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Pelvic inflammatory disease

Pelvic inflammatory disease
Other namesPelvic inflammatory disorder
Drawing showing the usual sites of infection in pelvic inflammatory disease
SpecialtyGynecology
SymptomsLower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, irregular menstruation[1]
ComplicationsInfertility, ectopic pregnancy, chronic pelvic pain, cancer[2][3][4]
CausesBacteria that spread from the vagina and cervix[5]
Risk factorsGonorrhea, chlamydia[2]
Diagnostic methodBased on symptoms, ultrasound, laparoscopic surgery[2]
PreventionNot having sex, having few sexual partners, using condoms[6]
TreatmentAntibiotics[7]
Frequency1.5 percent of young women yearly[8]

Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis.[5][2] Often, there may be no symptoms.[1] Signs and symptoms, when present, may include lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, bleeding after sex, or irregular menstruation.[1] Untreated PID can result in long-term complications including infertility, ectopic pregnancy, chronic pelvic pain, and cancer.[2][3][4]

The disease is caused by bacteria that spread from the vagina and cervix.[5] While it has been reported that infections by Neisseria gonorrhoeae or Chlamydia trachomatis are present in 75 to 90 percent of cases,[2] the strong association of PID with these infections is often a misconception. In the UK it is reported by the NHS that infections by Neisseria gonorrhoeae and Chlamydia trachomatis are responsible for only a quarter of PID cases.[9] Often, multiple different bacteria are involved.[2]

Without treatment, about 10 percent of those with a chlamydial infection and 40 percent of those with a gonorrhea infection will develop PID.[2][10] Risk factors are generally similar to those of sexually transmitted infections and include a high number of sexual partners and drug use.[2] Vaginal douching may also increase the risk.[2] The diagnosis is typically based on the presenting signs and symptoms.[2] It is recommended that the disease be considered in all women of childbearing age who have lower abdominal pain.[2] A definitive diagnosis of PID is made by finding pus involving the fallopian tubes during surgery.[2] Ultrasound may also be useful in diagnosis.[2]

Efforts to prevent the disease include not having sex or having few sexual partners and using condoms.[6] Screening women at risk for chlamydial infection followed by treatment decreases the risk of PID.[11] If the diagnosis is suspected, treatment is typically advised.[2] Treating a woman's sexual partners should also occur.[11] In those with mild or moderate symptoms, a single injection of the antibiotic ceftriaxone along with two weeks of doxycycline and possibly metronidazole by mouth is recommended.[7] For those who do not improve after three days or who have severe disease, intravenous antibiotics should be used.[7]

Globally, about 106 million cases of chlamydia and 106 million cases of gonorrhea occurred in 2008.[10] The number of cases of PID, however, is not clear.[8] It is estimated to affect about 1.5 percent of young women yearly.[8] In the United States, PID is estimated to affect about one million people each year.[12] A type of intrauterine device (IUD) known as the Dalkon shield led to increased rates of PID in the 1970s.[2] Current IUDs are not associated with this problem after the first month.[2]

  1. ^ a b c "Pelvic Inflammatory Disease (PID) Clinical Manifestations and Sequelae". cdc.gov. October 2014. Archived from the original on February 22, 2015. Retrieved February 21, 2015.
  2. ^ a b c d e f g h i j k l m n o p q Mitchell, C; Prabhu, M (December 2013). "Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and treatment". Infectious Disease Clinics of North America. 27 (4): 793–809. doi:10.1016/j.idc.2013.08.004. PMC 3843151. PMID 24275271.
  3. ^ a b Chang, A. H.; Parsonnet, J. (2010). "Role of Bacteria in Oncogenesis". Clinical Microbiology Reviews. 23 (4): 837–857. doi:10.1128/CMR.00012-10. ISSN 0893-8512. PMC 2952975. PMID 20930075.
  4. ^ a b Chan, Philip J.; Seraj, Ibrahim M.; Kalugdan, Theresa H.; King, Alan (1996). "Prevalence of Mycoplasma Conserved DNA in Malignant Ovarian Cancer Detected Using Sensitive PCR–ELISA". Gynecologic Oncology. 63 (2): 258–260. doi:10.1006/gyno.1996.0316. ISSN 0090-8258. PMID 8910637.
  5. ^ a b c Brunham RC, Gottlieb SL, Paavonen J (2015). "Pelvic inflammatory disease". The New England Journal of Medicine. 372 (21): 2039–48. doi:10.1056/NEJMra1411426. PMID 25992748. S2CID 207846620.
  6. ^ a b "Pelvic Inflammatory Disease (PID) Patient Counseling and Education". Centers for Disease Control. October 2014. Archived from the original on February 22, 2015. Retrieved February 21, 2015.
  7. ^ a b c "2010 STD Treatment Guidelines Pelvic Inflammatory Disease". Centers for Disease Control. August 15, 2014. Archived from the original on February 22, 2015. Retrieved February 22, 2015.
  8. ^ a b c Eschenbach, D (2008). "Acute Pelvic Inflammatory Disease". Glob. Libr. Women's Med. doi:10.3843/GLOWM.10029. ISSN 1756-2228. S2CID 40912241.
  9. ^ "Acute Pelvic Inflammatory Disease" (PDF). National Health Service. Archived from the original (PDF) on 2023-01-24.
  10. ^ a b World Health Organization (2012). "Global incidence and prevalence of selected curable sexually transmitted infections - 2008" (PDF). who.int. pp. 2, 19. Archived (PDF) from the original on March 19, 2015. Retrieved February 22, 2015.
  11. ^ a b "Pelvic Inflammatory Disease (PID) Partner Management and Public Health Measures". Centers for Disease Control. October 2014. Archived from the original on February 22, 2015. Retrieved February 21, 2015.
  12. ^ "Self-Study STD Modules for Clinicians — Pelvic Inflammatory Disease (PID) Next Centers for Disease Control and Prevention Your Online Source for Credible Health Information CDC Home Footer Separator Rectangle Epidemiology". Centers for Disease Control. October 2014. Archived from the original on February 22, 2015. Retrieved February 21, 2015.

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