Pelvic inflammatory disease is an inflammatory and infectious disease of the upper portion of female reproductive tract, including pelvic structures, fallopian tubes and uterus. The infection is a result of a severe complication, arising due to certain sexually transmitted diseases, like gonorrhea or chlamydia.
Under PID, tissues present in and around the ovaries and uterus as well as fallopian tubes gets damaged, leading to serious problems of infertility, ectopic pregnancy, chronic pelvic pain and abscess formation. PID infection ascends through vagina and cervix to the upper genital tract.
Higher Risk Group for PID
The high risk group includes menstruating women below 25 years of age, undergoing unsafe sex with multiple partners, and residing in areas with high prevalence of sexually transmitted disease (STD). This is majorily, since, the cervix of young girls is not completely matured and hence, highly prone to STD infections, linked to pelvic inflammatory disease. PID inflammation and infection may spread to the perihepatic structures of the abdomen, causing Fitz-Hugh-Curtis syndrome.
Women undergoing vaginal douches, increase their risks of having PID compared to ones who do not douche. Research has shown that douching changes the microflora of vagina in harmful ways and forces bacteria to reach the upper genital tract from the vagina. Women with intrauterine device (IUD) show an increased risk of PID near the time of insertion, but the risk could be reduced, if tested for STDs, before insertion of IUD.
Around one million of US women experience an infection of PID, resulting in infertility to more than 100,000 women every year. Additionally, 100, 00 of ectopic pregnancies are linked to PID, with the rate being highest amongst teenagers.
Major Symptoms and Signs of PID
PID is predominantly caused by chlamydia trachomatis, which may show mild symptoms, in spite, of severe damage to reproductive organs of a woman. Chlamydia may cause infection of fallopian tubes without any signs. Often, the vague symptoms could go unnoticed in many women, and even the practitioners.
The symptoms of PID usually vary and include tenderness in lower abdomen or pain in the upper abdomen or irregular menstrual bleeding. There may be green or yellow color discharge from the vagina with an unusual odor. There can be phases of high fever or chills, painful urination and nausea or vomiting.
Complications of Pelvic Inflammatory Disease
Bacteria causing infection in PID may silently and slowly invade the fallopian tubes, turning normal tissues into scar tissue. The scar tissue interrupts the usual movement of eggs through fallopian tubes into uterus. In case, fallopian tubes get blocked due to scar tissue, then sperm is not able to fertilize an egg, making women infertile.
Even slight damage or partial blockage of fallopian tubes may result in infertility. Around 10 to 15% of women afflicted with PID may become fertile and those with repetitive episodes of PID infection, increases the chance of getting infertile.
A partially damaged fallopian tube may still lead to fertilization, but restricts the fertilized egg movement towards uterus, resulting in an ectopic pregnancy. Sadly, an ectopic pregnancy never completes as implantation cannot happen in uterus and may further lead to rupturing of fallopian tube, causing internal bleeding, pain or even death.
Chronic Pelvic Pain
Tissue scarring in pelvic structures may also lead to chronic pelvic pain that usually lasts for months or even years.
Diagnosis of Pelvic Inflammatory Disease
PID diagnosis is usually performed with initial blood tests to analyze blood for any sign of bacterial infection, followed by ultrasound test to visualize state of reproductive organs.
Certain tests performed for PID
A small tissue sample is removed from the uterus lining (endometrium) for testing and evaluation of possible infection that may lead to PID.
A thin, viewing instrument (laparoscope) is being inserted into the lower abdomen, through a small cut to examine the internal genital organs, more minutely. Laparoscopic studies have reported that PID infection is polymicrobial (caused by more than one bacterium) in around 30 to 40% of cases.
Pathogenesis of PID may occur due to various organisms that includes Gardnerella vaginalis, Neisseria gonorrhea, Haemophilus influenzae and anaerobic species of Bacteroides and Peptococcus.
Prevention of Pelvic Inflammatory disease
Women need to protect them from PID infections, by taking immediate actions on appearance of any genital sign of an unusual sore, burning sensation, irregular bleeding or odor.
The best way to avoid STD transmission is abstaining yourself from sexual intercourse and maintaining a monogamous relationship with an uninfected partner. One can make use of easily available latex male condoms, which on correct and consistent use reduce the transmission risk of gonorrhea and chlamydia infections.