|
PID — Pelvic Inflammatory Disease Pelvic inflammatory disease (PID) affects thousands of women every year, yet many women have never heard of it. Caused by bacteria in the internal reproductive organs, PID can be treated successfully with antibiotics when dealt with quickly. Without prompt diagnosis and treatment, however, PID can lead to long-term complications, including infertility, chronic pain and recurring PID. Unfortunately, there are often no obvious symptoms and, even when there are, women may be misdiagnosed or their symptoms dismissed as 'normal' period pain. These information pages explains what PID is, what causes it, how to treat it and what you can do to help prevent it. What is PID? |
|
||||||||||||||
 Pelvic inflammatory disease (PID) is the term used to describe any infection in a woman’s upper genital tract or reproductive organs. An infection can develop in the fallopian tubes (salpingitis), ovaries (oophoritis), lining of the womb (endometritis), the pelvic tissue surrounding the reproductive organs (peritonitis), or a combination of these. When diagnosed early, PID can be successfully treated with antibiotics and rest. If PID goes untreated, it can lead to serious long-term complications, including chronic pelvic pain, ectopic pregnancy (when an embryo begins to develop in the fallopian tube) or infertility. Unfortunately, many women don’t know they have PID until permanent damage has been done. Symptoms The symptoms of PID vary from woman to woman, and some women have no obvious symptoms at all. When symptoms are present, they may include:
Symptoms may appear suddenly, they may come and go, or they may be constant. Many women first notice symptoms of PID during, or just after, their period. If you are concerned that you may have PID, or if you have more than one of the symptoms listed above, talk to your doctor or go to a GUM (genito-urinary medicine) clinic. See Resources for more information. Causes  PID develops when bacteria (germs) get into a woman’s internal reproductive organs. There are a number of ways this can happen. The internal organs are usually protected by the cervix, which blocks bacteria in the vagina from moving up into the womb. But when the cervix is open (e.g. during menstruation or at ovulation), or if the cervix itself becomes infected, bacteria have a greater chance of getting through and causing infection. Bacteria may also get into the reproductive organs during pelvic surgery or invasive procedures that disrupt the cervix, such as abortion, childbirth or insertion of an IUD (intra-uterine device). Bacteria from severe appendicitis can lead to PID if it spreads to the pelvic tissues, but this is uncommon. Chlamydia and Gonorrhoea PID can be caused by many types of bacteria, but most cases are caused by the bacteria from Chlamydia trachomatis and Neisseria gonorrhoea, two sexually transmitted infections (STIs). Both infect a woman’s cervix and can damage its surface, making it easier for bacteria to get to the internal reproductive organs. Chlamydia — Chlamydia is one of the most common sexually transmitted infections in the world, and in the UK, it is the number one cause of PID. It is estimated that as many as one in ten sexually active women under the age of 25 may be infected with chlamydia, and while it is less common in older age groups, the number of cases in people over 25 is on the rise. Chlamydia can live in the body without causing any symptoms for months or years. Up to 70% of women and 50% of men with chlamydia have no noticeable symptoms, but when symptoms are present, in women they are:
It is estimated that 40% of women who have chlamydia will develop PID. PID caused by chlamydia often produces very mild symptoms, if any at all (called silent or subclinical PID). This does not mean the infection is less serious than other forms of PID, but does mean that the infection may go undetected until permanent damage has been done. Gonorrhoea — Like chlamydia, gonorrhoea is found most commonly among teenagers and those in their 20s, but recent public health figures show an increase in gonorrhoea among 35 to 44 year-olds. Up to 50% of women (and 10% of men) who become infected with gonorrhoea have no symptoms. But when symptoms do occur, in women they are:
Other sources of infection Other bacteria commonly found in the vagina can lead to PID if they get past the cervix and into the internal reproductive organs. This is most likely to happen if your cervix has been damaged, if you have had PID before, or if your cervix is opened during a surgical procedure. Pelvic surgery — Any surgery carries the risk of infection, and pelvic surgery is no exception. Bacteria may be introduced from the outside or may be spread internally from one organ to another.  IUD (intra-uterine device) — When the cervix is opened to insert an IUD, bacteria from the vagina have an opportunity to get into the womb. Studies show that the risk of developing PID is increased for about one month following IUD insertion. Childbirth, miscarriage and abortion — The cervix is dilated (opened) during vaginal childbirth, miscarriage and abortion, and this creates an opportunity for bacteria to make their way into the internal reproductive organs. Before undergoing any procedure that disturbs the cervix, you should be screened for chlamydia, even if you are in a monogamous relationship or think you are unlikely to have chlamydia. Risk factors Sexually active women under the age of 25 have the highest risk of developing PID, with most cases occurring in teenagers. This may be because young women are more likely than older women to have multiple sexual partners and practice unsafe sex – two high risk behaviours for getting PID (see below). Another age-related factor that may influence the development of PID is cervical mucus. Thick cervical mucus can protect the cervix from some forms of bacteria (such as gonorrhoea), but young women in their teens tend to have thin mucus that is less protective. Sexual activity — Having multiple sexual partners is one of the main risk factors for developing PID. The more partners you have penetrative sex with, the more likely you are to be exposed to bacteria that can lead to PID, particularly if you are not using barrier contraception – a condom, femidom, diaphragm or cervical cap with spermicide. The rate of PID is lower among lesbians than heterosexual women, and this is probably related to a lower incidence of the STIs that can lead to PID. Some studies suggest that having sex during your period may increase your chances of developing PID. This is believed to be because the cervix is open during menstruation and the presence of blood may help some bacteria to multiply. IUD — The IUD was once thought to increase a woman’s risk of PID significantly, but recent research suggests it may be the process of inserting the IUD that increases risk, not the IUD itself. Current studies show that risk is increased mainly during the month following insertion, and after that, risk is related more to sexual activity and exposure to STIs than to the use of an IUD. The Pill — There is conflicting information about whether the Pill increases or decreases a woman’s risk of PID. The Pill does not protect against sexually transmitted infections, but it does have a thickening effect on cervical mucus that may prevent some bacteria from getting through the cervix. Other risk factors — Once you’ve had PID, you have an increased risk of getting it again. Smoking, douching and cocaine-use also have been linked to an increased risk of PID, but more research is needed to investigate these links. Prevention The best way to prevent PID is to protect yourself from sexually transmitted infections. Always use a barrier method of contraception during sex. Condoms and femidoms offer the most protection when used correctly and consistently. A diaphragm or cervical cap (used with a spermicide) may also help prevent gonorrhoea and chlamydia, but not other STIs. Get regular sexual health check-ups. This will help to ensure timely diagnosis and treatment of STIs. Screening for gonorrhoea and chlamydia, however, is not always part of a routine check-up. Tell the doctor or nurse if you want to be tested for chlamydia and gonorrhoea. Make sure you are tested for chlamydia and gonorrhoea before any procedure that opens the cervix (for example:abortion, IUD insertion, vaginal childbirth). |
|||||||||||||||
|
Written by Tamara Beus and published in printed format (2002) by Women's Health
|
|||||||||||||||
