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| |    Pelvic Inflammatory Disease (PID) by Marjorie Greenfield, M.D. reviewed by Elisa Ross, MD Pelvic inflammatory disease, or PID, is an infection of the uterus, fallopian tubes, and ovaries that usually starts as an infection of the cervix with gonorrhea or chlamydia. Most cases of PID are sexually transmitted, although occasionally the infection is brought about by douching, the insertion of an IUD, or recent vaginal or pelvic surgery. Symptoms of PID can range from mild pelvic discomfort to feeling quite ill with a high fever to severe pelvic pain. Sometimes the infection can lead to an abscess of the ovary and fallopian tube, called a tubo-ovarian abscess (or TOA). Making the diagnosis In addition to such symptoms as pelvic pain and fever, PID also may be diagnosed based on certain examination findings, such as pus draining from the cervix or a blood test that indicates infection. The cervix is tested for gonorrhea and chlamydia, because these infections usually initiate PID, although other germs often are involved by the time the infection progresses up into the uterus. An abscess may be found during pelvic examination or with ultrasound. Treatment of PID Women who aren't very ill may be sent home with antibiotic pills, but severe infection often requires admission to the hospital for intravenous antibiotics. If a tubo-ovarian abscess is present, it may resolve with intravenous antibiotic treatment; however, sometimes surgery is needed. There are many antibiotics that can be used to treat PID. The Centers for Disease Control (CDC) advocates a few antibiotic regimens that have been shown to be the most effective and updates these recommendations on a regular basis. Healthcare personnel can get these recommendations through CDC publications or by going to its website. Short-term complications from PID Pelvic inflammatory disease can be miserable, with severe pelvic pain and fever. If fever and symptoms don't subside in a few days, surgery may be necessary to help clear the infection. Most of the time the pus can be removed and any abscesses can be cleaned out; unfortunately, though, some women with PID will lose an ovary and tube, or even the whole uterus, if the infection doesn't respond to antibiotics. If a TOA bursts, it can be a life-threatening situation that requires emergency surgery. Long-term consequences of PID Even with only mild symptoms, pelvic inflammatory disease can cause obstruction of the fallopian tubes and infertility later in life. The more times that a girl or woman has PID, the more likely she is to have difficulty getting pregnant. The infection also can scar the inside of the tube, increasing the risk for ectopic pregnancy if the woman does conceive. Some women continue to experience pelvic pain, despite treatment of the infection. How can PID be prevented? The best way to prevent this condition is by practicing abstinence or safe sex. Condoms are quite effective at preventing transmission of gonorrhea and chlamydia. Girls and women who don't catch STDs--especially gonorrhea and chlamydia--run less of a risk of developing PID. Early treatment of gonorrhea and chlamydia infection of the cervix can prevent progression of the infection up into the uterus. Some experts recommend that sexually active young women have a pelvic examination to check for chlamydia every six months, particularly those who don't use condoms or have multiple sexual partners.
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