Pelvic Inflammatory Disease and Infertility.
Background: Pelvic inflammatory disease (PID) is an infection of the upper part of the female reproductive system which include the uterus, fallopian tubes, ovaries and inside of the pelvis. PID occurs when a sexually transmitted infection (STI) like chlamydia or gonorrhea is not treated early. The classical high-risk patient is a menstruating woman <25 years of age who has multiple sex partners, does not use contraception and lives in an area with a high prevalence of sexually transmitted diseases (STDs). Untreated PID can result in long term complications including infertility, ectopic pregnancy, chronic pelvic pain and cancer. PID is initiated by infection that ascends from the vagina and cervix into the upper genital tract. Chlamydia trachomatis is the predominant sexually transmitted organism associated with PID. Other organisms implicated in the pathogenesis of PID include Neisseria gonorrhea, Gardnerella vaginalis, Haemophilus influenza and anaerobes such as Peptococcus and Bacteroides species. Although some studies suggest that 24-32% women in India suffer from PID, adequate information on magnitude, distribution and determinants of PID and other gynecological morbidities in developing countries is unavailable. Rates are higher within teenagers and first time mothers. A number of factors may increase risk of contracting pelvic inflammatory disease. These include
– Being a sexually active women younger than 25 years of age.
– Having multiple sexual partners and unprotected sex.
– Having had an IUD (Intrauterine Devices) inserted recently.
– Douching regularly, which upsets the balance of good versus harmful bacteria in the vagina and may mask symptoms that might otherwise cause you to seek early treatment.
– Having a history of pelvic inflammatory disease or a sexually transmitted infection.
Symptoms range from none to severe. They include pain in the lower abdomen and pelvis, heavy vaginal discharge with an unpleasant odor, irregular menstrual bleeding, pain during sexual intercourse & painful or difficult urination. PID with mild or no symptoms is especially common when the infection is due to chlamydia.
Pelvic inflammatory disease is diagnosed based on signs and symptoms, a pelvic examination, an analysis of vaginal discharge and cervical cultures or urine tests. During the pelvic examination, a cotton swab is used to take samples from the vagina and cervix. The samples are sent to a lab for analysis to determine the organism that’s causing the infection. To confirm the diagnosis or to determine how widespread the infection is, other tests such mentioned under may be recommended:
– Ultrasound: This test uses sound waves to create images of your reproductive organs.
– Endometrial biopsy: During this procedure, your doctor removes a small piece of your uterine lining (endometrium) for testing.
– Laparoscopy: During this procedure, your doctor inserts a thin, lighted instrument through a small incision in your abdomen to view your pelvic organs.
Treatment is often started without confirmation of infection in lieu of the serious complications that may result from delayed treatment. Choice of treatment is dependent on the infectious agent and generally involves the use of antibiotic therapy. Treatment depends upon the severity of disease. Generally, intravenous and oral therapies proven to be very effective in case of mild to moderate severity of PID. Typical treatment regimens include cefoxitin or combination of cefotetan and doxycycline. However, there are alternative regimens which include ampicillin/sulbactam and doxycycline and in other instances the parenteral regimens will involve ceftriaxone or combination of cefoxitin and doxycycline. This information is not intended as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs.
Regular testing and monitoring sexually transmitted infections is the preferred mode of prevention. Use of contraceptive pills (which contain hormones) also helps in reducing the chances of PID by thickening the cervical mucosal plug thereby preventing the ascent of causative organisms from the lower genital tract. Seeking medical attention after learning that a current or former partner has or might have had a sexually transmitted infection is highly recommended. Also the STI history of the current partner should be obtained and the person should be tested and treated before indulging in intercourse. Diligence in avoiding vaginal activity, particularly intercourse, soon after the end of a pregnancy (delivery, abortion or miscarriage) or certain gynecological procedures is necessary ensure that the cervix closes.
Ritu Anwesha, M.Sc (Biomedical Genetics), Department of Biomedical Genetics, Vellore Institute of Technology (VIT), Vellore, India.
May 14, 2017
– MMWR Morb Mortal Wkly Rep. 2017 Jan 27;66(3):80-83. doi: 10.15585/mmwr.mm6603a3.
Prevalence of Pelvic Inflammatory Disease in Sexually Experienced Women of Reproductive Age – United States, 2013-2014.