A Guide To Pelvic Inflammatory Disease, Its Causes, Symptoms, And Treatment

The sexually transmitted infections are a rapidly growing medical problem in the United States. The total number of patients suffering from Chlamydia, Gonorrhea, and Syphilis were 2 million in the year 2016. According to the Centers for Disease Control and Prevention (CDC), Washington, these were the highest recorded figures in the US till date. Out of these cases, Chlamydia accounted for 1.6 million cases, Gonorrhea for 0.47 million cases and Syphilis both primary and secondary for 28000 cases.

All these figures were greater than the figures in 2015. The rapidly growing cases of sexually transmitted diseases also resulted in an increased number of people suffering from medical conditions like Pelvic Inflammatory Diseases, infertility, etc. The Pelvic Inflammatory Disease is a dangerous condition that affects the women suffering from certain sexually transmitted infections like Chlamydia and Gonorrhea. The bacteria causing Chlamydia and Gonorrhea are responsible for 75 to 90 percent reported cases of Pelvic Inflammatory Disease.

What is the PID?

The PID is an infection caused by a bacteria that affects the reproductive system in women. As the name suggests PID affects the pelvis that's present in the lower abdomen area and consists of reproductive organs such as the uterus, ovaries, Fallopian tubes and the cervix. The seriousness of this condition can be understood by the fact that it affects nearly one million US women every year and causes infertility in more than 100000 women. The PID is basically a bacterial infection that can be caused by a number of bacteria, including the ones that cause Chlamydia and Gonorrhea. The detection of PID in earlier stages is difficult due to lack of symptoms.

How does a woman get infected with PID?

When the bacteria enter the vagina the risk of Pelvic Inflammatory Disease increases manifold. If a bacterial infection caused by sexually transmitted infection remains undetected and untreated, it may progress to the pelvic region and cause the Pelvic Inflammatory Disease. The women often get the PID through sexually transmitted diseases, but they can also contract the disease from a normal bacteria present in the vagina. When these bacteria infect the reproductive organs it may lead to PID. The progress of the normal bacteria from the vagina to the reproductive organs is sometimes caused by Douching. The PID becomes dangerous and life-threatening when the infection progresses to the blood.

Who can get Pelvic Inflammatory Disease?

The women suffering from a sexually transmitted infection like Gonorrhea and Chlamydia are highly susceptible to PID. Apart from a sexually transmitted disease the following factors may lead to Pelvic Inflammatory Disease

Multiple sexual partners- Sexual engagement with multiple partners exponentially increases the risk of contracting the PID.
Sexual contact with a person that has multiple partners- The potential of such a person contracting the STI or being a silent carrier of PID is quite high, thereby enhancing the risk to you.
Douching- It may facilitate the bacterial movement into the vagina. It's also responsible for hiding the symptoms of the disease.
Unprotected sex- Engaging in sexual activities without a condom can lead to contracting the Pelvic Inflammatory Disease. Only the touch of an infected penis to the mouth, anus or vagina can cause STI that may lead to PID. There's no need of ejaculation for getting infected with an STI, the primary cause of PID.
IUD or intrauterine device usage- The risk of contracting PID is higher during the initial few weeks. After that time risk of contracting the disease is minimal. One should get herself tested before getting an IUD to keep the risk of contracting the disease at the minimum.

In addition to the above factors, a sexually active woman between the age of 15 years to 25 years is at a high risk of getting infected by the PID. Also, a woman with a history of PID is at a high risk of contracting the disease again.

What are its symptoms?

Most of the times, PID is asymptomatic in nature, so there are no visible symptoms. In other cases, the following symptoms occur

The most common symptom is a pain in the lower abdominal region
Pain or discomfort within the pelvis during intercourse
Pain while urinating
Excessive bleeding or pain during periods
Unusual and foul-smelling vaginal discharge
Bleeding after the intercourse or between the periods

The above-mentioned symptoms are commonly experienced by women but in certain extreme cases the symptoms may include one or all of the following

High fever that's greater than 101°F.
Extreme lower-abdominal pain.
Vomiting and Nausea.
Fainting.

When should a woman seek medical assistance/opinion?

Medical assistance or opinion becomes necessary whenever one or more of the above-mentioned symptoms are experienced by a woman. In case of the symptoms associated with extreme cases, the need for medical assistance becomes urgent. Failure to do so may allow the infection to spread into the bloodstream or other organs and may become life-threatening.

How is PID diagnosed, and its damage assessed?

The medical diagnosis of the Pelvic Inflammatory Disease is often based on the symptoms being experienced by the patient. In addition to the analysis of symptoms following laboratory tests are conducted to verify and confirm the diagnosis

A pelvic exam that involves examination of the pelvic organs.
Cervical culture to determine the presence of the infection in the cervix.
Test of urine to determine the presence of blood traces, and diseases like cancer.

After the diagnosis further test could be conducted to determine the extent of damages caused by the Pelvic Inflammatory Disease. There are a number of complications that are caused by PID and the following additional tests are conducted to determine the extent of these damages

Ultrasound of the pelvis- it is an imaging test. In this test, the sound waves are used to examine the internal organs.
Endometrial biopsy- It involves removal and examination of a small sample from the uterine lining.
Laparoscopy- It involves an incision in the abdominal region through which a medical instrument is inserted to take the photographs of the pelvic organs.

What is the treatment of PID?

The treatment of Pelvic Inflammatory Disease and its results are dependent on the stage at which the disease was diagnosed. The damage sustained due to PID is permanent and irreversible. The treatment of PID involves administering a combination of antibiotics since the bacteria causing the disease is often remains unidentified and a group of antibiotics that cover the likely bacteria’s are used.

Hospitalization is suggested in cases when the infected patient is ill, pregnant, unable to swallow pills or if they have a pus-filled pocket/abscess in the pelvis. Surgery may be required in rare cases when an abscess gets ruptured or it's expected to get ruptured. In cases when the disease doesn't respond to the treatment, surgery may be required for the treatment.

In earlier stages, the PID is usually treated with a 14-day course of antibiotics. At least a combination of two antibiotics is used for the treatment. The antibiotics are administered both in their tablet and injectable forms. The symptoms usually go away within a few days of taking the medicines/antibiotics. It's necessary to complete the entire course even when the symptoms go away before the course is completed. This is necessary to completely cure the Pelvic Inflammatory Disease.

The PID should be treated as soon as it's detected any delay may lead to complications. The infected person should get her partner informed and both should get tested and treated for a potential STI infection. Any type of sexual engagement should be avoided till the treatment is complete to prevent the possibility of re-infection. The risk of PID increases in people that have already had the infection caused by Pelvic Inflammatory Disease and the Sexually Transmitted Infections.

What happens when the treatment is delayed?

The delay in treatment is usually due to the late identification of the disease. This is mostly due to the asymptomatic nature of the disease. The need for early detection of the disease is paramount, since the negative effects or the damages done by the Pelvic Inflammatory Disease are permanent.

The primary area that gets damaged is the reproductive system and it involves the scar tissue formation that leads to tubal blockage, infertility or long-term pain in the pelvis. The risk of contracting an infection that may lead to PID increases with following occurrences

Postpartum- Its the period just after the childbirth.
Post pelvic surgery.
Abortion.
Miscarriage.

The scarring of the reproductive system and organs like Fallopian tubes caused by the PID can lead to following complications

Chronic pain in the pelvis- The pain may last a long time even for years. The scarring caused by PID to the reproductive organs may also cause pain during ovulation and intercourse.
Ectopic pregnancy- PID is considered to be a principal cause of Ectopic pregnancy. The scar tissue caused by PID to the reproductive organs prevents the movement of the fertilized egg through the Fallopian tubes to the uterus for implantation. This may result in the fertilized egg being implanted outside the uterus. This type of condition can cause excessive and severe bleeding that may become life-threatening.
Infertility- The inability to conceive/ getting pregnant increases with the recurrence of the PID and the delay in the treatment of PID.
Tubo ovarian abscess- These are pus-filled pockets in the ovaries or the tube and are caused by PID. If left untreated, it may become life-threatening.
Diseases like Fitz-Hugh–Curtis syndrome

How can one prevent the PID?

The testing for sexually transmitted diseases at regular intervals is a strong preventive measure, especially in case of women that are at a high risk of contracting the disease. The risk of contracting the Pelvic Inflammatory Disease can be minimized through the following actions

Safe and protected sex- The use of condoms during the sexual intercourse minimize the risk of contracting the disease. Condoms should be used before the penis touches the vagina, anus or mouth since the disease can be contracted without an ejaculation. Other safe sex practices that should be implemented include limiting the number of sexual partners and inquiring about the sexual history of potential partners.
Try to be monogamous- The sexual engagement, with only a single partner, can minimize the risk drastically. To minimize the risk both the partner needs to be faithful to each other.
Using contraceptives that reduce the risk- The barrier methods of contraception like condoms are quite effective in minimizing the risk. The choice of contraceptive should be made after discussing it with a doctor.
Regular screening- The high-risk individuals should incorporate a regular screening schedule with their doctor to get tested for sexually transmitted infections at regular intervals.
Avoid douching- Douching not only increases the risk of Pelvic Inflammatory Disease, but it also hides certain symptoms of the disease. So, it may not only cause PID but delay its identification leading to complications associated with the disease such as infertility.
Make sure your partner is not infected- Getting your partner tested can help you in preventing the disease. In case you get infected, request your partner to get a test and if infected ask them to get the treatment. This not only restricts the disease from spreading, but it also prevents the PID from recurring.
Avoiding sexual activities associated with the vagina immediately after the pregnancy, abortion or miscarriage to ensure the closure of the cervix.

The Pelvic Inflammatory Disease can be life-threatening in severe cases and may lead to other life-threatening medical conditions like Ectopic pregnancy. In fact, a majority of Ectopic pregnancy cases occur due to the PID. The younger women under the age of 25 years are highly susceptible to the disease especially in cases when they are sexually active with multiple partners.

An age-old saying, "Prevention is better than the cure" is the best advice for everyone, that's worried about the Pelvic Inflammatory Disease or STI's. The implementation of the preventive measure is the best course of action to save yourself from the dangers of PID. In case you get infected, rush to your doctor and start the treatment also, don't forget to make your sexual partner get tested and treated.