Discover the causes, symptoms, and treatment options for pelvic inflammatory disease (PID) at Meri Sehat. Stay informed and healthy.

Pelvic Inflammatory Disease

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Ismail Munir

Overview

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs, the uterus, fallopian tubes, or ovaries. 
Pelvic inflammatory disease (PID) occurs when bacteria spread from the vagina or cervix into the upper reproductive organs, including the uterus, fallopian tubes, and ovaries. 
&nbsp;

The exact mechanism of action of PID is not fully understood, but it is believed to involve several factors.

Bacteria that cause sexually transmitted infections, such as chlamydia and gonorrhea, can travel from the cervix to the upper reproductive organs, causing infection and inflammation. Other bacteria, such as those that cause bacterial vaginosis or urinary tract infections, can also contribute to the development of PID. Once the bacteria reach the upper reproductive organs, they can cause damage to the tissues and trigger an inflammatory response.

The inflammation can cause swelling and scarring in the reproductive organs, which can lead to pain, infertility, and other complications. In some cases, the infection can spread beyond the reproductive organs and cause a condition known as sepsis, which can be life-threatening if not treated promptly<a href="#accordion">[1][6]</a>.

In the United States, PID is estimated to affect approximately 1 million women annually, with a prevalence of 4.4% among sexually active women<a href="#accordion">[3]</a>. However, the true incidence and prevalence of PID are likely underestimated due to the asymptomatic nature of some cases and the limitations of diagnostic tests.

PID is more commonly diagnosed in low- and middle-income countries, where access to reproductive healthcare services is limited. Approximately 5% of gynecological admissions in Pakistan and India are due to pelvic inflammatory disease (PID)<a href="#accordion">[2]</a>. 
&nbsp;

There are no known types of pelvic inflammatory disease. 
&nbsp;

Signs and Symptoms

Pelvic inflammatory disease (PID) is a common gynecological condition that can cause a range of signs and symptoms. The severity and duration of symptoms may vary depending on the extent of the inflammation and the presence of underlying infections. 
 
Some common signs and symptoms of PID include<a href="#accordion">[1][5][6]</a>:

<ol>
	<li>Lower Abdominal Pain: This is the most common symptom of PID and is often described as a dull or sharp pain in the lower abdomen.</li>
	<li>Abnormal Vaginal Discharge: PID can cause changes in vaginal discharge, including an increase in volume, change in color or odor, and presence of pus.</li>
	<li>Painful Urination: PID may cause pain or burning during urination.</li>
	<li>Painful Sex: PID can cause pain during sexual intercourse, especially deep penetration.</li>
	<li>Irregular Menstrual Bleeding: PID may cause changes in menstrual bleeding, including heavier or lighter periods, spotting, or irregular bleeding.</li>
	<li>Fever And Chills: In severe cases of PID, fever, and chills may occur.</li>
	<li>Nausea And Vomiting: PID can cause nausea, vomiting, and general malaise. 
	&nbsp;</li>
</ol>

Note: It is important to seek prompt medical attention if you experience any of these symptoms, as untreated PID can lead to long-term complications. 
&nbsp;

Causes

The following are some common causes of PID<a href="#accordion">[3][4]</a>:

<ol>
	<li>Sexually Transmitted Infections (STIs): The most common cause of PID is an STI, particularly chlamydia and gonorrhea. These infections can cause inflammation and scarring of the fallopian tubes, which can lead to infertility. 
	&nbsp;</li>
	<li>Childbirth Or Abortion: PID can occur after childbirth or abortion, particularly if the pregnant woman contracted a bacterial infection during the procedure. 
	&nbsp;</li>
	<li>Intrauterine Devices (IUDs): Women who use an IUD as a form of contraception may be at a slightly higher risk of developing PID, particularly in the first few weeks after insertion. 
	&nbsp;</li>
	<li>Douching: Douching is a practice that involves washing out the vagina with water or other fluids, such as vinegar or commercially available douching products. Some women may use douching as a means of cleaning the vagina or reducing odor or discharge. Women who douche regularly may be at an increased risk of developing PID because douching can disrupt the natural balance of bacteria in the vagina and introduce harmful bacteria. 
	&nbsp;</li>
	<li>Multiple Sexual Partners: Women who have multiple sexual partners are at an increased risk of developing PID because they are more likely to come into contact with a sexually transmitted infection. 
	&nbsp;</li>
</ol>

There are no specific screening tests for pelvic inflammatory disease. However, sexually active women younger than 25 years who are at an increased risk of STIs are recommended annual screening for <a href="https://merisehat.pk/disease/chlamydia">chlamydia </a>and <a href="https://merisehat.pk/disease/gonorrhea">gonorrhea</a>.&nbsp; 
&nbsp;

Diagnosis

Pelvic inflammatory disease (PID) is often difficult to diagnose, as it can present with nonspecific symptoms and may not cause any symptoms at all. However, several diagnostic tests can help healthcare providers identify PID and underlying infections that may contribute to its development. Some of the commonly used diagnostic tests for PID are<a href="#accordion">[1][5][6]</a>:

<ol>
	<li>Pelvic Examination: A pelvic examination is the first step in diagnosing PID. This examination can help identify any signs of inflammation in the reproductive organs, such as tenderness, swelling, or discharge. 
	&nbsp;</li>
	<li>Transvaginal Ultrasound (TVUS): This imaging test uses high-frequency sound waves to produce images of the reproductive organs and can help identify any abnormalities or signs of inflammation. 
	&nbsp;</li>
	<li>Urine Tests: Urine tests can also help detect underlying infections that may contribute to the development of PID. 
	&nbsp;</li>
	<li>Culture Tests: Culture tests can help detect the presence of bacterial infections, such as chlamydia and gonorrhea, which are common causes of PID. These tests involve taking a sample of vaginal discharge or urine and culturing it in a lab to identify any bacteria present. 
	&nbsp;</li>
	<li>Blood Tests: Blood tests can help detect elevated levels of white blood cells, which may indicate an active infection. Blood tests can also help detect other markers of inflammation, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). 
	&nbsp;</li>
	<li>Ultrasound: Ultrasound imaging can help visualize the reproductive organs and identify any abnormalities or signs of inflammation. 
	&nbsp;</li>
	<li>Laparoscopy: In severe or recurrent cases of PID, a laparoscopy may be performed. This is a surgical procedure that involves inserting a small camera through a small incision in the abdomen to visualize the reproductive organs and identify any signs of inflammation or scarring. Samples from the lining of the uterus may be taken for a biopsy. 
	&nbsp;</li>
</ol>

It is important to note that a combination of diagnostic tests may be necessary for an accurate diagnosis of PID. 
&nbsp;

Treatment

Pelvic inflammatory disease (PID) is a serious infection of the female reproductive organs that can lead to significant long-term health consequences if left untreated. 
 
The following are some common treatments for PID<a href="#accordion">[1][3][4]</a>:

<ol>
	<li>Antibiotics: PID is usually treated with a combination of antibiotics that are effective against the bacteria causing the infection. Treatment may be given orally or intravenously, depending on the severity of the infection. The CDC recommends a regimen of ceftriaxone, doxycycline, and metronidazole. Another regimen consisting of cefoxitin, doxycycline, and metronidazole may also be used for the outpatient treatment of PID. 
	&nbsp;</li>
	<li>Pain Relief: Women with PID may experience significant pain, particularly during sexual intercourse. Over-the-counter pain relief medications such as ibuprofen or acetaminophen can help alleviate discomfort. 
	&nbsp;</li>
	<li>Rest And Hydration: Women with PID should get plenty of rest and drink plenty of fluids to help their bodies fight the infection. 
	&nbsp;</li>
	<li>Follow-Up Care: Women with PID should follow up with their healthcare provider to make sure the infection has been fully treated and to address any lingering symptoms. 
	&nbsp;</li>
	<li>Partner Treatment: If the PID is caused by a sexually transmitted infection, sexual partners need to be treated to prevent reinfection. 
	&nbsp;</li>
	<li>Surgical Intervention:&nbsp;In severe infections, hospitalization is required. Intravenous antibiotics are administered and the patient may undergo laparotomy. Ideally, a unilateral salpingo-oophorectomy is conducted. A hysterectomy and bilateral removal of the ovaries and fallopian tubes may also be considered. 
	&nbsp;</li>
</ol>

The following are some common complications of PID<a href="#accordion">[3][4][11]</a>:

<ol>
	<li><a href="https://merisehat.pk/disease/infertility-in-women">Infertility</a>: PID can cause scarring and damage to the fallopian tubes, which can lead to infertility. According to the Centers for Disease Control and Prevention, up to 12% of women with PID become infertile. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/ectopic-pregnancy">Ectopic Pregnancy</a>: Women with PID are at an increased risk of developing an ectopic pregnancy, where the fertilized egg implants outside the uterus. This is a potentially life-threatening condition. 
	&nbsp;</li>
	<li>Chronic Pelvic Pain: Some women with PID may experience chronic pelvic pain, which can be debilitating and affect their quality of life. 
	&nbsp;</li>
	<li>Abscesses: An abscess is a localized collection of pus that results from an infection or inflammation. It can occur anywhere in the body but is most commonly found in the skin, under the skin, or in an organ. In severe cases of PID, abscesses can form in the fallopian tubes or ovaries. These may need to be drained surgically. 
	&nbsp;</li>
	<li>Peritonitis: Rarely, PID can lead to peritonitis, a serious infection of the lining of the abdomen that can be life-threatening. 
	&nbsp;</li>
</ol>

Several risk factors can increase a person&#39;s likelihood of developing pelvic inflammatory disease (PID). 
 
These include<a href="#accordion">[5][7][8]</a>:

<ol>
	<li>Sexual Activity: Engaging in sexual activity, especially with multiple partners or without using protection, increases the risk of developing PID. Sexually transmitted infections, such as chlamydia and gonorrhea, are common causes of PID. 
	&nbsp;</li>
	<li>Age: Younger women are at a higher risk of developing PID. This is because the cervix and other reproductive organs are not fully matured, making them more vulnerable to infection. 
	&nbsp;</li>
	<li>History Of Sexually Transmitted Infections (STIs): Women who have a history of STIs, particularly chlamydia and gonorrhea, are at a higher risk of developing PID. 
	&nbsp;</li>
	<li>Intrauterine Device (IUD) Use: Women who use an IUD for birth control are at a slightly higher risk of developing PID in the first few weeks after insertion. However, this risk decreases over time. 
	&nbsp;</li>
	<li>Previous History Of PID: Women who have previously had PID are at an increased risk of developing it again. 
	&nbsp;</li>
	<li>Douching: Douching, or washing the vagina with water or other solutions, can disrupt the natural balance of bacteria in the vagina and increase the risk of infection. 
	&nbsp;</li>
	<li>Smoking: Smoking has been shown to increase the risk of developing PID, as it can weaken the immune system and make it harder for the body to fight off infections. 
	&nbsp;</li>
</ol>

It is important to note that not all women with these risk factors will develop PID, and many women who develop PID may not have any identifiable risk factors. 
&nbsp;

Several measures can be taken to reduce the risk of developing pelvic inflammatory disease (PID). 
 
These include<a href="#accordion">[1][5][6]</a>:

<ol>
	<li>Practicing Safe Sex: Using condoms or other barrier methods during sexual activity can reduce the risk of acquiring sexually transmitted infections, which are common causes of PID. 
	&nbsp;</li>
	<li>Getting Regular STI Screenings: Regular screenings for STIs, particularly chlamydia and gonorrhea, can help detect and treat infections before they progress to PID. 
	&nbsp;</li>
	<li>Avoiding Douching: Douching can disrupt the natural balance of bacteria in the vagina and increase the risk of infection. 
	&nbsp;</li>
	<li>Promptly Treating Vaginal Infections: Promptly treating vaginal infections, such as bacterial vaginosis or yeast infections, can help prevent the spread of infection to other parts of the reproductive system. 
	&nbsp;</li>
	<li>Avoiding Multiple Sexual Partners: Having multiple sexual partners increases the risk of acquiring STIs and developing PID. 
	&nbsp;</li>
	<li>Not Smoking: Smoking has been shown to weaken the immune system and increase the risk of developing PID. 
	&nbsp;</li>
	<li>Using Contraception Properly: Proper use of contraception, including oral contraceptives and intrauterine devices, can help prevent unintended pregnancies and reduce the risk of PID. 
	&nbsp;</li>
</ol>

It is important to note that while these measures can reduce the risk of developing PID, they are not foolproof and may not prevent all cases of the disease. 
&nbsp;

One of the recent studies was published in the Journal of Medical Systems in 2021, which used machine learning algorithms to predict the severity of PID using data from electronic medical records. The study found that the algorithm accurately predicted the severity of PID in 70% of cases, demonstrating the potential for AI to assist in the diagnosis and management of the disease<a href="#accordion">[9]</a>. Another study published in the Journal of Clinical Medicine in 2020 explored the use of AI to predict the risk of adverse outcomes in patients with PID. The study used a machine learning algorithm to analyze data from electronic medical records and found that the algorithm accurately predicted the risk of adverse outcomes in 80% of cases<a href="#accordion">[10]</a>. While these studies are promising, further research is needed to evaluate the potential for AI to improve the diagnosis and treatment of PID. 
&nbsp;

Key Points

<ul>
	<li>Pelvic inflammatory disease (PID) is an infection of the reproductive organs in women.</li>
	<li>Bacteria that cause sexually transmitted infections, such as chlamydia and gonorrhea, can travel from the cervix to the upper reproductive organs, causing infection and inflammation.</li>
	<li>The inflammation can cause swelling and scarring in the reproductive organs, which can lead to pain, infertility, and other complications.</li>
	<li>Lower abdominal pain is the most common symptom of PID.</li>
	<li>PID may cause changes in menstrual bleeding, including heavier or lighter periods, spotting, or irregular bleeding. It can also cause changes in vaginal discharge, including an increase in volume, change in color or odor, and the presence of pus</li>
	<li>The most common cause of PID is an STI, particularly chlamydia and gonorrhea.</li>
	<li>Women who use an IUD as a form of contraception may be at a slightly higher risk of developing PID.</li>
	<li>Women who douche regularly may be at an increased risk of developing PID because douching can disrupt the natural balance of bacteria in the vagina and introduce harmful bacteria.</li>
	<li>Pelvic inflammatory disease (PID) is often difficult to diagnose, as it can present with nonspecific symptoms and may not cause any symptoms at all.</li>
	<li>A pelvic examination is the first step in diagnosing PID.</li>
	<li>Culture tests can help detect the presence of bacterial infections, such as chlamydia and gonorrhea.</li>
	<li>In severe or recurrent cases of PID, a laparoscopy may be performed.</li>
	<li>If the PID is caused by a sexually transmitted infection, sexual partners need to be treated to prevent reinfection.</li>
	<li>PID is usually treated with a combination of antibiotics that are effective against the bacteria causing the infection.</li>
	<li>PID can cause scarring and damage to the fallopian tubes, which can lead to infertility.</li>
	<li>Women with PID are at an increased risk of developing an ectopic pregnancy, where the fertilized egg implants outside the uterus.</li>
	<li>Younger women are at a higher risk of developing PID.</li>
	<li>Smoking has been shown to increase the risk of developing PID.</li>
	<li>Using condoms or other barrier methods during sexual activity can reduce the risk of acquiring sexually transmitted infections.</li>
	<li>Regular screenings for STIs, particularly chlamydia and gonorrhea, can help detect and treat infections before they progress to PID.</li>
	<li>Promptly treating vaginal infections, such as bacterial vaginosis or yeast infections</li>
	<li>A recent study, published in the Journal of Medical Systems in 2021, used machine learning algorithms to predict the severity of PID using data from electronic medical records. &nbsp;</li>
	<li>Another study published in the Journal of Clinical Medicine in 2020 explored the use of AI to predict the risk of adverse outcomes in patients with PID. 
	&nbsp;</li>
</ul>

[1] Pelvic inflammatory disease (PID) (no date) ACOG

[2]Ahmed S, Parvin S, Shaha DR, et al. Clinical profile of pelvic inflammatory disease (PID). Faridpur Medical College Journal. 2017;12(1):25-30. doi:10.3329/fmcj.v12i1.33487

[3] Centers for Disease Control and Prevention. (2020). Pelvic Inflammatory Disease (PID) - CDC Fact Sheet

[4] Harvard Health Publishing. (2019). Pelvic inflammatory disease (PID).

[5] Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1-137.

[6] Haggerty CL, Ness RB. Diagnosis and treatment of pelvic inflammatory disease. Womens Health (Lond). 2011;7(1): 69–83.

[7] Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) randomized trial. Am J Obstet Gynecol. 2002;186(5):929-37.

[8] Westrom L. Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. Am J Obstet Gynecol. 1980;138(7 Pt 2):880-92.

[9] Du J, Sun Y, Guo Y, et al. Severity Prediction of Pelvic Inflammatory Disease Using a Machine Learning Model. J Med Syst. 2021;45(4):43.

[10] Hu L, Feng Y, Zhang Y, et al. Machine Learning-Based Prediction of Adverse Outcomes in Patients with Pelvic Inflammatory Disease. J Clin Med. 2020;9(3):658.

[11] Pelvic inflammatory disease (PID) (2022) Mayo Clinic. Mayo Foundation for Medical Education and Research.

[12] Ali TS, Ali SF, Ayub S, et al. Pelvic inflammatory disease: a comparative study of clinical and laboratory diagnosis. J Coll Physicians Surg Pak. 2014;24(3):187-190.