What is PID?
Pelvic inflammatory disease refers to infection leading to inflammation of the tissues of the upper genital tract including the inner lining of the womb, fallopian tubes, ovaries and lining of the pelvis (peritoneum). We do not know how common this condition is but think it is fairly common as it reflects the number of sexually-transmitted infection episodes in society.
What causes it?
The most common cause of PID is sexually transmitted infections and current estimates suggest over half of all cases are caused by Chlamydia. Gonorrhoea as a cause of PID has been rising over recent years and is the next most common cause. Other less common bacterial causes include Bacteriodes and Mycoplasma. Besides these infections, PID could also arise from medical/surgical interventions including HSG/HyCoSy, hysteroscopy, egg collection for IVF and pelvic surgery.
What problems can it lead to?
Unfortunately, many cases of PID do not give rise to any symptoms and so the condition progresses untreated for a long time leading to severe damage to pelvic organs.
- Immediate problems: the most common symptoms caused by PID include pelvic pain, vaginal discharge, feeling unwell, and painful sex. In more severe cases it can lead to poor appetite, vomiting and fever. The most severe cases can lead to life-threatening conditions known as peritonitis and septic shock.
- Long-term problems: women with PID run a risk of tubal damage and infertility with the risk increasing with the number of episodes (10% with 1 episode, 25% with 2 episodes and over 50% with 3 episodes). Following an episode of PID, women run a long-term risk of having unexplained pelvic pain and so have a 10-fold greater risk of having a hysterectomy for pelvic pain.
How is it investigated?
The starting point of the investigation of PID is detailed history and abdominal and pelvic examination. Vaginal and cervical swabs are crucial in detecting sexually transmitted diseases. Pelvic ultrasound might be useful in detecting a pelvic abscess or other collection. Very occasionally, it is necessary to perform a laparoscopy for severe cases and those that do not respond to treatment.
How is it treated?
The treatment of PID is use of appropriate antibiotics for up to two weeks. The exact cause of PID is often not obvious and so we start treatment with a combination of two strong antibiotics that we know will cover the common bugs that cause this infection. Very occasionally, it might be necessary to undertake some form of surgery to achieve cure such as drainage of a pelvic abscess.