What is Pelvic Inflammatory Disease?

Pelvic Inflammatory Disease, PID, is a term that is often thrown around in reproductive health conversations, however, it’s not always clearly understood. 

Affecting an estimated 4.4% of women of reproductive age in the U.S., PID is fairly common, and when left untreated, can come with serious long term health implications. 

PID develops when bacteria travels through the cervix, causing an infection in the upper reproductive organs – uterus, fallopian tubes, and/ or ovaries. When microorganisms from the cervix and vagina move up the reproductive tract, it can lead to PID.

Typically these microorganisms are bacteria from STIs, namely chlamydia and gonorrhea, but it can also develop from other pathogens. STIs are the cause of about one-third of PID, although this rate is higher for people under the age of twenty-five. 

What are The Symptoms of Pelvic Inflammatory Disease?

Some people with PID are asymptomatic, while others may have a gradual increase of symptoms, or acute onset. The symptoms of PID can appear non-specific, and can easily be confused with other reproductive health or abdominal issues.  

Here are some common symptoms of PID:

• Pain in the lower pelvic area.
• Increased vaginal discharge, or discharge that is yellow, greenish, or pus-like.
• Irregular periods or spotting.
• Pain with intercourse.
• Frequent and painful urination.
• Pelvic organ and abdominal tenderness.
• Presence of endometriosis.

In the case of an acute infection, people may experience nausea, vomiting, dehydration, fever, and rapidly worsening pain. 

Diagnosing Pelvic Inflammatory Disease

Diagnosing PID can be challenging because symptoms are non-specific. 

If you or your provider suspect PID, you will most likely be diagnosed using a variety of methods: 

• An external and internal examination of the reproductive and abdominal organs, to test for tenderness and visual signs of an infection.
• A complete STI test.
• Possibly a pregnancy test.
• A white blood cell count to test for an infection.
• An ovarian ultrasound or transvaginal sonogram.
• A blood culture to determine which bacteria are present.
• A diagnostic laparoscopy.

Risk Factors for Pelvic Inflammatory Disease

Outside of contracting an STI, there are a few other ways PID can develop.

People who have had a recent gynecological procedure or surgery like an IUD insertion or endometrial biopsy, have an increased risk of PID.  

Recent pregnancies or birth, no matter the outcome of it, also increases someone’s risk of PID.

Long Term Health Impacts of PID

PID causing bacteria can potentially infect and damage any organs it comes in contact with, but the fallopian tubes are the most susceptible to damage, because of their fragility. When the infection ends at the fallopian tubes, it is called salpingitis.

If it spreads into the abdominal cavity, it can lead to peritonitis, inflammation of the tissues on the inner wall of the abdomen.  

One of the most common complications of PID is infertility, difficulty conceiving, or bringing a baby to term. One in eight women who have had PID report difficulty conceiving. PID also increases someone’s chance of having an ectopic pregnancy, a painful and possibly life-threatening complication.

For people with untreated PID who are pregnant, the infection-causing bacteria can potentially cause health issues in the developing fetus.

Other people may experience chronic pelvic pain, and possibly the development of scar tissue, known as adhesions.

PID can lead to a tubo-ovarian abscess, an inflammatory mass in the fallopian tubes, and possibly the surrounding organs. 

In very rare cases PID can lead to death. Fatality is less than 1% and is typically from a subsequent health issue like TOA or ectopic pregnancy.

Long term health complications and the risk of infertility increases with multiple PID infections.

How Do You Treat PID?

Sometimes PID may go away on its own, this is typically in cases where patients exhibited no symptoms. However, this isn’t the case for most people, which means it’s important to seek treatment as soon as symptoms arise.

The most common course of treatment is through antibiotics. While antibiotics cannot reverse scarring that has already occurred, they should prevent future damage from an infection. 

In some cases, a provider may collect a blood culture from the fallopian tubes that would tell what kind of bacteria it is. Since this is a difficult process, they usually just prescribe a broad-spectrum antibiotic that should kill all possible strains of PID causing bacteria. 

If you are given antibiotics for PID (or anything else), it’s important to finish the full round, even if your symptoms disappear.  

In severe cases, someone may require inpatient care with intravenous antibiotics.

Other possible, but not common, treatments are a drainage procedure or other surgery, especially for those that do not respond to antibiotics, or if there is a rupture in their reproductive organs.

How to Prevent PID

There are many steps you can take to help minimize your risk of developing PID.

• Don’t Douche. Douching can impact the vagina’s natural flora, throwing off its pH levels, and increasing the risk of infection.
• Use Protection. Use condoms or other protective barriers, especially when having sex with a new partner.
• Get tested for STIs, the sooner STIs are detected, the lower your chances of PID.
• Seek Treatment immediately if symptoms develop.

Although there is no such thing as “safe sex”, you can practice safer sex by getting tested after a new partner, or if you have more than one partner, discussing STIs with your partner, and getting tested regularly – at least every six months.