Pelvic inflammatory disease (PID) is a general term that refers to infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus) and other reproductive organs. It is a common and serious complication of some sexually transmitted diseases (STDs), especially chlamydia and gonorrhea.

Each year in the United States, it is estimated that more than 1 million women experience an episode of acute PID. More than 100,000 women become infertile each year as a result of PID, and a large proportion of the ectopic pregnancies occurring every year are due to the consequences of PID. Annually more than 150 women die from PID or its complications.

Risk Factors

PID occurs when bacteria move upward from a woman's vagina or cervix (opening to the uterus) into her reproductive organs. Many different organisms can cause PID, but it is often associated with gonorrhea and chlamydia, two common bacterial STDs.

Those most at risk for developing PID are:

• Sexually active women in their childbearing years with multiple sex partners.
• Women under age 25 because the cervix is not fully matured, increasing susceptibility to STDs linked to PID.
• Women with untreated chlamydia or gonorrhea.
• Women who douche, which can upset the balance of organisms that live in the vagina and force bacteria into the upper reproductive organs.
• Women who have an intrauterine device (IUD) inserted. This risk is greatly reduced if a woman is tested treated for STDs before an IUD is inserted.
• Women with a prior episode of PID.

Symptoms

Symptoms of PID vary from non to sever, which is why the disease goes unrecognised by women and their health care providers about two thirds of the time.

Women who have symptoms of PID most commonly experience:

• Lower abdominal pain
• Fever
• Unusual vaginal discharge that may have a bad odor
• Painful intercourse
• Painful urination
• Irregular menstrual bleeding
• Pain in the right upper abdomen (rare)

Diagnosis and Treatment

There are no precise tests for PID. A diagnosis is usually based on clinical findings. Once detected, PID can be cured with several types of antibiotics, however, antibiotic treatment does not reverse any damage that may have already occurred to the reproductive organs. The longer a woman delays treatment for PID, the more likely she is to become infertile or to have a future ectopic pregnancy because of damage to the fallopian tubes.

Even if symptoms go away, the woman should finish taking all of the prescribed medicine. In addition, a woman's sex partner(s) should be treated to decrease the risk of re-infection, even if the partner(s) has no symptoms. Although sex partners may have no symptoms, they may still be infected with the organisms that can cause PID.

Hospitalization to treat PID may be recommended if the woman:

• Is severely ill (e.g., nausea, vomiting, and high fever)
• Is pregnant
• Does not respond to or cannot take oral medication and needs intravenous antibiotics
• Has an abscess in the fallopian tube or ovary.

If symptoms continue or if an abscess does not go away, surgery may be needed.

Possible Complications

Without treatment, PID can cause permanent damage to the female reproductive organs. Women with repeated episodes of PID are more likely to suffer infertility, ectopic pregnancy, or chronic pelvic pain.

Infertility. About one in eight women with PID becomes infertile. Infection-causing bacteria can cause normal tissue in the fallopian tubes to turn into scar tissue, which blocks or interrupts the normal movement of eggs into the uterus. If the fallopian tubes are totally blocked, sperm cannot fertilize an egg. Infertility can also occur if the fallopian tubes are partially blocked or damaged.

Ectopic Pregnancy. A fallopian tube that is partially blocked or slightly damaged by PID may cause a fertilized egg to remain in the fallopian tube. Ectopic pregnancy is when this fertilized egg begins to grow in the tube as if it were in the uterus. As the egg grows, the fallopian tube can rupture causing severe pain, internal bleeding, and even death.

Chronic Pelvic Pain. Scarring in the fallopian tubes and other pelvic structures can also cause chronic pelvic pain that lasts for months or years.

Complications of PID, such as chronic pelvic pain and scarring can sometimes be improved with surgery.

Prevention

Sexually transmitted disease (STD) is the main preventable cause of PID. Women can protect themselves from PID by taking action to prevent STDs, especially chlamydia or gonorrhea, or by getting early treatment if they have an STD.

Safe sexual practices will reduce your risk of STD. These include limiting the number of sex partners and correct use of condoms every time you have sex. Any genital symptoms such as discharge or burning during urination or an unusual sore or rash should be a signal to stop having sex and to consult a doctor immediately. Treating STDs early can prevent PID. Yearly chlamydia testing of all sexually active women age 25 or younger and of older women with a new or multiple sex partners is recommended. If you have any STD, you should notify all of your recent sex partners so they know to receive treatment.

Additional information is available from the Centers for Disease Control and Prevention.