Dr. Arvind Vaid
Pelvic Inflammatory Disease (PID) is an infection of the uterus, fallopian tubes, ovaries and can involve the pelvic peritoneum too.. Treating PID right away is of utmost importance as it can even cause sequel of ectopic pregnancy, infertility and chronic pelvic pain among women.
The infection, which is mostly bacterial, can cause symptoms such as lower abdominal pain, fever, vaginal discharge, abnormal bleeding, painful intercourse or urination.
However, since many of these PID symptoms go unnoticed, PID often goes undiagnosed. Hence most patients come to us only during the end stage of PID.
But what is the primary cause of pelvic inflammatory disease? It occurs in women when bacteria moves upward to her reproductive organs from her vagina or cervix. While many different types of bacteria can cause PID, most often it is associated with bacterial sexually transmitted diseases – primarily chlamydia and gonorrhea. Therefore, it’s important to make women aware about the risks involved with having multiple sexual partners . Though, in few cases PID is also caused due to tuberculosis (TB). It is more common in women aged 20-40 years, but can also be found in older women after menopause.
Complications With PID
PID can cause permanent damage to the female reproductive organs and scarring in the fallopian tubes. Scarring in the fallopian tubes can interfere with the egg traveling to the uterus. This can result in the sperm not being able to reach the egg or the egg fertilizing in the tube causing an ectopic pregnancy. As a result of the damage and complications, the risk of infertility continues to increase with the number of episodes.
And, in cases where PID is caused due to TB, patients have endometrial tuberculosis which again causes infertility. It is even responsible for cessation of menstruation.
Diagnosing and Treating PID
PID is fundamentally a preventable condition. Since PID can be assymptomatic or symptomatic and there is no confirmatory test for PID, therefore, it’s diagnosis is typically based on the clinical suspicion. Your doctor may also need to identify the type of organism causing the PID and may ask for a test for chlamydia and/or gonorrhea. An ultrasound might also be used to see if the fallopian tubes show evidence of an infection.
PID is treated with antibiotics; the patient has to follow complete course. However, the antibiotics will not reverse any damage already occurred, making it important for women to seek care immediately if she is experiencing any symptoms. Because of the lack of definitive diagnostic criteria, a low threshold for empiric treatment of PID is recommended. Broad spectrum antibiotic therapy is required . the earlier treatment is given the lower the risk of future fertility problems. A woman’s sexual partner(s) should also be treated if a sexually transmitted disease is the cause of infection.
Tuberculous pelvic inflammatory disease treatment is mainly supportive therapy and anti-TB treatment. Usually it can be cured after TB treatment, but it’s the longer course of treatment, and needs to be regularly reviewed. If it shows no improvement, timely surgical treatment is recommended.
Becoming Pregnant after PID
For women who have had PID and have caused damage to their reproductive organs, they will likely have to consult with a fertility specialist so as to maintain a healthy pregnancy. The risk of an ectopic pregnancy increases 6-7 times as a result of pelvic infection. To address this risk and the inability to conceive due to scarring in their fallopian tubes, IVF is often the advised therapy to help achieve pregnancy because with IVF the tubes are bypassed completely. And in case there is Fallopian tube blockage, assisted reproductive technology treatment is recommended. Recurrence PID in pregnancy is also associated with an increase in both maternal and fetal morbidity, so immediate doctor consultation is required for starting iv antibiotics.
Who is at Risk
There are several things which would put a woman at risk for PID. However, you can develop PID without ever having an STI. Other factors that can cause pelvic inflammatory disease includes:
* having sex and being under the age of 25
* having polygamous relationship
* having sex without a condom
* using an intrauterine device (IUD) to prevent a pregnancy
* having a history or a prior episode of pelvic inflammatory disease
Preventing PID
With PID prevention is the keyword. Many a times you may not be able to prevent PID as it is not always caused by an STI. But you can certainly lower your risk of PID by following these steps:
* Use barrier contraception .
* Get tested. Be sure you and your partner are tested for STIs.
* Be monogamous. Having sex with just one partner can lower your risk for STIs.
* Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs may put you at risk of sexual assault and possible exposure to STIs.
(The author is IVF expert, Indira IVF Delhi)
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