Pelvic Inflammatory Disease: Key Q&A

Reviewed By:
Joanne Poje Tomasulo, M.D., ACOG

What is pelvic inflammatory disease?
Pelvic inflammatory disease (PID) is a bacterial infection that affects a woman's upper reproductive organs, including the uterus, ovaries and, most commonly, the fallopian tubes.

These organs can become inflamed when bacteria spreads through the cervix (the opening that separates the uterus from the vagina) and into the uterus. The bacteria may occur naturally in the vagina or be introduced during sexual intercourse.

Unlike infections in other body parts, which are usually caused by one organism, PID infections frequently include multiple bacterial organisms.

How common is pelvic inflammatory disease?
According to the Centers for Disease Control and Prevention, more than 1 million women in the United States are diagnosed annually with PID. It is the most common cause of female infertility and is responsible for 100,000 cases of infertility annually.

What are the major complications of PID?
During a woman's monthly cycle, an egg is released by one ovary and travels through the fallopian tube to the uterus. For pregnancy to occur, the egg must be fertilized by sperm, usually in the fallopian tube, and then implant in the uterus. When PID scars the tissues of any of these organs, the egg may be blocked, which prevents fertilization.

PID is also the most common cause of ectopic pregnancy, which occurs when scar tissue prevents a fertilized egg from moving to the uterus and the egg implants and grows in the fallopian tube instead. If the pregnancy is not terminated, the growing embryo can rupture the tube and cause massive abdominal bleeding.

What are the different types of pelvic inflammatory disease?
The types of pelvic inflammatory disease (PID) are defined by the parts of the reproductive tract that become inflamed due to infection. These include:

• Salpingitis. Occurs in the fallopian tubes and is the most common form of the disease.
  
  
• Myometritis. Occurs in the uterine wall.
  
  
• Endometritis. Occurs in the endometrium, or uterine lining. This should not be confused with endometriosis, an unrelated condition of the uterine lining.
  
  
• Parametritis. Occurs in the uterine serosa (the outer layer of the uterine wall) and the broad ligaments that support the uterus and pelvis.
  
  
• Oophoritis. Occurs in one or both ovaries.

 

What are the symptoms of pelvic inflammatory disease?
Many women with pelvic inflammatory disease experience no symptoms. When symptoms do occur, lower abdominal pain and abdominal and cervical tenderness during examination are the most common ones. Other potential symptoms include unusual or odorous vaginal discharge or bleeding between menstrual periods, pain during intercourse, fever, nausea or vomiting.

What diagnostic tests may be used if PID is suspected?
A pelvic ultrasound is sometimes used to determine the areas that may be affected by pelvic inflammatory disease. Ultrasound can be useful in identifying an abscess or enlarged areas.

Sometimes a doctor will conduct a laparoscopic examination. During this procedure, the doctor inserts a slender, lighted tube through an incision in the abdomen and examines the pelvic organs. This procedure provides a view of the organs that can help the doctor diagnose and plan treatments.

How is pelvic inflammatory disease treated?
Doctors usually prescribe two antibiotics that fight a broad spectrum of infections.

If PID is suspected, a woman will often begin treatment with antibiotics immediately, even before the results of diagnostic tests are known. This is because the value of treating the infection early and avoiding potential damage to the reproductive system outweighs the risks of treatment should PID not actually be present.

How can pelvic inflammatory disease be prevented?
Most cases of pelvic inflammatory disease are caused by sexually transmitted diseases. You can minimize your risk of getting a sexually transmitted disease (STD) by always using latex condoms during sex. It also helps to limit your number of sexual partners and to know the sexual history of your partners.