Can Pelvic Inflammatory Disease be Treated?

PID Treatment Guide: Cure, Complications & How to Prevent Recurrence

PID (Pelvic Inflammatory Disease) is a severe infection impacting a woman's reproductive system, specifically the uterus, fallopian tubes, and ovaries. It is most commonly triggered by sexually transmitted bacteria like Chlamydia trachomatis and Neisseria gonorrhoeae.

The infection must be diagnosed and treated promptly since untreated PID may result in chronic pelvic pain, ectopic pregnancy, and infertility. This comprehensive FAQ blog explores the causes, symptoms, treatment options, and prevention methods of PID, empowering women to make informed health decisions.

What Causes PID in Females?

Pelvic inflammatory disease (PID) commonly results from bacteria ascending from the cervix or vagina into the upper genital tract. The most frequent causes are:

• Sexually Transmitted Diseases (STIs) : The bacteria Chlamydia trachomatis and Neisseria gonorrhoeae are the most frequent etiological agents of PID. Inflammation occurs as bacteria move from the cervix into the fallopian tubes, uterus, and ovaries.
• Bacterial Vaginosis or Balance of Normal Vaginal Flora : When the vaginal flora's balance is disrupted, it can lead to a significant proliferation of disease-causing bacteria, resulting in an infection beyond the cervix.
• Post-Surgical or Post-Procedure Infections : Medical procedures like endometrial biopsy, intrauterine device (IUD) insertion, or instrumentation after delivery or abortion can seed bacteria into the upper reproductive tract.
• Unprotected Sexual Activity with Multiple Partners : Having more than one sexual partner or having unprotected sex greatly increases the risk of picking up infectious agents that lead to PID.
• Douching : Douching can upset the protective balance of vaginal flora, allowing harmful microbes to travel as far up as the uterus and the fallopian tubes.

What Are 6 Symptoms of PID?

Symptoms of PID vary, sometimes presenting as mild or severe and frequently as subtle or absent. This absence of obvious symptoms delays diagnosis and treatment to some extent. If present, the following six are typically associated with pelvic inflammatory disease:

• Pelvic or Lower Abdominal Pain : This is the most common symptom. Pain tends to be aching, persistent, and in the lower abdomen or pelvis. Pain can be increased by movement, sex, or exercise.
• Abnormal Vaginal Discharge : Women with PID could experience more yellow or green, strongly smelling vaginal discharge. The discharge is usually caused by pus or accumulation of inflammatory fluids due to the infection.
• Pain during intercourse (dyspareunia) : Painful inflammation of the ovary, tubes, or uterus makes penetration of the vagina painful. Pain is usually deep and can remain even after having sexual intercourse.
• Irregular Menstrual Bleeding : PID may result in menstrual irregularities in the form of intermenstrual spotting, postcoital bleeding, or abnormally heavy and prolonged menses. This is a result of the infection's effect on the endometrial lining.
• Fever and Chills : A moderate to severe fever accompanied by aches and chills indicates that the infection is systemic. This is frequently observed in cases of advanced or untreated PID.
• Painful Urination (Dysuria) : When the infection leads to inflammation of the bladder or the urethra, there can be stinging or burning during urination. Women can also experience the feeling of needing to urinate frequently.

How is PID Diagnosed?

There is no one 'gold standard' test for the diagnosis of Pelvic Inflammatory Disease (PID). Diagnosis is based mainly on clinical findings and aided by the investigations below:

• Pelvic examination : The latter can detect cervical, uterine, or adnexal tenderness, which are typical presentations of PID inflammation.
• Vaginal swabs : These can be tested for sexually transmitted pathogens such as Chlamydia trachomatis, Neisseria gonorrhoeae, or Mycoplasma genitalium, which are frequently found in association with PID.
• Blood studies : An elevated white blood cell count or C-reactive protein level points to an active infection or inflammatory process.
• Imaging or MRI : Tests help detect tubo-ovarian abscesses or pelvic fluid collections in advanced PID.
• Laparoscopy : This is a less invasive procedure that provides direct visualisation of the pelvic organs and is especially useful in borderline or severe cases when other tests are uninformative.

Can PID Be Treated Successfully?

Treatment for PID is possible, and it's often more effective when caught in its initial stages. The aim of treatment is to cure the infection, avoid complications, and preserve fertility. Routine interventions are:

Antibiotic Therapy

• Broad-spectrum antibiotics are initiated immediately, often even before receiving test results. A common combination is ceftriaxone (IM) and oral doxycycline, with or without metronidazole.
• For severe PID, intravenous antibiotics like cefotetan or cefoxitin may be necessary. The course of treatment typically takes 14 days, and the partner must also be treated.

Hospitalisation

• Hospitalisation is recommended in cases of severe infection, presence of a tubo-ovarian abscess, pregnancy, or when oral medications cannot be tolerated. It provides strict monitoring and IV antibiotics.

Surgical Intervention

• Reserved if there is rupture of the abscess or lack of response to medications. Laparoscopy is employed for drainage or diagnosis.

Follow-Up Evaluation

• Reevaluation at 48-72 hours is advised.
• Recurring symptoms may necessitate a change in medication or imaging to evaluate for complications.

Is PID a Curable Condition?

Yes, pelvic inflammatory disease can be effectively treated when addressed early with the right course of antibiotics. Although the infection can be cleared, harm from untreated PID is potentially permanent, such as:

• Scarring and occlusion of the tubes
• Ectopic pregnancy
• Chronic pelvic pain
• Infertility

Early diagnosis and compliance with recommended treatment are therefore essential.

What Are the Complications of Untreated PID?

If left untreated, PID may cause the following reproductive and systemic problems:

• Infertility : About 1 out of 8 women with untreated PID can become infertile due to damage to the fallopian tubes.
• Ectopic Pregnancy : PID inflammation has a possibility of causing scarring and a higher risk of an embryo attaching in a place outside the uterus.
• Chronic Pelvic Pain : Adhesions and persistent inflammation can lead to chronic pelvic pain and decreased quality of life.
• Fitz-Hugh–Curtis Syndrome : An uncommon complication where the infection is transmitted to the liver capsule, resulting in tender upper abdominal pain.
• Peritonitis and Sepsis : If the infection spreads beyond the pelvis, it may result in a potentially life-threatening systemic infection.

Can PID Come Back After Treatment?

Yes, recurrent PID is possible, especially in women who keep being exposed to risk factors. Such women include those who:

• Resume sex with untreated or partly treated partners
• Do not take their entire antibiotic regimen as prescribed.
• Have sex with multiple or new partners without safety
• Have frequent or recurrent gynaecological procedures without proper precautions

Each re-infection episode contributes to the cumulative damage of the reproductive tract and greatly increases the risk of long-term complications like infertility and chronic pelvic pain.

Who is at Risk for PID?

Some are more likely to get PID because of behaviour, biology, or illness that increases the risk for infection:

• Young sexually active women under the age of 25 : Younger women are more biologically susceptible to cervical infection that can ascend to the upper reproductive tract.
• Multiple sex partners : Greater exposure to sexually transmitted infections increases the risk of acquiring infection-causing agents of PID.
• Prior STI or PID : Prior infection can destroy reproductive tissue and make it susceptible to subsequent infection.
• Insertion of IUDs without STI testing : IUDs increase PID risk only if STIs are present at insertion; screening mitigates this.
• Repeated surgery of the pelvis in women : Surgery or diagnostic intervention of the cervix or uterus can introduce or reinitiate infections.

How Can PID Be Prevented?

Preventative measures must be taken to significantly decrease the occurrence of PID:

• Consistent use of condoms during intercourse avoids sexually transmitted diseases that lead to PID.
• STS screening regularly, particularly in sexually active women under 25 years of age, allows infection to be detected and treated before it reaches the upper genital tract.
• Early treatment of STIs in the patient and their sex partners is needed to avoid reinfection and further transmission of pathogenic bacteria.
• Do not douche, as this interferes with the natural vaginal flora, making it vulnerable to easier development of pathogenic bacteria and infecting it.
• Practise monogamy or have fewer sex partners to reduce exposure to STIs that predispose to PID.

Conclusion

Pelvic inflammatory disease is a preventable and curable disease. Early antibiotic treatment, follow-up, and treatment of the partner can avoid such complications as chronic pelvic pain and infertility. Women need to be sexually aware, obtain regular checkups, and immediately seek medical attention when they present with symptoms that are typical for PID.

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