Pelvic Inflammatory Disease: Stop Before It Starts

Pelvic inflammatory disease (PID)—Overview

Untreated sexually transmitted infections (STIs) like chlamydia or gonorrhea can develop into pelvic inflammatory disease (PID), which affects the uterus, fallopian tubes, and ovaries. Chronic pelvic pain, infertility, and ectopic pregnancy can all be the result of missed treatments. In newborn females, PID is an infection of the upper reproductive tract. It impacts the uterus, fallopian tubes, and ovaries. Infections from germs rising from the vagina or cervix are usually associated with STIs.

Pelvic inflammatory disease symptoms

Pelvic Inflammatory Disease (PID) can cause pelvic pain, abnormal vaginal discharge, fever, and irregular bleeding, although symptoms might be modest or absent, making early detection difficult.

Common PID Symptoms

• Most common symptom: pelvic or lower abdomen pain
• Vaginal discharge that is atypical in color, consistency, or odor
• Dyspareunia—intercourse pain
• Period irregularities—spotting or increased bleeding in between periods
• A fever and chills indicate systemic illness.
• Painful urination—sometimes resembling UTI
• More severe nausea or vomiting

Quiet Symptoms

• PID might go undiagnosed until consequences like infertility or chronic pelvic pain occur because some women have no symptoms.
• Silent PID is harmful since internal damage is undetected.

Possible Risks

• STI (particularly untreated)
• Multiple sexual partners
• Risks of PID include unprotected sex, prior episodes, and douching (which affects vaginal flora and increases infection risk).

Complications

• An estimated 1 in 8 women with PID have infertility.
• Fertilized eggs can implant outside the uterus due to fallopian tube scar tissue.
• Scar tissue and adhesions cause chronic pelvic pain.
• Ovarian or fallopian tube abscesses.

Prevention

• Consistent condom use
• Regular STI screening and treatment
• Douching avoidance
• Seeking medical attention immediately if symptoms emerge

Pelvic inflammatory disease types

Pelvic inflammatory disease types are characterized by the intensity, duration, recurrence, or absence of symptoms. A spectrum of infections affecting different sections of the female reproductive tract is called pelvic inflammatory disease (PID). It can be characterized by infection site and clinical presentation (acute, chronic, recurrent, or silent).

Types of PID by Infection Site

• PID may involve upper genital tract structures:
• Endometritis: Uterine lining inflammation.
• Salpingitis is the most frequent kind of fallopian tube inflammation.
• Oophoritis → Ovarian inflammation.
• Parametritis: Infection of pelvic ligaments and connective tissue.
• Pelvic Peritonitis is an inflammation of the peritoneum, which lines the abdominal cavity.
• A tubo-ovarian abscess is a severe infection that causes pockets of pus in the fallopian tube and the ovary.

Types of PID by Clinical Presentation

• Clinical presentation can also classify PID:
• Primary acute PID
• The symptoms of Primary Acute PID include sudden onset, acute pelvic discomfort, fever, and abnormal discharge.
• There are connections between this condition and untreated sexually transmitted infections such as chlamydia and gonorrhea.

Chronic PID

• Chronic, low-grade infection.
• Constant pelvic pain, menstruation abnormalities, and infertility are symptoms.
• Recurrent PID
• Reinfection or insufficient treatment causes recurring episodes.
• Scarring and infertility increase.
• Subclinical PID
• Damage occurs internally without symptoms.
• It is often discovered following infertility or ectopic pregnancy.

When to seek medical care 

• If you experience severe abdominal or pelvic pain, high fever, or chills, seek immediate medical assistance.
• Severe abdominal or pelvic pain
• High fever, chills
• Sudden fainting, dizziness, or shock
• Constant abnormal bleeding or discharge

Pelvic Inflammation Causes

Pelvic Inflammatory Disease (PID) is mostly caused by STIs, mainly chlamydia and gonorrhea, but other germs can enter the reproductive system following medical operations, childbirth, or miscarriage.

• The main causes of PID include STIs.
• The main causes are Chlamydia trachomatis and N. gonorrhoeae.
• The uterus, fallopian tubes, and ovaries receive these germs from the vagina/cervix.
• The vagina undergoes changes in the balance of normal bacteria, such as Anaerobes, Gardnerella vaginalis, and Mycoplasma genitalium.

Medical Procedures:

• Intrauterine device insertion
• Biopsy endometrium
• Miscarriage or abortion
• Childbirth
• Bacteria can enter the upper genital tract.
• Nearby Spread Infections:
• Appendicitis or peritonitis can affect the pelvic organs.

Increased Susceptibility Risks

• Multiple sexual partners
• Unprotected sex prior PID episodes
• Douching alters the vaginal flora and increases the risk of infection.
• Due to cervical immaturity, teenagers and those in their early 20s are at higher risk.

Pelvic inflammation diagnosis

No single test diagnoses pelvic inflammatory disease (PID), although medical history, physical examination, and laboratory/imaging testing do. Clinicians confirm diagnosis with clinical suspicion and supportive findings.

Key PID Diagnosis Steps: Medical History

• The diagnostic process involves reviewing sexual history, contraception use, STIs, and PID occurrences.
• Signs and symptoms
• Pelvic or lower abdominal pain, abnormal discharge, fever, irregular bleeding, and intercourse pain are all taken into consideration.

Pelvic Exam

• The examination also includes checking for tenderness in the uterus, fallopian tube, and ovaries.
• Cervical motion tenderness is characteristic.
• Laboratory Tests
• Chlamydia trachomatis and Neisseria gonorrhoeae are detected through vaginal and cervical swabs.
• C-reactive protein and white blood cell counts indicate infection.

Imaging Exams

• Ultrasound detects tubo-ovarian abscesses and fallopian tube thickening.
• The MRI/CT scan can be challenging or confusing.
• Diagnostic Laparoscopy (Gold Standard)
• The procedure involves visualizing the pelvic organs for signs of inflammation, adhesions, or abscesses.
• This procedure is typically reserved for serious or uncertain conditions.

Diagnostic Challenges

• Combinations of tests determine diagnosis.
• Subclinical PID might harm without symptoms.
• Diagnostic overlap with appendicitis, ectopic pregnancy, or ovarian cysts might be difficult.

Pelvic inflammatory disease treatment

The video about,  How to prevent and treat PID

Broad-spectrum antibiotics for STIs, including chlamydia and gonorrhea, and supportive care are used to treat pelvic inflammatory disease (PID). Hospitalization, intravenous treatment, or surgery for abscesses may be needed in severe situations. Prevention of infertility and chronic pelvic pain requires early therapy.

Standard Treatment Methods

1. Antibiotics for first-degree infections

• Broad-spectrum antibiotics are used to treat Chlamydia trachomatis, Neisseria gonorrhoeae, and anaerobic bacteria.
• Treatments sometimes involve combinations like Ceftriaxone + Doxycycline + Metronidazole.
• Doxycycline + Cefoxitin
• Severity determines the oral or intravenous route.Usually 14 days.

2. Hospitalization (Severe)

Noted if:

• High fever, vomiting, severe discomfort
• Pregnancy
• Possible tubo-ovarian abscess
• Without a response to outpatient treatment, IV antibiotics are given and transitioned to oral once stable.

3. Surgery

• This rare procedure may be necessary for tubo-ovarian abscess drainage.
• Unresponsive severe consequences to antibiotics

4. Manage Partners

• Sexual partners should be checked and treated for STIs to avoid reinfection.
• Sexual activity should stop until treatment is complete.

5. Support

• NSAIDs treat pain
• Rest and hydration
• Sexual safety education

Pelvic inflammatory disease: how common?

Pelvic Inflammatory Disease (PID) is common globally, especially among reproductive-age women (15–49). Every year, millions of people are affected, with implications for fertility and pelvic health.

Global Prevalence

• Public health issues affecting reproductive-aged women globally include PID.
• According to the Global Burden of Disease Study (2019), PID remains the leading cause of infertility, ectopic pregnancy, and chronic pelvic pain in women aged 15 to 49.
• STIs (particularly chlamydia and gonorrhea) are the main causes of PID, making it more common in locations with higher STI rates.

Why PID Is Common

• Chlamydia and gonorrhea are common.
• Underdiagnosis occurs for mild or absent symptoms.
• Healthcare and STI screening are scarce in many areas.
• Untreated partners cause recurrent infections.

Conclusion

PID is common worldwide, especially in women. Silent PID often remains unnoticed, causing long-term consequences. Early STI screening, safe sex, and prompt medical care mitigate PID's burden best. Public health education helps women notice symptoms and seek care early.