Who gets pelvic inflammatory disease?

Pelvic inflammatory disease (PID) is an infection of the female reproductive tract. It is usually caused by an infection spreading from the vagina and cervix, into the uterus, fallopian tubes, ovaries and pelvis. Any woman can get pelvic inflammatory disease, but it is more common in young, sexually active women.

Causes

Although Chlamydia and Gonorrhoea are often implicated, these bacteria only account for a quarter of all cases of PID in the UK. Other bacteria naturally found in the vagina can track up the cervix and also cause PID.

Risk factors for the development of PID are:

• Unprotected sexual intercourse
• Multiple sexual partners
• Intrauterine devices – i.e. Copper and Mirena Coil. The risk of PID with these devices is only increased in the first 3 weeks after insertion.

Symptoms

Not everyone has symptoms of PID. It is therefore important to be regularly checked for STIs if you are having unprotected intercourse. When symptoms do present, they can range from mild to severe.

Symptoms include:

• Lower abdominal pain – usually on both sides
• Change in appearance or smell of vaginal discharge
• Pain during intercourse
• Bleeding in between periods or after intercourse
• Fever

Prevention

The use of condoms is the most effective way of preventing the transmission of sexually transmitted infections (STIs). Although the oral contraceptive pill, the coils and depot injections are very effective contraceptive methods, they do not prevent the transmission of STIs.

Complications

When PID is treated early and effectively, complications are unlikely. In cases of severe infection or where the infection is untreated, some serious long-term problems can arise.

The most worrying complication from PID is damage to the fallopian tubes, which increases the risk of ectopic pregnancy and potentially compromises future fertility.

There is also a risk of an abscess forming within the fallopian tube. This is called a tubo-ovarian abscess. Women can become extremely unwell with this and often require admission to hospital for intravenous antibiotics. In some circumstances, the abscesses need draining either under guidance from an ultrasound or via an operation called a laparoscopy.

In some women, previous PID can lead to long-term problems with pelvic pain due to persistent inflammation.

Diagnosis

Diagnosing PID is not always easy. It is usually diagnosed based on presenting symptoms. There is also a high index of suspicion in women in a high-risk category, particularly those with a history of STIs.

The doctor that sees you will examine you. They will feel your abdomen and will also do a speculum examination to look inside the vagina and at the cervix. They will then do the necessary swabs.

Blood tests, in the early stages, tend to be normal. In cases of significant infection, there will be a rise in the blood markers of inflammation/infection.

An ultrasound scan doesn’t usually show active infection unless an abscess is present. The ultrasound can be helpful in looking for other potential causes of pelvic pain.

Treatment options

PID is treated with a course of antibiotics. You usually have to take antibiotics for 2 weeks. Although the active infection can be treated, any damage already caused, unfortunately, cannot be reversed. Complications from PID tend to arise more commonly with repeated infections. This highlights the importance of using adequate protection during intercourse and of regular STI checks.

Once you have received a diagnosis of PID, it is important that your partner is also tested for STIs. You should both avoid intercourse until treatment is completed and should be tested following this to ensure the infection has cleared.

Effect on Fertility

One in eight women with PID can have difficulty with conception. This is because PID causes inflammation and subsequent damage of the delicate fallopian tubes. Without the tubes being able to carry the fertilised egg into the uterus, there is a higher risk of having an ectopic pregnancy or struggling to conceive.

It is devastating for a lot of women to struggle with conception. However, in situations where PID has significantly affected the chances of spontaneous pregnancy, there are always other options available. These include fertility treatments such as in vitro fertilisation (IVF), adoption and surrogacy.

Main Points

• Pelvic inflammatory disease (PID) is an infection of the female reproductive tract.
• PID can have many causes. One in four cases are caused by STIs.
• Having an intrauterine device fitted can also increase the risk of PID, but only in the three weeks after it’s inserted.
• PID can be prevented by avoiding unprotected sexual intercourse, not having multiple sexual partners and having regular STI check.
• Symptoms of PID include lower abdominal pain, changes in vaginal discharge, pain during intercourse, bleeding between periods, and fever.
• Diagnosing PID can be difficult. It’s usually diagnosed based on presenting symptoms.
• PID is treated with antibiotics. With prompt treatment, PID will generally be successfully managed.
• Long-term complications of untreated PID include tubo-ovarian abscesses, fertility problems and chronic pelvic pain.
• In cases where PID has caused fertility problems, IVF treatment, adoption, and surrogacy are alternative options.

References:

1. UK National Guideline for the Management of Pelvic Inflammatory Disease. 2011. British Association for Sexual Health and HIV.
2. RCOG Acute PID : Tests and Treatments. Information for you. 2010
3. Pelvic Inflammatory Disease. https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/