Salpingo. Graphic examination, childbirth or insertion of an Intra-Uterine Device (IUD). Bacteria from severe appendicitis can also lead to PID if it spreads to the pelvic tissues.
Having more than one sexual partner, miscarriage, spontaneous abortion, vaginal childbirth can also create an opportunity for bacteria to make their way into the internal reproductive organs.
PID can be caused bacteria’s like Chlamydia trachomatis, Neisseria gonorrhoea, E-coli, Tubercular bacilli etc. Some Fungus & Viruses can also cause infection.
Tuberculosis– Tuberculosis of the pelvic organ is one of the common PID. It is caused by blood borne infections.
Gonorrhoea- Like Chlamydia, Gonorrhoea is found most commonly among younger women. Up to 50% of women (and 10% of men) who become infected with gonorrhoea have no symptoms.
Chlamydia- Chlamydia is one of the most common sexually transmitted infections. It is common in sexually active women under the age of 25. It is less common in older age groups. Chlamydia can live in the body without causing any symptoms for months or years.
TYPES OF PID
PID can be classified into
- Acute PID
- Chronic PID
Acute PID: In the early stage of infection, the pelvic organs gets inflamed & swollen. It usually starts as acute infection of fallopian tube (Salpingitis). Later on the pus pours into the pelvic cavity causing pelvic abscess, Tubo ovarian mass, Pyosalpinx & Peritonitis.
Chronic PID: If the PID is not treated during acute stage, it may result in chronic PID causing Hydrosalpinx, Tuboovarian cyst, Fibrosis & Tubal block.
SPREAD OF THE DISEASE
Any woman can get PID but those at higher risk include, younger women, women who have unprotected sex with someone who has a sexually transmitted disease, usually Chlamydia or Gonorrhea and women who have had PID infection before.
SIGNS & SYMPTOMS
The symptoms of PID vary from woman to woman, and some women have no obvious symptoms at all. When symptoms are present, it usually depends upon the severity of the infection.
Symptoms In Acute PID –
- Nausea, vomiting and dizziness.
- Increased period pain & increased pain at ovulation.
- Burning or pain when urinating & frequent urination.
- Abnormal vaginal discharge.
- Bleeding between periods or after sex
- Fever feeling tired or unwell.
Symptoms in Chronic PID –
- Pain in the lower abdomen.
- Lower back ache.
- Painful menses followed by heavy bleeding.
- Painful intercourse.
Many women recover from PID without any lasting problems, but if the infection is not treated early or entirely, PID can lead to serious complications. Just one episode of PID increases a woman’s risk of Abscess (a pocket of infected fluid), chronic pelvic pain, Ectopic pregnancy & Infertility.
Investigation for the diagnosis of PID includes routine blood tests, urine examination, pelvic scanning & Laparoscopic examinations.
Medical Treatment: PID almost always involves more than one type of bacteria, and therefore is treated with a combination of at least two antibiotics. Antibiotics prescribed for PID include Ofloxacin, Metronidazole, Doxycycline, Ceftriaxone (injection), and Cefoxitan (injection) plus Probenecid. Pain killers are given to reduce the pain. Placental extract is found to be useful as an anti inflammatory drug.
Surgical Treatment: Drainage of the abscess can be done by Ultrasound guidance or by Laparoscopy.
Other Treatments: Taking hot bath or relaxing with a hot water bottle or heating pad on the abdomen, maintaining healthy diet, getting plenty of C, A, D and B vitamins to fight infection can help to cure PID.
The best way to prevent PID is to protect from sexually transmitted infections.
- Always using a barrier method of contraception during sex like Condoms and Femidoms.
- A diaphragm or cervical cap (used with a spermicide) may also help prevent gonorrhea and Chlamydia, but not other STIs.
- Get regular sexual health check-ups.
- Screening for Gonorrheal and Chlamydia infections if suspected.
- Delivery should be conducted under aseptic precautions in hospitals.
- Repeated D&C, Medical termination of pregnancies should be avoided.
- Abortions should not be carried out from non qualified persons (Septic abortions).
Pelvic infection is difficult to understand as well as to treat effectively and a real bother and nuisance to many women. It can be a signal of severe pelvic illness & Infertility. All medications prescribed by the Doctor should be followed. Sometimes symptoms may go away before the infection is cured, but always the whole course of medicine should be completed as prescribed by the doctor & proper follow up with respective doctor should be maintained to monitor improvement.