What is pelvic inflammatory disease?
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Aside from AIDS, the most common and serious complication of sexually transmitted diseases (STDs) among women is Pelvic Inflammatory Disease (PID), an infection of the upper genital tract. PID can affect the uterus, ovaries, fallopian tubes, or other related structures. Untreated, PID causes scarring and can lead to infertility, tubal pregnancy, chronic pelvic pain, and other serious consequences.Cause
PID occurs when disease-causing organisms migrate upward from the urethra and cervix into the upper genital tract. Many different organisms can cause PID, but most cases are associated with gonorrhea and genital Chlamydia infections, two very common STDs. Scientists have found that bacteria normally present in small numbers in the vagina and cervix also may play a role.Investigators are learning more about how these organisms cause PID. The gonococcus, Neisseria gonorrhea, probably travels to the fallopian tubes, where it causes sloughing (casting out) of some cells and invades others. Researchers think it multiplies within and beneath these cells. The infection then may spread to other organs, resulting in more inflammation and scarring.
Chlamydia trachomatis and other bacteria may behave in a similar manner. Researchers do not know how other bacteria that normally inhabit the vagina (e.g., organisms such as Gardnerella vaginalis and Bacteroides) gain entrance into the upper genital tract. The cervical mucus plug and secretions may help prevent the spread of microorganisms to the upper genital tract, but it may be less effective during ovulation and menses. In addition, the gonococcus may gain access more easily during menses, if menstrual blood flows backward from the uterus into the fallopian tubes, carrying the organisms with it. This may explain why symptoms of PID caused by gonorrhea often begin immediately after menstruation as opposed to any other time during the menstrual cycle. It is noteworthy that the co-incidence of menses and Chlamydia infection is not a prominent feature of Chlamydia PID.
Symptoms
The major symptoms of PID are lower abdominal pain and abnormal vaginal discharge. Other symptoms such as fever, pain in the right upper abdomen, painful intercourse, and irregular menstrual bleeding can occur as well. PID, particularly when caused by Chlamydia infection, may produce only minor symptoms or no symptoms at all, even though it can seriously damage the reproductive organs.Risk Factors for PID
- Women with STDs – especially gonorrhea and Chlamydia infection – are at greater risk of developing PID; a prior episode of PID increases the risk of another episode because the body’s defenses are often damaged during the initial bout of upper genital tract infection.
- Sexually active teenagers are more likely to develop PID than are older women.
- The more sexual partners a woman has, the greater her risk of developing PID.
Recent data indicate that women who douche once or twice a month may be more likely to have PID than those who douche less than once a month. Douching may push bacteria into the upper genital tract. Douching also may ease discharge caused by an infection, so the woman delays seeking health care.
Diagnosis
PID can be difficult to diagnose. If symptoms such as lower abdominal pain are present, the doctor will perform a physical exam to determine the nature and location of the pain. The doctor also should check the patient for fever, abnormal vaginal or cervical discharge, and evidence of cervical Chlamydia infection or gonorrhea. If the findings of this exam suggest that PID is likely, current guidelines advise doctors to begin treatment.If more information is necessary, the doctor may order other tests, read more
