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Pelvic Inflammatory Disease

A woman with pelvic inflammatory disease (PID) has an infection of one or more pelvic organs. The infection is generally the result of a sexually transmitted infection. The two infections involved most often are gonorrhea and chlamydia. There is also evidence that mycoplasmas and organisms of the normal cervical and vaginal flora can cause PID. The organs usually infected are the fallopian tubes, although the uterine lining and ovaries may also be involved.

PID is a serious condition requiring prompt medical attention and strict compliance with treatment instructions. Possible consequences of PID include chronic pelvic pain; a higher risk of infertility (inability or difficulty in becoming pregnant); ectopic pregnancy (pregnancy in the tube); and serious illness. If left untreated, PID can be life threatening. Prompt medical care reduces possible consequences of the disease.

While any woman can develop PID, certain women share characteristics of higher risk. These risk factors include:

• sexual activity, especially in women 15 - 24 years of age
• having had multiple sexual partners
• using an intrauterine device (IUD) for contraception
• a sexual partner with gonorrhea or non-gonococcal urethritis (NGU is an inflammation of the urethra, generally caused by chlamydia)
• untreated gonorrhea or chlamydia infections
• previous development of PID

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The most common symptoms leading a health care provider to suspect that a woman has pelvic inflammatory disease is recent onset of pelvic pain. This pain may be accompanied by abnormal vaginal bleeding, discharge, fever, back pain or painful intercourse. The health care provider will inquire about symptoms, contraception, menstrual history and sexual history. The next step in diagnosis is a physical examination. This examination includes a pelvic exam, including tests for sexually transmitted infections. The uterus, fallopian tubes and ovaries are checked for tenderness and pain. A rectal exam may also be done. Blood tests may be drawn.

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Some women have infections of such severity that they require hospitalization. Many others, however, are treated as outpatients. PID can become a life-threatening and fertility-threatening condition. It is essential that a patient follow the medical regimen prescribed by a nurse practitioner or physician. Any sexual partner(s) of the previous two months may need to be examined, tested and treated for sexually transmitted infections. Pelvic inflammatory disease is treated by antibiotics. A woman may receive an injection or intravenous medication, followed by oral medication to be taken over a 7-14 day time period. It is VERY IMPORTANT that the instructions for taking the medications be followed exactly as prescribed, in order for the infection to completely go away. Additional examinations will also be required to be sure the infection is gone. A woman must abstain from sexual intercourse until she has taken all the medication and follow-up exams are normal.

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Women can take steps to decrease the risk of developing pelvic inflammatory disease. Prevention includes limiting one's risk factors for developing a sexually transmitted infection, as well as prompt action to limit the transmission and severity of the disease once it has developed. Those who have had PID previously are at higher risk of developing it again and need to take special care.

Ways women can limit the risk of developing PID:

• limiting the number of sexual partners
• using barrier methods of contraception (use of condoms and spermicide or the diaphragm may protect against transmission of gonorrhea and chlamydia)
• seeking medical evaluation for any symptoms of sexually transmitted infections, and by requesting routine sexually transmitted infection and screening tests when having annual pap smears done
• following up pregnancy termination by taking medication as ordered and by having follow-up physical examinations as directed

• take ALL medications until gone, even if the symptoms start to go away
• if treated for PID, return for follow-up medical appointments as directed; return sooner if symptoms do not improve or become worse in any manner
• call the clinic if there are any adverse reactions to medication(s). Do not discontinue medication(s) without consulting the clinic
• consider vaccination against Hepatitis B and testing for HIV

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Reprinted with Permission - Copyright © 2000 McKinley Health Center, University of Illinois.