PID (pelvic inflammatory disease) is an infection of the female upper genital tract, including ovaries, fallopian tubes and womb. This is a common condition but it is not known why many women are affected in the United Kingdom. [1] PID mostly affects women who are sexually active, between 15 and 24 ages. This condition often causes no signs or symptoms. As a result, many women do not realize that they have it and to get the proper treatment. Pelvic inflammatory disease might be detected later if you develop chronic pelvic pain or you have trouble getting pregnant.
Symptoms of pelvic inflammatory disease
This infection does not cause any obvious symptoms. Most women have mild symptoms which can include one or more of the following symptoms [2]:
- Unusual vaginal discharge, especially if it is yellow or green
- Painful periods
- Heavy periods
- Bleeding between periods and after sex
- Pain during urination
- Discomfort or pain during the sex that is felt deep inside the pelvis
- Pain around the pelvis or lower abdomen (tummy)
A few women can become very ill and then, they will have some of the mentioned symptoms:
- Nausea and vomiting
- A high temperature (fever)
- Severe lower abdominal pain
This condition can cause only mild symptoms or none at all. If you experience some of the above mentioned symptoms of pelvic inflammatory disease, then visit your doctor or a sexual health clinic.
Pelvic inflammatory disease causes
PID is caused by infection which is developing in the female upper genital tract. In the most cases, pelvic inflammatory disease is caused by a bacterial infection spreading from the cervix (entrance to the womb) or vagina into the ovaries, fallopian tubes and womb. This infection is often caused by more than one type of bacterium and in some cases can be difficult for doctors to tell the cause for it. In most cases combination of antibiotics will be prescribed, so different types of bacteria can be treated.
- STIs (sexually transmitted infections): In about 1 in 4 cases, pelvic inflammatory disease is caused by STI (sexually transmitted infection) such as gonorrhea or Chlamydia. These types of bacteria usually only infect the cervix and there they can be easily treated with a single dose of antibiotics. But if they are not treated, then there is a risk the bacteria could travel into the upper genital tract. It is estimated that one in ten women with untreated Chlamydia can develop pelvic inflammatory disease within a year. [3]
- Other causes: There are many cases when the cause for pelvic inflammatory disease is not known. There are some cases when normally harmless bacteria found in the vagina can get past the cervix and into the female reproductive organs. It is known that these bacteria are harmless in the vagina, but these types of bacteria can cause infection in other parts of the body. This is most likely to happen if:
- You have a procedure that involves opening of the cervix – such as an abortion, inspection of the womb, or insertion of an intrauterine contraceptive device (coil) [4]
- There has been damage to the cervix following a childbirth or a miscarriage [5]
- You have had pelvic inflammatory disease before
Risk factors: There are many factors that can increase the risk of pelvic inflammatory disease such as
- Having a history of pelvic inflammatory disease or a STI (sexually transmitted infection) [3]
- Douching regularly, which upsets the balance of good versus harmful bacteria in the vagina and might mask symptoms [6]
- Having sex without a condom
- Being in a sexual relationship with a person who has more than one sex partner
- Having multiple sexual partners
- Being a sexually active woman younger than 25 years old [7]
Nowadays there are many experts who agree that having an IUD (intrauterine device) inserted does not increase the risk of PID. Also it is known that any potential risk is generally within the first 3 weeks after insertion.
Complications: When PID is not treated, then it can cause scar tissue. Also you can develop collections of infected fluid (abscesses) in your fallopian tubes, which could damage your reproductive organs. Also there could be other complications such as
- Tubo – ovarian abscess
- Chronic pelvic pain
- Infertility
- Ectopic pregnancy
References:
[1] Nicholson A, Rait G, Murray-Thomas T, et al. Management of first-episode pelvic inflammatory disease in primary care: results from a large UK primary care database. British Journal of General Practice 2010;60(579):e395-e406.
[2] Mitchell C, Prabhu M. Pelvic inflammatory disease: Current concepts in pathogenesis, diagnosis and treatment. Infectious Disease Clinics of North America. 2013;27(4):10.1016/j.idc.2013.08.004.
[3] Simms I, Stephenson JM. Pelvic inflammatory disease epidemiology: what do we know and what do we need to know? Sexually Transmitted Infections. 2000;76:80–7.
[4] Hubacher D. Intrauterine devices & infection: Review of the literature. Indian Journal of Medical Research. 2014;140(Suppl1):S53–S57.
[5] Huang CC, Huang CC, Lin SY, et al. Association of pelvic inflammatory disease (PID) with ectopic pregnancy and preterm labor in Taiwan: A nationwide population-based retrospective cohort study. PLoS One. 2019;14(8):e0219351.
[6] Martino JL, Vermund SH. Vaginal Ddouching: Evidence for risks or benefits to women’s health. Epidemiologic Reviews. 2002;24(2):109–24.
[7] Hay PE, Kerry SR, Normansell R, et al. Which sexually active young female students are most at risk of pelvic inflammatory disease? A prospective study. Sexually Transmitted Infections. 2016;92(1):63–6.
