Pelvic Inflammatory Disease (PID) Diagnosis and Treatment

What is Pelvic Inflammatory Disease (PID)?

Pelvic inflammatory disease is a significant infection that impacts the uterus, fallopian tubes, and/or ovaries, primarily affecting women. It happens when microbes such as bacteria, usually from untreated sexually transmitted infections (STIs), travel from the vagina into the reproductive organs. While bacteria such as gonorrhoea and chlamydia are the usual culprits, PID can also result from bacteria typically found in the vagina.

PID can cause symptoms like abdominal pain and unusual vaginal discharge. In severe cases, it may permanently damage reproductive organs, potentially leading to infertility. Early diagnosis and treatment of STIs are essential to preventing PID.

How is PID spread?

PID is most commonly transmitted through unprotected sexual activity, which allows bacteria to enter and infect the reproductive system.

How Prevalent is PID?

In the UK, over one million women and individuals AFAB are diagnosed with PID annually, with more than 100,000 cases leading to infertility. Those aged 15 to 25 are particularly at risk.

Symptoms of PID

PID symptoms may range from mild to severe or may even go unnoticed. Key symptoms include:

• Pain or tenderness in the lower abdomen or pelvis which is the most frequent symptom.
• Abnormal vaginal discharge, often yellow or green, with an unpleasant odour.
• Chills or fever.
• Nausea and vomiting.
• Pain during intercourse.
• Discomfort or burning during urination.
• Irregular periods or spotting.

Location of PID Pain

PID-related pain is usually centred in the lower abdomen or pelvic region. It may manifest as tenderness, a dull ache, or deep pain during intercourse.

Causes of PID

PID occurs when bacteria enter the reproductive tract, often via the vagina, and spread to the uterus, fallopian tubes, and ovaries. The cervix typically acts as a barrier, preventing bacterial spread. However, infections can compromise the cervix's function.

The majority of PID cases—approximately 90%—are caused by gonorrhoea and chlamydia. Other less common causes include:

• Childbirth.
• Pelvic surgeries.
• Miscarriages.
• Insertion of intrauterine devices (IUDs), with the highest risk occurring shortly after insertion.

Timeframe for PID Symptom Onset

Symptoms of PID can develop within days to weeks if triggered by gonorrhoea or chlamydia. If it is caused by other factors, it may take months to manifest.

Role of douching in PID

Although there is no definitive evidence linking douching to PID, it is known to increase the risk of bacterial vaginosis, which may contribute to PID. Most medical professionals discourage douching.

Is PID Contagious?

Yes, PID is contagious and commonly spreads through direct sexual contact.

Who is at Risk?

You are likely to develop Pelvic Inflammatory Disease if you:

• Have an STI, particularly gonorrhoea or chlamydia.
• Engage with multiple sexual partners or have a partner with multiple partners.
• Have previously had PID.
• Are under 25 and sexually active.
• Have undergone tubal ligation or other pelvic procedures.

Complications of PID

Untreated PID can lead to serious complications, including:

• Chronic pelvic pain: Approximately 20% of individuals with PID experience long-term pelvic pain.
• Ectopic pregnancy: Scarring caused by PID may result in fertilised eggs implanting in the fallopian tubes.
• Infertility: Around 10% of PID cases result in infertility due to blocked fallopian tubes.
• Tubo-ovarian abscess (TOA): Severe cases can lead to infected abscesses in the pelvis.

Diagnosis and Testing

If you suspect you have PID, seek medical attention promptly. Diagnosis often involves:

• Discussing your medical history, symptoms, and sexual activity.
• A pelvic examination to identify tenderness or abscesses.
• Vaginal cultures to detect bacterial infections.

Additional Tests

Healthcare providers may also recommend:

• Blood and urine tests.
• STI screening.
• Ultrasound imaging of reproductive organs.
• Endometrial biopsy or laparoscopy in complex cases.

Management and Treatment

PID is typically treated with oral antibiotics taken over 14 days. It is essential to complete the full course, even if symptoms improve early. Follow-up appointments are often advised to confirm treatment effectiveness.

In severe cases, hospitalisation and intravenous (IV) antibiotics may be required, particularly if:

• You are pregnant.
• The infection is severe or causes an abscess.

Sexual Partners and PID Treatment

It is vital to inform sexual partners if you are diagnosed with PID, as they may require treatment to prevent reinfection. Abstain from sexual activity until completing treatment.

Surgical Intervention

Surgery is rarely needed but may be necessary for abscess removal or persistent symptoms following antibiotic therapy.

Prevention & Reducing the Risk of PID

The following can be done to lower the risk of PID:

• Practise safe sex by using condoms or diaphragms with spermicide.
• Limit the number of sexual partners.
• Avoid douching to prevent bacterial spread.
• Seek prompt treatment for STI symptoms such as unusual discharge or pelvic pain.

Regular Screenings

Annual screenings for chlamydia and gonorrhoea are recommended for sexually active individuals, particularly those with new partners.

Can PID Be Cured?

When diagnosed early, PID can be treated effectively with antibiotics. However, existing damage to reproductive organs cannot be reversed.

Impact on Fertility

PID can impair fertility due to scarring in the fallopian tubes, which blocks eggs from reaching the uterus. Approximately 1 in 8 individuals with PID experience difficulty conceiving.

Risk of Recurrence

Having PID once does not provide immunity; reinfection is possible.

Resuming Sexual Activity

Wait at least one week after completing treatment—and ensure your partner has been treated—before resuming sexual activity.

Conclusion

Pelvic inflammatory disease is a severe infection of the reproductive organs, often caused by STIs like gonorrhoea and chlamydia. Early detection and treatment with antibiotics is crucial to prevent complications such as infertility. Preventative measures, including safe sexual practices and regular STI screenings, are essential. If you experience symptoms such as pelvic pain or unusual discharge, consult your healthcare provider immediately.

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