Deborah Breeding, RN

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The statistics are shocking: One in seven US women will be treated for pelvic inflammatory 	disease (PID) over the course of her lifetime. That translates into more than a million women diagnosed with PID 	each year. Worse yet, for every four women who get PID, one will suffer a complication, such as chronic abdominal 	pain, infertility, or an abnormal pregnancy. But the statistics tell only part of the story. The number of women 	with unrecognized disease is estimated to be far higher than one in seven. Many women with undiagnosed disease 	will learn of their infection only when they try to have a baby--and can't. This situation would be tragic under 	any circumstance, but it is doubly so when it is the result of a treatable--and largely preventable--disease.

 	 Pelvic inflammatory disease is a term for a variety of infections affecting a woman's upper reproductive organs, 	including the uterus, the ovaries, and the two fallopian tubes that serve as passageways between the ovaries and 	the womb. PID occurs when disease-causing microorganisms in the lower genital tract rise through the opening in 	the cervix, which separates the uterus and the vagina (see "How PID infects the reproductive organs"). 	

Most cases of PID are acquired during sexual intercourse with a partner who has a sexually transmitted disease 	(STD), primarily chlamydia or gonorrhea. Up to 40% of women who get one of these infections and don't have it adequately 	treated will wind up with PID. PID can occur after a miscarriage, abortion, or any other procedure that opens the 	cervix or abdomen, allowing disease-causing germs easy entry to the reproductive organs.

PID can spread beyond the reproductive tract, causing serious and potentially deadly complications. Each year 	about 250,000 US women are hospitalized because of PID, and more than 150 die.

Even aside from the immediate dangers, the long-term effects of PID can be devastating. PID can permanently 	scar and damage the fallopian tubes, causing blockage of the tubes. About 12% of women suffer enough tubal damage 	from one episode of PID to become infertile. After three episodes of PID, the infertility rate reaches 50%.

PID also increases the risk of an ectopic pregnancy, in which the fertilized egg gets trapped in the tube and 	begins to grow there. Without treatment, the tube may burst, causing internal bleeding and possibly death. Finally, 	tissue damage can leave many women with chronic pelvic pain long after the PID infection is gone.

Anyone can get PID, but the risk is highest for women who:

Although anyone can get PID, the disorder is especially common in women under 25 years old (see "Who's 	at Risk for PID?"). As with STDs in general, the more sexual partners a woman has, the more likely she is 	to get PID. Even if you have only one sexual partner, you can still get PID if your partner is having intercourse 	with other people. A woman who has only one partner (who is also sexually exclusive) has a very low risk of PID.

Using an intrauterine device (IUD) for birth control increases the risk of PID somewhat, especially for the 	first few months after the device is inserted. Douching has also been linked to PID, perhaps because it pushes 	vaginal organisms up through the cervical opening.

Once you've had one bout of PID, you're more likely to have another, regardless of your behavior. These later 	infections are not always caused by a new STD. Instead, they commonly result from bacteria that were not completely 	wiped out by earlier therapy. PID also seems to leave the reproductive tract more sensitive to vaginal organisms 	that wouldn't ordinarily cause a problem. "In a sense, it's like you catch the infection from yourself," 	observes Dr Paul Feldman, an adult and adolescent obstetrician-gynecologist and infertility specialist in Saranac, 	New York.

The symptoms of PID can be dramatic or they can be barely noticeable. Symptoms caused by chlamydia are especially 	likely to be mild. The most common symptom is a dull, constant pain in the lower abdomen. The pain often begins 	right after menstruation and may be worse during sexual intercourse. Other symptoms include an abnormal vaginal 	discharge or bleeding, painful urination, fever, nausea, and vomiting.
 	Because even mild infections can cause extensive tubal damage, don't hesitate to call a doctor if you think you 	might have PID or a sexually transmitted disease. Women who have already had PID need to be especially watchful, 	because any abnormal symptom could signal another infection.

To make a diagnosis of PID, the doctor will usually ask you about your sexual habits and other risk factors, 	perform a pelvic examination, and take samples of cervical cells or vaginal discharge to test for chlamydia, gonorrhea, 	and other infections. Blood tests, x-rays, or ultrasound imaging may also be needed.

The diagnosis is not always easy, because many other conditions can cause similar symptoms. "There isn't 	any one test that will tell the doctor for certain that you have PID," says Dr Cynda Johnson, a professor 	in the departments of Family Medicine and Obstetrics and Gynecology and Vice Chairman of the department of Family 	Medicine at the University of Kansas.

Sometimes the questions can be resolved only by doing a laparoscopy, a surgical procedure that allows the doctor 	to look into the abdominal cavity, check the pelvic organs for signs of infection, and rule out other possible 	disorders, such as appendicitis and ectopic pregnancy.

Antibiotics are the mainstay of PID treatment. If the infection fails to respond to the medications or has become 	walled off in an abscess, surgery may be needed. Depending on the cause and severity of the problem, the antibiotics 	may be given by mouth, injection, or intravenously. Some women can be treated at home; others must be cared for 	in a hospital. For treatment to succeed, it's essential to follow the doctor's instructions; not taking the antibiotics 	as directed or stopping them too soon can lead to a relapse. Since PID is often sexually acquired, sexual partners 	may need to be examined and treated to prevent a reinfection.


 				While it may be impossible to eliminiate the risk of PID completely, there are things women can do to protect themselves.

You can reduce your risk of getting PID by reducing your risk of acquiring a sexually transmitted infection 	in the first place (see "Reduce Your Risk"). Short of refraining from sex altogether, the best way to 	do that is by remaining in a monogamous relationship or using a latex condom and a spermicide for every sexual 	encounter. Using a diaphragm and spermicide also reduces the risk, though not to the same degree as using a condom. 	"PID is one of those conditions that everyone assumes is not going to happen to them," warns Dr Feldman. 	"No matter how clean-cut the other person is and no matter what you've said to each other, you have to presume 	that he could be carrying an STD--even if he doesn't know it--and stick by your guns and protect yourself."

Having regular gynecologic checkups and screenings is also important, because cervical infections can be identified 	and treated before they have time to spread. Experts estimate that regular chlamydia screenings could reduce the 	number of PID cases by half. "Don't wait until you have symptoms," Dr Feldman advises. "If you have 	more than one sexual partner, if you've had sex without a condom, or if you're concerned that you may have been 	exposed to an STD, go for a screening." Your future health and well-being may depend on it.

Deborah Breeding is a registered nurse and a freelance medical writer.

Originally published in The Female Patient -- November, 1997

Reprints are not allowed without the expressed written consent of Quadrant Publishing. 

Articles

The statistics are shocking: One in seven US women will be treated for pelvic inflammatory disease (PID) over the course of her lifetime. That translates into more than a million women diagnosed with PID each year.

Pelvic Inflammatory Disease: Don't Let It Sneak Up on You

 Pelvic inflammatory disease is a term for a variety of infections affecting a woman's upper reproductive organs, 	including the uterus, the ovaries, and the two fallopian tubes that serve as passageways between the ovaries and 	the womb. PID occurs when disease-causing microorganisms in the lower genital tract rise through the opening in 	the cervix, which separates the uterus and the vagina (see "How PID infects the reproductive organs"). 	

Author | Deborah Breeding, RN

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Pelvic Inflammatory Disease: Don't Let It Sneak Up on You

Pelvic Inflammatory Disease: Don't Let It Sneak Up on You