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Pelvic inflammatory disease, or PID, is an infection of a woman's reproductive organs.

What is going on in the body?

PID is usually caused by a sexually transmitted infection. The cervix, or opening to the uterus, may allow bacteria to enter. Then, an infection may begin in the reproductive organs.

This infection can spread up through the lining of the uterus (the endometrium) and out into the fallopian tubes and peritoneum (the lining of the abdominal cavity).

What are the signs and symptoms of the infection?

There may not be any symptoms in the early stages of PID. As the infection spreads however, the symptoms may include:

• back pain that spreads down the legs
• dyspareunia, or pain with intercourse
• pain in the pelvic area
• flu-like symptoms, such as fever, fatigue, backache, or vomiting
• heavy, foul-smelling vaginal discharge
• abnormal uterine bleeding
• pain and tenderness in the lower abdomen

What are the causes and risks of the infection?

Most cases of PID are caused by a sexually transmitted infection, such as Chlamydia or gonorrhea. In some cases, bacteria that are normally found in the vagina contribute to the infection of PID; these bacteria are often anaerobes (bacteria that only grow in the absence of oxygen). Sometimes the specific cause or type of bacteria cannot be found.

PID may also occur after the pelvic organs have been manipulated in some way. This includes procedures such as:

• abortion
• dilatation and curettage, or D and C
• insertion of an intrauterine device, or IUD

Childbirth puts a woman at risk for developing PID. However, PID in pregnancy is very rare and if it occurs probably preceded the pregnancy.

What can be done to prevent the infection?

Safer sex practices can help reduce the risk of sexually transmitted infections which can lead to PID. If a woman has a sexual partner who has a STI, or thinks she has been exposed to an STI, then she needs to be evaluated and possibly treated.

How is the infection diagnosed?

Diagnosis of PID begins with a history and physical exam, including a pelvic exam. The healthcare provider may order additional tests, such as:

• bacterial cultures of the cervix or vagina
• a complete blood count, which may indicate if there is infection in the body
• insertion of a needle into the vagina to obtain fluid from the abdomen if it is felt that there is a pelvic abscess (this can also be done at the time of laparoscopy).
• sedimentation rate, a blood test that can tell if there is inflammation in the body
• an ultrasound or a special X-ray test of the pelvic area

What are the long-term effects of the infection?

The long-term effects of PID depend on several factors. These include the severity and length of the infection as well as the organism that caused the infection.

Possible complications include:

• abscess, or pus pocket, in the tubes, ovaries, or behind the uterus (tubo-ovarian abscess or TOA)
• arthritis or swelling of the joints due to a gonococcal infection
• bowel obstruction
• destruction of the ovaries and tubes
• increased risk of ectopic pregnancy
• infertility
• sepsis, a serious blood infection that may lead to septic shock and death

What are the risks to others?

The sexually transmitted infection that caused PID may be passed to the woman's sexual partners.

What are the treatments for the infection?

Treatment of mild cases of PID includes antibiotics, pain medicine, bed rest, and avoiding sexual activity. If a woman has an IUD, it will be removed. With severe symptoms, the woman may need to be hospitalized. Higher doses of antibiotics and pain medicines can be given intravenously.

The woman may need surgery to drain pus through the vagina. Laparoscopy is occasionally done to evaluate the pelvic organs, and obtain material for culture, take down adhesions or remove involved organs.

Other procedures can include removing the injured ovaries, fallopian tubes, or any scar tissue. If the bowel is blocked, surgery can release the obstruction. A hysterectomy, or removal of the uterus, is sometimes recommended.

What are the side effects of the treatments?

Antibiotics can cause stomach upset, rash, and allergic reactions. Surgery may cause bleeding, infection, or reaction to anesthesia.

What happens after treatment for the infection?

Treating the infection early gives the best results. PID can cause infertility. This happens in roughly 20% of affected women. Each episode of PID increases a woman's risk of infertility. Forty percent of all female infertility is secondary to PID.

The risk of ectopic pregnancy is also increased. This is because the tubes may be blocked by scar tissue.

How is the infection monitored?

A woman may need to have more frequent cervical tests. A woman's sexual partners should also be checked and treated. Ultrasound exams can check for an abscess that may need to be drained with surgery. Any new or worsening symptoms should be reported to the healthcare provider.