About Pelvic Inflammatory Disease (PID)

Pelvic Inflammatory Disease (PID) is an infection of the female reproductive organs, often caused by untreated sexually transmitted infections like chlamydia or gonorrhea. It can lead to chronic pelvic pain, infertility, and ectopic pregnancy if not treated early. Symptoms may be mild or absent, making early diagnosis challenging. PID most commonly affects women aged 15–24. Globally, it affects about 1 in 8 sexually active young women at some point in their lives.

What is Pelvic inflammatory disease (PID)?

Pelvic Inflammatory Disease (PID) is an infection of the female reproductive organs, including the uterus, fallopian tubes, and ovaries, most commonly caused by sexually transmitted bacteria like Chlamydia trachomatis and Neisseria gonorrhoeae. It typically occurs when these bacteria spread from the vagina or cervix into the upper reproductive tract. PID may cause symptoms such as lower abdominal pain, abnormal vaginal discharge, painful intercourse, fever, and irregular menstrual bleeding, though some women may have mild or no symptoms. 

If untreated, PID can lead to serious complications like infertility, ectopic pregnancy, chronic pelvic pain, and abscess formation. Diagnosis is based on clinical symptoms, pelvic examination, and may be supported by ultrasound or lab tests. Treatment includes prompt use of broad-spectrum antibiotics, and in severe cases, hospitalization or surgery may be needed. Prevention involves practicing safe sex, regular STI screening, and early treatment of any infections.

Types of PID - Pelvic inflammatory disease

Types of pelvic inflammatory disease (PID) are classified based on the duration of inflammation that follows as

Acute PID (Pelvic inflammatory disease) : Acute pelvic inflammatory disease is characterised by sudden or severe inflammation of the female reproductive organs (uterus, fallopian tubes, ovaries) due to infection.

Chronic PID (Pelvic inflammatory disease) : Chronic pelvic inflammatory disease is characterised by persistent inflammation for a long time, which can lead to severe complications.

Signs and symptoms of Pelvic inflammatory disease (PID)

Most pelvic inflammatory disease symptoms (female) are mild and may include one or more of the following signs and symptoms of pelvic inflammatory disease:

• Lower abdominal or pelvic pain (common)
• Vaginal discharge (yellow, green or fishy odour).
• Abnormal vaginal bleeding
• Dyspareunia (painful sex)
• Increased temperature
• Painful urination
• Bleeding and spotting after sex
• Pain in the upper right abdomen (rare)

Regular reproductive health checkups are crucial for sexually active women since some individuals may not experience noticeable symptoms of pelvic inflammatory disease. However, PID symptoms might show extreme pain and fever if it is caused by a bacteria called gonorrhoea.

Pelvic inflammatory disease (PID) Causes

Pelvic Inflammatory Disease (PID) is primarily caused by bacterial infections that spread from the vagina or cervix to the upper genital tract, including the uterus, fallopian tubes, and ovaries. The most common culprits are sexually transmitted infections (STIs), particularly:

• Neisseria gonorrhoeae (the bacterium responsible for gonorrhea)
• Chlamydia trachomatis (the bacterium responsible for chlamydia)

These bacteria are often transmitted through unprotected sexual contact. Once in the lower genital tract, they can ascend to infect the upper reproductive organs, especially if left untreated.

In addition to STIs, other types of bacteria can contribute to PID:

• Mycoplasma genitalium – another sexually transmitted organism increasingly recognized in PID cases.
• Normal vaginal flora – bacteria that are typically harmless in the vagina can sometimes migrate upward, especially when the normal balance of flora is disrupted.

PID can also result from non-sexually transmitted infections or procedures that introduce bacteria into the upper genital tract, including:

• Bacterial vaginosis – a condition where the natural balance of vaginal bacteria is disrupted, allowing harmful bacteria to overgrow and ascend into the reproductive tract.
• Gastrointestinal sources of infection, such as a ruptured appendix or bowel infection, can lead to secondary spread of bacteria to the pelvic area.
• Medical or surgical procedures, such as:
  
  • Dilation and curettage (D&C)
  • Induced abortion
  • Insertion of an intrauterine device (IUD) (though the risk is typically highest within the first few weeks after insertion).

These procedures may introduce bacteria directly or disrupt the natural barriers that normally prevent bacteria from ascending into the uterus and fallopian tubes.

Pelvic Inflammatory Disease (PID) Risk Factors

Factors increasing the risk of PID include:

• Being sexually active, especially women aged 15-25
• Having multiple sexual partners or a partner with multiple partners
• History of untreated STIs or previous PID episodes
• Douching, which can push bacteria into the reproductive organs
• Recent insertion of an IUD (especially within the first few weeks)
• Tubal ligation surgery

Pelvic Inflammatory Disease (PID) Complications

Untreated or recurrent PID can lead to serious and long-term complications:

• Infertility: Scarring and blockage of fallopian tubes prevent fertilization.
• Ectopic pregnancy: Scarring increases risk of fertilized eggs implanting outside the uterus, which can be life-threatening.
• Chronic pelvic pain: Persistent inflammation and scarring cause ongoing pain.
• Tubo-ovarian abscess: Collection of pus in the fallopian tubes or ovaries, sometimes requiring surgical drainage.
• Fitz-Hugh-Curtis syndrome: Inflammation of the liver capsule causing right upper abdominal pain

Diagnosis of Pelvic Inflammatory Disease (PID)

The diagnosis of Pelvic Inflammatory Disease (PID) is primarily clinical, based on the patient's symptoms, medical history, and physical examination findings. Because early diagnosis and treatment are crucial to prevent long-term complications, clinicians often initiate treatment based on clinical suspicion even before all test results are available.

Key components of the diagnostic process include:

• Pelvic Examination
  A thorough pelvic exam is essential to assess for:
  
  • Cervical motion tenderness – pain when the cervix is moved, a classic sign of PID
  • Uterine tenderness and adnexal tenderness (pain in the areas of the ovaries and fallopian tubes)
  • Abnormal vaginal or cervical discharge, which may be purulent
  • Evidence of inflammation or bleeding at the cervix
• Laboratory Tests
  
  • Vaginal and cervical swabs are taken to test for Neisseria gonorrhoeae, Chlamydia trachomatis, and possibly Mycoplasma genitalium.
  • Blood tests may be performed to assess markers of infection and inflammation such as:
    
    • White blood cell (WBC) count
    • C-reactive protein (CRP)
    • Erythrocyte sedimentation rate (ESR)
• Imaging Studies
  
  • A pelvic ultrasound is commonly used to evaluate for:
    
    • Tubo-ovarian abscesses
    • Hydrosalpinx (fluid-filled fallopian tubes)
    • Other pelvic or abdominal abnormalities
  • A CT scan may be used in complex cases or when appendicitis or bowel pathology is suspected as a differential diagnosis
• Pregnancy Test
  
  • A urine or serum pregnancy test is important to rule out ectopic pregnancy, which can present with similar symptoms but requires different management.

Pelvic Inflammatory Disease (PID) Treatment Management

Treatment involves prompt administration of broad-spectrum antibiotics targeting N. gonorrhoeae, C. trachomatis, and anaerobic bacteria. Empiric treatment is often started before test results return due to the risk of complications. Common regimens include:

• Ceftriaxone (intravenous or intramuscular)
• Doxycycline (oral or IV)
• Metronidazole to cover anaerobes

Hospitalization may be required for severe cases or if abscesses are present. Sexual partners must also be treated to prevent reinfection

Note: Medication is only advisable under doctor's consideration.

If abscesses develop, they may require drainage through laparoscopic.

Laparoscopic removal of an abscess is a minimally invasive surgical procedure that uses a camera system to provide enhanced depth perception and precision. This allows the surgeon to accurately locate, drain, and remove a pelvic abscess with minimal damage to surrounding tissues, leading to faster recovery and reduced complications.