Pelvic Inflammatory Disease

In this fact sheet, we learn more about pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infection with the resulting inflammation of the female upper genital tract, including the endometrium, the Fallopian tubes and the ovaries, which generally originates as a consequence of an infection ascending from the cervix and which occasionally extends to adjacent structures.

How does PID affect fertility?

PID may provoke chronic discomfort in the inferior hemiabdomen, an increased risk of ectopic pregnancy, pain due to adherences, and infertility due to Fallopian tube obstruction. Approximately 12% of women become infertile following a simple episode, almost a 25% after two episodes, and almost 50% following three episodes. Another associated sequel is dyspareunia (pain during sexual intercourse).

What are the symptoms?

• Abdominal pain (including adnexal pain, dyspareunia). It is the most common symptom.
• Increase in vaginal discharge, discharge of abnormal characteristics.
• Abnormal bleeding (intermenstrual, post-coital).
• Urinary symptoms
• Vomiting
• The absence of symptoms is also possible.

What causes pelvic inflammatory disease?

Generally, it is a consequence of an ascending infection originating in the cervix:

Due to a sexually transmitted disease (STD): cervicitis.

Polymicrobial infections related to vaginosis or opportunistic interactions of the vaginal/perineal flora with a primary STD.

Are there any treatments available?

It is possible to treat with oral antibiotics at home, or with intravenous antibiotics in a hospital stay.

In some cases, it is necessary to perform surgery, generally a laparoscopy, (a surgical diagnostic procedure used to examine the organs inside the abdomen. It’s a low-risk, minimally invasive procedure that requires only small incisions. Laparoscopy uses an instrument called a laparoscope to look at the abdominal organs.) but in the most serious cases, a laparotomy may be performed.

How does it affect pregnancy?

One of the most severe complications of PID is an ectopic pregnancy. This happens because there are alterations to the structure and the functioning of pelvic organs which cause the embryo to be implanted outside the uterus.

PID is not very frequent in later stages of pregnancy, however, it can lead up to severe consequences for both the mother and the baby. Diagnosis and effective treatment are of the utmost importance.

How does it affect men and their fertility?

PID is often caused by sexually transmitted diseases, so these can be passed on to the partner. These microorganisms cause infection and swelling. Chronic swelling can alter the functioning of reproductive organs and affect the mobility, concentration, and morphology of the sperm.

How long can you have it before becoming infertile?

Fertility can normally be preserved after an episode of PID with adequate treatment, but the more episodes, the bigger the chances of PID causing infertility. Severe cases of PID increase the risk of decreasing fertility.

How do you test for PID?

If there are signs of PID your doctor will perform a complete physical examination.

A diagnosis is reached testing the vaginal discharge to detect microorganisms. Blood testing is used to get infection data.

Transvaginal ultrasound helps with the diagnosis of severe cases of PID.

Endometrial biopsies can be helpful in some cases.

Sometimes a laparoscopy is needed to diagnose the most severe cases.

What are the warning signs?

Persisting pain in the lower area of the abdomen

Fever

Unusual vaginal discharge

Bleeding or pain during sexual intercourse