Pelvic Inflammatory Disease
Pelvic Inflammatory Disease
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Newsfeed display by CaRP Pelvic inflammatory disease (PID) is a general term that refers to infection and inflammation of the upper genital tract in women. It can affect the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus), ovaries, and other organs related to reproduction. The scarring that results on these organs can lead to infertility, tubal (ectopic) pregnancy, chronic pelvic pain, abscesses (sores containing pus), and other serious problems. PID is the most common preventable cause of infertility in the United States.

Women at greater risk for PID include those at risk for sexually transmitted infections (STIs) and those with a prior episode of PID. Sexually active women under age 25 are at risk as well because the cervix (opening to the uterus) of teens and young women has greater susceptibility to STIs. This may be because the cervix of teenage girls and young women is not fully matured, increasing their risk for STIs linked to PID.

Other potential risk factors include douching, which women should avoid. In some women, using an intrauterine device (IUD) to prevent pregnancy can also cause PID.

Rarely, PID results from gynecological procedures or surgeries.

In the United States, more than 1 million women seek treatment for PID each year, according to the Centers for Disease Control and Prevention (CDC). A similar or greater number of women may have PID and not know it. PID is more common among teen-age than adult women. It is also more common among African-American and Hispanic women. Every year, more than 100,000 women become infertile and more than a hundred women die from PID or its complications.

The usual causes of PID are bacteria that cause STIs such as chlamydia or gonorrhea. Other bacteria and even more than one kind of bacteria together also can cause PID.

Even if you have PID, you might not have symptoms. If you do have symptoms, they could be severe. The most common symptom of PID is pain in your lower abdomen.

Other symptoms that you may or may not have include:
1. Fever.
2. Vaginal discharge that may have an odor.
3. Painful intercourse.
4. Painful urination.
5. Irregular menstrual bleeding.
6. Pain in the upper right abdomen – which is rare.
7. Sometimes PID occurs suddenly with extreme pain and fever, especially if it is caused by gonorrhea.

PID can be difficult for a health care provider to diagnose because symptoms can be subtle and mild and are like those of some other diseases. If you think you might have PID, you should get medical care promptly because early treatment can limit long-term complications such as infertility.

If you have symptoms such as lower abdominal pain, your health care provider will perform a physical exam, including a pelvic internal exam, to find out the nature and location of the pain.

Your health care provider also will check for:
1. Abnormal vaginal or cervical discharge.
2. Masses near your ovaries and tubes.
3. Tenderness or pain of your abdomen, cervix, uterus, and ovaries.
4. You should get laboratory tests for chlamydia, gonorrhea, urinary tract infection, and if appropriate, pregnancy. Your health care provider also might test you for HIV infection and syphilis.
5. If necessary, your health care provider may do other tests such as an ultrasound (sonogram), endometrial (uterine) biopsy, or laparoscopy to distinguish between PID and other serious problems that can mimic PID. Laparoscopy is a surgical procedure in which a tube is inserted through a small incision near your navel. This allows your health care provider to view the internal abdominal and pelvic organs and to take specimens to examine in the laboratory.

According to CDC, health care providers should start treatment in sexually active young women and other women at risk for STIs if they have motion tenderness of the uterus, ovaries, fallopian tubes, or cervix.

If you have PID, your health care provider will prescribe antibiotics that can kill bacteria suspected of causing the disease. Many different bacteria may cause an episode of PID. Therefore, your health care provider will prescribe antibiotics generally two at once, by injection or by mouth that are effective against a wide range of bacteria, including those causing chlamydia and gonorrhea.

Even if your symptoms go away, you should finish taking all of the medicine. You also should return to your health care provider 2 to 3 days after beginning the medicine to be sure the antibiotics are working.

Your health care provider may recommend going into the hospital to treat your PID if you:
1. Are severely ill.
2. Are pregnant.
3. Do not respond to or cannot take oral medicine.
4. Need intravenous antibiotics.
5. Have an abscess in your fallopian tube or ovary.

If your symptoms continue or if an abscess does not go away, you may need surgery. Complications of PID such as chronic pelvic pain and scarring are difficult to treat, but sometimes they improve with surgery.
Your sex partner may be infected with bacteria that can cause PID even without symptoms. Indeed, many women with PID caused by STIs have sex partners who have no symptoms and don’t know they’re infected.

To protect yourself from being re-infected with bacteria that cause PID
1. Your sex partners should be treated even if they don’t have symptoms.
2. You should not have sex with a partner who hasn’t been treated.

The surest way to avoid transmission of STIs is to abstain from sex or to be in a long-term mutually monogamous relationship with a partner who has been tested and isn’t infected. Condoms, when used consistently and correctly, can reduce your risk of getting chlamydia and gonorrhea.

In addition, you can protect yourself from PID by getting treated quickly if you do get an STI. The most common preventable cause of PID is an untreated STI, mainly chlamydia or gonorrhea. CDC recommends yearly chlamydia testing of all sexually active women age 25 or younger and of older women with risk factors for chlamydial infections - those who have a new sex partner or multiple sex partners. If you have had chlamydia, you also should be re-tested several months after completing treatment so you can be re-treated, if necessary.

Prompt and appropriate treatment can help prevent complications of PID. Without treatment, PID can cause permanent damage to the female reproductive organs. Infection-causing bacteria can silently invade the fallopian tubes causing normal tissue to turn into scar tissue. This scar tissue blocks or interrupts the normal movement of eggs into the uterus. If your fallopian tubes are totally blocked by scar tissue, sperm cannot fertilize an egg and you become infertile. Infertility also can occur if the fallopian tubes are partially blocked or even slightly damaged. About one in eight women with PID become infertile.

In addition, a partially blocked or slightly damaged fallopian tube may cause a fertilized egg to remain in the fallopian tube. If this fertilized egg begins to grow in the tube as if it were in the uterus, it is called an ectopic or tubal pregnancy. An ectopic pregnancy can rupture the fallopian tube causing severe pain, internal bleeding, and even death.
Scarring in the fallopian tubes and other pelvic organs can also cause chronic pelvic pain - pain lasting for months or even years. You are more likely to suffer infertility, ectopic pregnancy, or chronic pelvic pain if you have repeated episodes of PID.

Although scientists have learned much about the biology of the microbes that cause PID and the ways in which they damage the body, they still have much to learn. Scientists supported by the National Institute of Allergy and Infectious Diseases (NIAID) is studying the effects of antibiotics, hormones, and substances that boost the immune system. These studies may lead to insights about how to prevent infertility and other complications of PID.

Scientists are developing rapid, inexpensive, and easy-to-use diagnostic tests to detect chlamydia and gonorrhea. A study conducted by NIAID-funded researchers demonstrated that screening and treating women who did not know they had chlamydia-reduced cases of PID by more than half. Researchers also are developing topical microbicides and vaccines that prevent gonorrhea and chlamydia. Others are investigating whether other microbes such as Mycoplasma genitalium cause PID and are developing diagnostic tests and treatments for this infection. Meanwhile, researchers continue to search for better ways to detect PID itself, particularly in women who have PID without symptoms.
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Submitted: 07/23/06

Description: Pelvic inflammatory disease (PID) is a general term that refers to infection and inflammation of the upper genital tract in women. It can affect the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus), ovaries, and other organs related to reproduction.

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