PID

Women between ages 15 and 25 have the highest incidence of PID. In the United States, PID is the leading cause of infertility in women (the inability to have children).

Two other sexually transmitted infections (STIs), chlamydia and gonorrhea, are the most common causes of PID. Other bacteria or germs can also cause PID. If you have an infection in the genital tract and do not get treated right away, it can cause PID. The infection spreads from the cervix into the uterus, fallopian tubes, and ovaries. It can take anywhere from several days to several months after being infected to develop PID.

• Using an intrauterine device (IUD). According to the Centers for Disease Control and Prevention (CDC), the risk for PID associated with IUD use is primarily confined to the first 3 weeks after insertion and is uncommon thereafter.
• Germs
• Douching. Women who douche once or twice a month are more likely to have PID than those who douche less than once a month. Douching may also ease symptoms of an infection, thus delaying effective treatment.

• Dull pain or tenderness in the lower abdomen
• Burning or pain when you urinate (pee)
• Nausea and vomiting
• Bleeding between menstrual periods
• Increased or changed vaginal discharge
• Pain during sex
• Fever and chills

It is possible for a woman to have PID and be asymptomatic (without symptoms), or have symptoms too mild to notice, for an unknown period of time. PID can also be misdiagnosed as appendicitis, ectopic pregnancy, ruptured ovarian cysts or other problems.

The diagnosis of PID can be made when all three of the following symptoms are found during a pelvic exam:

• Lower abdominal tenderness
• Tenderness of fallopian tubes and ovaries
• Tenderness of the cervix

All other explanations for these findings must have been ruled out, so your healthcare provider may also order tests to identify the organism which led to the infection (such as chlamydia or gonorrhea) or to distinguish between PID and other problems with similar symptoms.

A pelvic ultrasound is a helpful procedure for diagnosing PID. An ultrasound can view the pelvic area to see whether the fallopian tubes are enlarged or whether an abscess (pus-filled area) is present.

In some cases, a laparoscopy may be necessary to confirm the diagnosis. A laparoscopy is a surgical procedure in which a thin, flexible tube with a lighted end (laparoscope) is inserted through a small incision in the lower abdomen. This procedure enables the doctor to view the internal pelvic organs and to take specimens for laboratory studies, if needed.

• Broad-spectrum antibiotics are the recommended treatment, as they can cover the likely pathogens.
• Treatment may include antimicrobial agents to treat gonorrhea, chlamydia, streptococci and other gram-negative bacteria.
• Ofloxacin (oh-flox-ah-sin) tablets (FLOXIN) can be used alone to treat PID.
• Aggressive treatment of PID is recommended for women with HIV, who may be more likely to require surgical intervention.
• Sex partners of patients who have PID should be examined and treated if they have had recent sexual contact to avoid re-infection.

Follow-up:

• Take all medications as directed.
• You may need a follow-up exam 48 to 72 hours after start of treatment to make sure the medicine is working.
• Return for another exam after completion of treatment to make sure the infection is completely gone.
• Tell your partner to get tested and treated.

Remember: Do not have sex until you and your partner(s) have been treated and cured.

Hospitalization to treat PID may be recommended if a woman:

• is severely ill (nausea, vomiting, and high fever);
• is pregnant;
• does not respond to or cannot take oral medication and needs intravenous antibiotics;
• has an abscess (infected area with pus) in the fallopian tube or ovary.

If symptoms continue or if an abscess does not go away, surgery may be needed. Complications of PID, such as chronic pelvic pain and scarring are difficult to treat, but sometimes they improve with surgery.

Untreated PID infections may lead to:

• Infertility. Because of PID, each year more than 100,000 women will not be able to have children as a result of scarring or damage to cells lining the fallopian tubes.
• Cystitis (inflammation of the urinary bladder)
• Ectopic (tubal) pregnancy
• Recurrent episodes of PID
• Chronic pelvic pain

• Abstain (do not have sex).
• Use latex condoms for vaginal, oral and anal sex from the very beginning of sexual contact until there is no longer skin contact.
• Mutual monogamy (have sex with only one uninfected partner). Multiple sex partners can increase your risk for getting any STI and developing PID.
• Have regular check-ups if you are sexually active.
• If you have an STI, do not have sex (oral, vaginal or anal) until all partners have been treated and cured. Treatment and follow-up are important steps in breaking the disease cycle.
• Water-based spermicides (foams, jellies, creams, or suppositories) can be used along with latex condoms for additional protection during vaginal intercourse. Use of spermicide is not recommended nor found to be effective for oral or anal intercourse.
• Since PID can be transmitted even if the penis or tongue does not completely enter the vagina, mouth or rectum, using latex condoms from the beginning of sexual contact until there is no longer skin contact is recommended.

Telling a partner can be hard, but keep in mind that most people with an STI don’t know they have it. It’s important that you talk to your partner as soon as possible so she or he can get treatment. Men are more likely than women to have symptoms of chlamydia or gonorrhea (two STIs that cause PID). It is possible to pass PID back and forth, so if you get treated and your partner doesn’t, you may get infected again.