Most cases of PID are caused by microorganisms responsible for sexually transmitted infections. They can get into the body during sexual contact with an infected person. If you are carrying these microorganisms, certain procedures or reproductive events can push them farther into your body, including miscarriage, childbirth, abortion, or other procedures involving the uterus, such as endometrial biopsy, hysterosalpingogram X-ray of the reproductive tract , IUD insertion, or donor insemination.
Men can be carrying the organisms that can cause PID without having symptoms, so they must be tested and treated, too, and they should use a condom during intercourse. Women using some IUDs are also at higher risk during the first four months after insertion.
In other areas, chlamydia is more often the cause of PID. Current guidelines recommend annual chlamydia screening for women age twenty-five and under who are having sex, to find and treat this infection before it causes PID. The complications of PID can be very serious. If untreated, PID can turn into peritonitis—a life-threatening condition—or into a tubo-ovarian abscess.
It can affect the bowels and the liver causing perihepatitis syndrome. Months or years after an acute infection, infertility or ectopic pregnancy can result if your fallopian tubes were damaged or clogged by scar tissue. PID can also cause chronic pain from adhesions or lingering infection. In the most extreme cases, untreated PID can result in death.
Because so much PID is caused by sexually transmitted organisms, preventing PID involves preventing sexually transmitted infections. You can reduce your risk by using condoms and engaging in safer sex practices.
If you could know right away exactly which organisms were causing your PID, you could get the right antibiotics. However, pinpointing the organisms often takes some tests that may be expensive and not readily available.
You may be told that you have a spastic colon or an emotional, not a physical, problem, when that is not true. Try to have your situation thoroughly assessed, particularly if symptoms persist despite treatment, or seek a second opinion.
Sometimes an endometrial biopsy can find hard-to-culture organisms, but if it is not done carefully, this procedure can spread germs from the cervix and vagina to the uterus. In some cases, ultrasound, including vaginal ultrasound, may be useful.
Diagnosis is based on your symptoms and the finding of tenderness on a vaginal internal examination. Swabs will be taken from your vagina and the neck of the womb cervix , but negative swabs do not rule out PID.
Most cases of PID are caused by a bacterial infection that's spread from the vagina or the cervix to the reproductive organs higher up. Many different types of bacteria can cause PID.
In many cases, it's caused by a sexually transmitted infection STI , such as chlamydia or gonorrhoea. In many other cases, it's caused by bacteria that normally live in the vagina. If diagnosed at an early stage, PID can be treated with a course of antibiotics, which usually lasts for 14 days.
You'll be given a mixture of antibiotics to cover the most likely infections, and often an injection as well as tablets. It's important to complete the whole course and avoid having sexual intercourse during this time to help ensure the infection clears. Your recent sexual partners also need to be tested and treated to stop the infection coming back or being spread to others. The fallopian tubes can become scarred and narrowed if they're affected by PID.
Recommended treatment regimens can be found in the STI Treatment Guidelines 7 Health care providers should emphasize to their patients that although their symptoms may go away before the infection is cured, they should finish taking all of the prescribed medicine.
Although sex partners may have no symptoms, they may still be infected with the organisms that can cause PID. In certain cases, clinicians may recommend hospitalization to treat PID.
This decision should be based on the judgment of the health care provider and the use of suggested criteria found in the STI Treatment Guidelines. A critical component to management is short-term follow-up, especially in the adolescent population.
Since many adolescent women rely on outpatient services for the evaluation and treatment of STD symptoms, the need for a low diagnostic and management threshold for PID is even more critical, as the likelihood for additional follow-up care is low. A patient should abstain from sexual intercourse until she and her partner s have completed treatment. Female latex condoms are also an option if a woman prefers them or if her male partner chooses not to use male condoms.
Women who are told they have an STD and are treated for it should notify all of their recent sex partners so they can see a health care provider and be evaluated for STDs. The diagnosis of PID provides an opportunity to educate adolescent and young women about prevention of STDs, including abstinence, consistent use of barrier methods of protection, immunization, partner evaluation and treatment, and the importance of receiving periodic screening for STDs and HIV.
Since STDs play a major role in PID, screening of women at risk for infection and treatment of infected women and their sex partners can help to minimize the risk of PID. Screening of young sexually active women for chlamydia has been shown to decrease the incidence of PID. The United States Preventive Services Task Force recommends annual chlamydia and gonorrhea screening in women younger than 25 years 25 and CDC recommends that providers screen the following populations for chlamydia and gonorrhea: all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.
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