Pelvic Inflammatory Disease (PID)

Often called PID, Pelvic Inflammatory Disease, is an unfortunately common and potentially serious gynaecological disorder. Pelvic inflammatory disease is associated with an inflammatory response followed by scarring to parts of the female genital tract. In particular, permanent and irreversible damage to the fallopian tubes may occur, leading to infertility. So let’s discuss this condition in a bit more detail.

How would I get PID?

PID is often a complication of certain sexually transmitted infections (STI’s). Following unprotected sex, bacterial agents my ascend into the upper female genital tract through the cervix. The infection may then affect the uterus, fallopian tubes, ovaries and the pelvic and abdominal cavities. You are more likely to be at risk of PID if you;

  • have more than 1 sexual partner
  • are under 25
  • have a new sexual partner
  • started having sex at a young age
  • have a history of STIs
  • have had PID in the past

Are there other causes of PID?

PID may follow as a complication of miscarriage, childbirth, or rarely as a part of generalised illness where bacteria may enter from the bloodstream.
On occasion, PID can follow surgery including the insertion of an IUD, though the risk of this is usually in the immediate weeks following placement of the IUD.

What actually causes PID?

The most common agent to cause PID is chlamydia trachomatis (usually just called chlamydia). Cases of gonorrhoea, mycoplasma genitalum, and other bacteria have been increasing in Australia for the last decade.

If I have PID, what symptoms would I have?

Pelvic pain, irregular bleeding between periods and after intercourse, abnormal discharge including odour and irritation or burning, dyspareunia (pain with sexual activity) or increasing period pain. You may also have associated urinary tract pain and frequency. Unfortunately, sometimes there are little or no symptoms, and still, damage to the fallopian tubes may occur.

How is PID diagnosed?

If you have the above symptoms, or have concerns about recent sexual contacts, make an appointment to see your doctor as soon as possible. A simple examination including a collection of swabs from the cervix or urine samples to test for bacteria will follow. Depending on your history, examination findings and test results, a course of treatment can be prescribed.

What is the treatment for PID?

Often, more than one bacteria is present in the genital tract in PID. Typically, two or sometimes three different antibiotics need to be prescribed to kill the infection.

If you are running a fever and have signs of acute inflammation in the pelvis, you may require admission to hospital. You may receive intravenous antibiotics, pain relief, and a pelvic ultrasound to exclude the formation of pelvic abscess (collections of pus). Very occasionally in this setting, emergency surgery is required.

Does my partner need testing and treating?

Absolutely. It is vital you inform your partner and he or she attends their doctor for assessment and treatment. If this does not occur the bacteria will be re-transmitted to you or perhaps others, leading back to the start of the process.

What follow up will I have with PID?

When you complete your antibiotics I recommend returning 1-2 weeks later for retesting. Only after the test results come back negative (including your partner’s results) and you feel well again should you resume sexual activity.

How to know if your fertility is affected by PID?

If you recover completely and feel well with treatment, usually no further investigation occurs at that time.
If you’re trying to conceive and have no luck falling pregnant for 6 months and have a history of PID, I would suggest assessment with a gynaecologist.
In this setting two options exist;

  1. Ultrasound with sterile fluid inserted through the cervix may reveal whether the fallopian tubes are blocked or swollen.
  1. You may be best served by having a laparoscopy to inspect the pelvic organs thoroughly. This includes the uterus/tubes/ovaries and looking for bowel adhesions.

How do I make an appointment?

Just call the rooms and make an appointment time.

Author: Dr Peter England, Obstetrician and Gynaecologist.
Read more about Dr Peter England

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