Pelvic Inflammatory Disease

An infection of the upper reproductive tract in women

Although this infection can lead to some pretty serious complications if left undiagnosed, it is also easily treated

What is Pelvic Inflammatory Disease?

Pelvic Inflammatory Disease (PID) is an infection of a woman’s upper reproductive organs including the uterus, fallopian tubes, and ovaries[1]. Without treatment, PID can lead to various complications including infertility issues [1, 2, 3]. 

How common is it?

A CDC study found that 4.4% of women in the US will have PID in their lifetime [1]. 

What causes PID and who is at risk?

Just like the vagina, the uterus contains bacteria including healthy and protective lactobacillus. Also like the vagina, the uterus can become infected when unfriendly bacteria are introduced [4]. PID tends to occur as a result of an untreated STD like chlamydia or gonorrhea, but can be caused by non-sexually transmitted infections like bacterial vaginosis as well [5]. PID is also a rare side effect of implanting an IUD (intrauterine device), though the risk is small and usually limited to the first few weeks after the device is placed [1]. 

Avoiding PID comes down to preventing or quickly treating STIs, and making sure to preserve the natural balance of your vaginal microbiome [1, 2, 3]. Some things will increase your risk of contracting PID, including:

  • Having sex with multiple partners or a new partner (regardless of gender)
  • Having unprotected sex 
  • Douching [8]
  • Leaving an STD or STI untreated 
  • Using an IUD (though, as we noted above, the risk is low and only for the first three weeks)

What are the symptoms?

Even though some women don’t exhibit symptoms, many will experience [1, 2, 3]:

  • Fever
  • Pain in lower abdomen or pelvis
  • Pain or bleeding during sex
  • Pain or burning from urination
  • Abnormal or heavy vaginal bleeding
  • Abnormal and/or bad-smelling discharge

How is it diagnosed?

There is no one, simple test for PID [1, 2]. Although it can sometimes be diagnosed by ultrasound, your doctor will likely ask for your medical history, conduct a pelvic exam, and look to rule out other conditions that cause similar symptoms [2]. It is difficult to easily and safely access the upper genital tract, but in serious cases laparoscopy or endometrial biopsy might be considered. 

What are the treatment options?

Thankfully, PID is treatable with antibiotics [7]. It might also be recommended that your sexual partner be treated, and that you abstain from sex while you are being treated. The key here is getting diagnosed and treated as soon as possible to avoid any potential long-term consequences.

Even after treatment, PID can come back. More research needs to be done to find out why this happens, when, and how often. 

What can be done to prevent PID?

Preventing PID comes down to avoiding the risks described earlier on. You can do this by avoiding douching, practicing safe sex, limiting your number of sexual partners, and making sure you test for and treat any vaginal infections (sexually transmitted or not) as quickly as possible.

Can PID lead to other complications?

Although symptoms might be mild, the scarring caused by untreated PID can lead to pregnancy complications (like ectopic pregnancy), chronic pelvic/abdominal pain, and abscesses on your ovaries or fallopian tubes. PID can also make getting pregnant a lot harder, with around 1 in 10 women becoming infertile. 

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References

1. Pelvic Inflammatory Disease - CDCFact Sheet [Internet]. Cdc.gov. 2020 [cited 17 September 2020]. Available from:https://www.cdc.gov/std/PID/STDFact-PID.htm

2. Pelvic inflammatory disease (PID) -Symptoms and causes [Internet]. Mayo Clinic. 2020 [cited 17 September 2020].Available from:https://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/symptoms-causes/syc-20352594

3. Pelvic inflammatory disease[Internet]. nhs.uk. 2020 [cited 17 September 2020]. Available from:https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/

4. Haggerty C, Ness R, Totten P, FarooqF, Tang G, Ko D et al. Presence and Concentrations of Select BacterialVaginosis-Associated Bacteria Are Associated With Increased Risk of PelvicInflammatory Disease. Sexually Transmitted Diseases. 2020;47(5):344-346.

5. Mitchell C. To Effectively TreatPelvic Inflammatory Disease, Look Beyond Coverage for Gonorrhea and Chlamydia.Clinical Infectious Diseases. 2020;.

6. Haggerty C, Totten P, Tang G, AsteteS, Ferris M, Norori J et al. Identification of novel microbes associated withpelvic inflammatory disease and infertility. Sexually Transmitted Infections.2016;92(6):441-446.

7. Savaris R, Fuhrich D, Duarte R,Franik S, Ross J. Antibiotic therapy for pelvic inflammatory disease. CochraneDatabase of Systematic Reviews. 2017;.

8. GondweT, Ness R, Totten P, Astete S, Tang G, Gold M et al. Novel bacterialvaginosis-associated organisms mediate the relationship between vaginaldouching and pelvic inflammatory disease. Sexually Transmitted Infections.2019;96(6):439-444.

Written by Aisha Ommaya, science comms officer with Juno Bio

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