About 10,000 women are hospitalised for pelvic inflammatory disease (PID) in Australia each year and more than 59,000 are treated for the condition by their GP. By Joanna Egan.
While early treatment reduces the risk of long-term complications, many women with PID experience no signs or symptoms so may not even know they are infected.
What is PID?
PID is a term used to refer to the infection or inflammation of organs and tissues in the pelvis. The condition is characterised by the infection of one or more of the following: the cervix (the opening of the uterus, located at the top of the vagina), the endometrium (the lining of the uterus), the fallopian tubes (the tubes that carry ova, or eggs, from the ovaries to the uterus), the ovaries, and/or other abdominal organs, such as the appendix.
What causes PID?
PID occurs when bacteria move upwards from the vagina to the cervix, uterus and fallopian tubes. Most cases occur as the result of sexually transmitted infections (STIs), such as chlamydia and gonorrhoea – more than half of all sexually acquired PID cases result from chlamydia, and about a quarter result from gonorrhoea. PID can also develop following pelvic procedures, such as the termination of a pregnancy or the insertion of an intra-uterine device (IUD). The disease can also occur as the result of childbirth, a ruptured (burst) appendix or a bowel infection.
The disease is most common among young, sexually active women. Since most cases of PID occur as the result of an STI, having unprotected sex can increase your risk of developing the disease. Women who have had a previous episode of PID are also at increased risk of future infection.
What are the symptoms?
Many women do not experience any symptoms of PID, so may not know they are infected. This is especially the case with infections that occur as the result of chlamydia. Women who do have symptoms, generally experience pain in their lower abdomen. Other common symptoms include:
- abnormal vaginal discharge
- unusual vaginal bleeding
- abnormal menstrual periods
- pain during sex
- bleeding following sex
- increased period pain
- painful urination
Sometimes symptoms are mild and develop slowly; in other cases women may experience severe pelvic pain and become very unwell in a matter of days. Women who show no symptoms are still at risk of developing serious complications.
What are the possible complications?
If left untreated, PID can lead to persistent pelvic pain. It can cause scarring in the fallopian tubes, which can narrow them, blocking the path of ova (eggs) travelling from the ovaries to the uterus. If an egg blocked in the fallopian tube is fertilised, an ectopic pregnancy (where the foetus develops outside the uterus) can occur. This is a serious, potentially life-threatening health condition that requires immediate medical attention.
As a result of PID, badly damaged tubes can also become completely blocked. This can cause infertility. Studies suggest that after one episode of PID, a woman's chance of having a successful pregnancy decreases by about 10 per cent. After two or three episodes of PID, a woman's risk of becoming infertile is about 50 per cent.
In addition, women with a history of PID who become pregnant have a higher risk of pregnancy complications, such as miscarriage, premature birth, and stillbirth.
How is PID diagnosed?
The disease can be difficult to diagnose because symptoms are often mild and nonspecific. To test for PID, a swab is usually taken from the vagina and cervix to test for the presence of bacteria. Blood and urine tests may also be performed – urine is tested for the presence of bacteria associated with chlamydia and gonorrhoea. If symptoms such as lower abdominal pain are present, a pelvic examination may also be performed. This involves the doctor or health practitioner feeling the pelvis to determine the nature and location of the pain.
A pelvic ultrasound is often used to diagnose PID. An ultrasound can view the pelvic area to see whether the fallopian tubes are enlarged or whether scar tissue is present. In some cases, a laparoscopy may be performed to confirm a PID diagnosis. A laparoscopy is a surgical procedure performed under a general anaesthetic. It involves a thin, rigid tube with a laparoscope (or camera) on its end being inserted into the pelvis through a small incision just below the naval, allowing the pelvic organs to be viewed by the doctor.
What are the treatment options?
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. Early treatment can prevent long-term complications.
PID is treated with antibiotics. Generally two or three different antibiotic varieties are prescribed at once.
It is important for women being treated for PID to complete the entire course of prescribed antibiotics because even if symptoms cease, the infection may still be present. Women are advised to undergo follow-up testing after completing the antibiotics to ensure the infection is cured. To avoid reinfection, women are also advised not to have sex until follow-up tests confirm that the infection is cured.
It is recommended that women diagnosed with PID contact any sexual partners they have had within the past six months to advise testing. Since most cases of PID are caused as a result of chlamydia, male partners may be infected with the STI. A course of antibiotics is usually advised whether or not infection is found on testing because men often show no symptoms and tests for chlamydia are not 100 per cent reliable.
Women with severe PID symptoms (fever, nausea, vomiting) may need to be hospitalised and to have intravenous antibiotics. Pregnant women with PID also need to be hospitalised for treatment, even if symptoms are mild, because it is safer to receive antibiotics intravenously during pregnancy.
It is important to know that antibiotic treatment cannot reverse damage that has already occurred to the reproductive organs. In some cases, surgery may be required to repair damage and remove scar tissue from the fallopian tubes.
How can a woman's risk be reduced?
To help prevent the transmission of bacteria that can cause PID, women should protect themselves against STIs. Condoms create a physical barrier that prevents bodily fluids, such as sperm and vaginal fluid, from passing between sexual partners. If used correctly and consistently, condoms are effective at preventing STIs. Women should also be tested for STIs regularly, particularly if they have engaged in unsafe sexual activity, or had sex with a new partner, or a partner who may have other partners.
Where to go for help?
To speak confidentially with a Women's Health nurse or midwife, call our Health Information Line on 3216 0376 or 1800 017 676 (toll-free outside Brisbane).
Last updated: October 2013
© Women's Health Queensland Wide Inc. This article was written by Joanna Egan and reviewed by the Women's Health Queensland Wide editorial committee. It was published in Health Journey Issue 3 2013.