Pelvic inflammatory disease (PID) is a state when there is inflammation in the pelvis affecting upper female reproductive organs as well as other pelvic structures.

Causes
PID is caused by bacteria ascending from the vagina through the cervix to the uterus, fallopian tubes, and ovaries before the pelvic spreading. The most common bacteria are chlamydia and gonorrhea. This typically occurs through unprotected sex. However, few are not sexually transmitted and are found after miscarriage or after childbirth, and even rarer after an intrauterine device (IUD) or other medical instrument insertion.

Risk factors

• Having multiple sexual partners or a partner having multiple partners.
• Having sex without any barriers, e.g., condoms.
• Having regular vaginal douching can cause an imbalance of good and bad bacteria in the vagina.
• Having previous episodes of PID or sexually transmitted infection (STI).

Prevention
Some risk factors of PID are preventable by:

• Refraining from having multiple sexual partners. Selecting and knowing the sexual history of the partner, ask him to get tested if he is at risk.
• Use of condoms during sexual activity. Other forms of contraception cannot prevent PIDs or STIs.
• Do not douche vagina.
• Seeking proper tests and medical treatment with abnormal vaginal discharge or symptoms of STI. The treatment of an STI can prevent the development of PID.

Symptoms
The PID may be asymptomatic and become chronic if unaware. However, common symptoms include:

• Mild to severe pelvic or abdominal pain, especially during sex
• Abnormal vaginal discharge with an unpleasant odor
• Irregular non-cyclic bleeding or cramping throughout the month
• Burning sensation when urinating
• Fever and chills

Complications
Many complications and sequelae can occur during the episode of PID or after that.

• Collection of pus or abscesses of the ovaries, fallopian tubes, and other pelvic structures may develop if PID is left untreated or inadequately treated. The abscesses may cause severe symptoms, especially if they rupture.
• Pelvic adhesion or fibrosis (scar)
• Chronic pelvic pain
• Infertility or subfertility
• Ectopic pregnancy

Diagnosis
The doctor will take several steps altogether to reach the diagnosis.

• Obtain detailed medical history
  • Personal health, sex life, use of birth control, and history of STIs or PID.
  • Symptoms, their duration and severity.
• Thorough physical examination, including a pelvic exam to check:
  • Any fever or signs of systemic infection
  • Any abnormal vaginal and cervical discharge
  • Any pain upon touching or compression or any palpable mass in the pelvis
• Laboratory tests including swab of vaginal discharge for gonorrhea or other STIs, blood test for white blood cell counts for signs of inflammation or infection, HIV, or others.
• Ultrasound to assess abnormality of pelvic structures
• If needed, additional tests may be ordered. For examples:
  • Laparoscopy to view and possibly swab pelvic organs to test for etiologic microorganisms by inserting an instrument through a small incision through the abdomen
  • Endometrial biopsy to get a sample of endometrial tissue through the cervix to test for infection or inflammation.

Treatment

• If you experience any symptoms suggesting STI (abnormal vaginal discharge with an unpleasant odor, bleeding between periods, painful urination, etc.), stop having sex and seek medical care as soon as possible. PID can be prevented with a timely treatment of STI.
• Seek immediate medical care if you have
  • Severe abdominal pain
  • Vaginal discharge with foul smell odor
  • High-grade fever (3 Celsius degree or higher)
  • Nausea and vomiting
• Certain antibiotics will be prescribed to you immediately. The medication may be adjusted according to your subsequent test results. Always finish the course of medication though the symptoms are relieved.
• You may need to be hospitalized and given intravenous antibiotics if your symptoms are not better with oral medications or you are severely ill, have an abscess, or are pregnant.

A surgery may be required if your abscesses are large, do not respond to antibiotics, rupture, or when a diagnosis is questionable.

Stop having sex until the treatment is completed and the disease resolves. Ask your sexual partner to seek medical care to find out if he is infected because the infection is often asymptomatic. An appropriate diagnosis and treatment of the partner can also help prevent the spread and reinfection.

Preparing for your appointment
What you should prepare

• When making a doctor’s appointment, ask if there are any restrictions you must follow in advance.
• Take note of your symptoms, whether related or unrelated to PID.
• List all medications and dietary supplements you are taking.

Questions you doctor may ask you:

• What symptoms are you having? When is the symptom onset? How severe?
• Do you have more than one sexual partner? Do you just start a new sexual relationship?
• Do you use condoms?

Questions you may ask your doctor:

• Is PID sexually transmitted?
• Do my partner, and I need to undergo any tests?
• Can I be treated at home? Do I need to get treatment at a hospital?
• What are the precautions? Can I still have sex during treatment?
• What should I do to prevent PID?
• Is it wholly cured? Can it recur?
• Do I need a follow-up visit?
• What are the long-term consequences? Can I still get pregnant?