Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infection of the upper female reproductive organs, including the uterus, ovaries and fallopian tubes.


Causes/associated factors
In the United States, more than 1 million women develop pelvic inflammatory disease every year. Sexually transmitted diseases (STDs) are the leading cause of PID. Chlamydia and/or gonorrhea are typically to blame. Once these infections invade the lower genital tract, the bacteria can spread into the upper genital organs and cause pelvic inflammatory disease. Less commonly, other bacterial infections can also cause the disease. For example, PID may develop after childbirth, abortion, a biopsy of the uterine cavity, or dilation and curettage (D & C, a procedure used to scrape the lining of the uterus). Bacterial vaginosis may also be associated with PID. Sometimes, the cause of PID is unknown.
Those at highest risk of developing PID include:

sexually active women under age 25 (including teenagers)
women who've contracted an STD (especially chlamydia or gonorrhea)
women who've had a previous bout with PID
women with multiple sexual partners or a partner who's not monogamous
women who douche (Researchers suspect that douching may push bacteria high into the upper genital tract, subsequently causing an infection.)
There's a slightly increased risk of PID within the first few weeks after an intrauterine device (IUD) is inserted. This is related to bacteria that may enter the uterus when the IUD is inserted.


Signs/symptoms
Some women with PID have very few or no symptoms. Some think they may have simply had bad cramps. For other women, symptoms may include:
recurring lower abdominal or pelvic pain
thick or foul smelling vaginal discharge
irregular menstrual bleeding
fever
painful sex
low back pain
Because PID can damage the fallopian tubes, it's important to seek medical attention immediately if you think you might have an infection.


Diagnosis
Pelvic inflammatory disease can be difficult to diagnose. First, your doctor will ask questions about your symptoms and medical history. he or she will do a physical exam, including a pelvic exam. You may need blood tests to help determine if there's an infection. If you have a vaginal discharge, a sample may be sent to the lab for analysis. Your doctor may also recommend an ultrasound (using sound waves to create an image of internal body parts) or a culture of the cervix. If necessary, your doctor may recommend a laparoscopy. This minor surgical procedure allows your doctor to examine the tissues and organs in your pelvic area with a laparoscope (a thin tube equipped with a camera lens and light).

Treatment
Antibiotics are used to treat PID. Often, two or more antibiotics must be taken together. You'll need a follow-up visit after you've started taking the medication to make sure the treatment is working. Remember to take the full course of antibiotics according to your doctor's instructions. Don't stop taking them because your symptoms improve or go away -- you may still have the infection.
Pain medication and warm baths may help relieve your pain, and you PID you have, the greater your risk of experiencing severe complications.


Pregnancy-specific information
Pelvic inflammatory disease during pregnancy can be serious. Hospitalization may be needed due to the higher risk of miscarriage, preterm labor and maternal complications. Consult your doctor right away if you suspect you have an infection.

Senior-specific information
Growing older is not a risk factor for this condition.

Prevention
Again, sexually transmitted diseases are the leading cause of PID. Abstinence is the most effective way to prevent STDs. If you're sexually active, it's best to remain in a monogamous relationship with an uninfected partner. If you're not in a monogamous relationship, here are some ways to reduce the risk of contracting an STD.
Limit your number of sexual partners.
Make sure each sexual partner is tested for STDs and completes proper treatment, if necessary, before you have sexual contact.
Avoid direct contact with genital lesions.
Use a latex or polyurethane condom consistently during any vaginal, oral or anal sexual contact. (Keep in mind that a condom doesneinfection, make sure your partner(s) receive medical care as well.
As a general precaution, the U.S. Preventive Services Task Force recommends routine screening for sexually active women age 25 and younger and for all other women who are at increased risk for infection. The Centers for Disease Control and Prevention recommends screening at least once a year.