Pelvic Inflammatory Disease

What is pelvic inflammatory disease?

Pelvic inflammatory disease (PID) is infection of the reproductive organs of women. This may include infection of:

• The uterus (womb)
• The cervix (the opening of the womb into the vagina)
• The fallopian tubes (these are the tiny tubes between the ovary and the womb - eggs released by the ovary pass through these tubes)
• The ovaries

The infections that can cause PID include:

• Gonorrhoea
• Chlamydia
• Other bacteria

PID can cause severe illness in a woman, requiring treatment in hospital. However, sometimes PID can occur without causing any signs or symptoms. That is, the woman may not feel sick and may not notice any change in her body. PID is a very serious disease because it can lead to long term problems.

PID is one of the leading causes of infertility in women. Women who have had PID may have difficulty becoming pregnant and if they do become pregnant, there may be problems with the pregnancy.

Risk factors

The primary risk factor for PID is infection with a sexually transmitted infection (STI) - in particular, chlamydia and gonorrhoea.

Risk factors for these STIs include:

• Engaging in unsafe sex
• Having sex with more than one partner
• Being in a sexual relationship with someone who has multiple sex partners

Symptoms

Women can have PID without any signs or symptoms. Women may notice:

• Pain in the abdomen
• Pain during sex
• Abnormal periods (women on the pill may notice this too)
• Bleeding after sex
• Abnormal discharge
• Fevers
• Some women become very sick and have severe pain

If you have symptoms suggestive of an STI or think you may have been exposed to one, you should seek medical attention immediately.

Prevention

Infection with PID can be prevented by avoiding risky sexual behaviours.
To reduce your risk:

• Use latex or polyurethane condoms during sex
• Limit your number of sex partners

If you have recently been treated or are being treated for an STI, you must make sure your sex partner(s) also receives treatment in order to prevent getting infected again. Sex partners should receive treatment even if they do not have any symptoms.

• Practice safe sex - Always using condoms when you have vaginal or anal sex is the best way to avoid getting PID. Using water-based lubricant with condoms is recommended. This reduces the risk of the condom breaking and increases both partners’ enjoyment of sex. Oil based lubricants (such as vaseline) should not be used. They weaken the condom and may cause it to break. If you are giving a man oral sex (his penis in your mouth) then he will need to wear a condom. It does not matter whether you are male or female, if you put your mouth in contact with your partner’s anus or vulva while having sex you will need to use a dental dam.
• If you are having unprotected sex, talk to your sexual partner about the risks involved (while some sexually transmitted infections can be cured, others cannot – don’t forget that by having unprotected sex you are at risk of being exposed to HIV). From a good discussion with your partner you may be able to come to a clear agreement about using condoms.
• There are lots of ways to enjoy physical intimacy with your partner. Explore other ways to be intimate, which do not put you at risk of sexually transmitted infections or an unintended pregnancy.
• If you tend not to use condoms after drinking alcohol or taking other drugs it may be time to have a think about this and the risks involved. While for some it may be unrealistic to think of not enjoying a drink, there are many ways of cutting down so that you stay in control and can make more rational choices about your sexual contact.
• Remember that using condoms not only protects you from STIs, it is also an effective form of contraception. If you do use other forms of contraception (like the pill, diaphragm and IUCD etc.), use condoms as well.

If you or your partner has more than one sexual partner and do not use condoms, have regular sexual health check-ups.

If you think you may have been at risk of getting a sexually transmissible infection, you may be at risk of having PID. Have a sexual health check to be sure.

Diagnoses

The doctor can test for PID by

• Examining and taking swabs from your vagina and cervix
• Testing urine for chlamydia and gonorrhoea
• Feeling the cervix, uterus and ovaries for any sign of tenderness or pain
• Doing blood tests

If you find out that you do have PID, anyone you have had sex with in the past few months will need to be tested and treated also. This is to make sure that they are cleared of the infection and to prevent you from getting the infection again and needing treatment all over again. If you feel uncomfortable or embarrassed about telling your partner or partners, the doctor or nurse can contact them. This is a confidential process and your name will not be mentioned. This is very important for your health, for your partner’s health, and the health of other people they have sex with.

How can you be treated for pelvic inflammatory disease?

PID is treated with antibiotics. Sometimes three different antibiotics are given.

To ensure the infection has been cured:

• It is important to take all the tablets – otherwise the infection may not be properly cured.
• You will be asked to return to Dr. Majid Rasekhi or clinic for follow-up appointments – this will include checking that signs of infection are settling. After you have finished the treatment, there will be tests to check if the infection is cured.
• It is best not to have sex until the tablets are finished and you have been tested to check if the infection is cured (even if you feel better).

Sexual partners who have the infection should be treated at the same time – otherwise you may get the infection again.

If a woman is very sick with PID, she may need to be admitted to hospital for treatment.