Pelvic inflammatory disease (PID), an infection of the female upper genital tract, is a serious complication of some sexually transmitted infections (STIs). It occurs most often in teenaged and young adult females. Pelvic inflammatory disease can affect the uterus, ovaries, and fallopian tubes.
Sexually transmitted organisms, especially those responsible for gonorrhea (Neisseria gonorrhoeae) and chlamydial infections (Chlamydia trachomatis), are thought to be the cause of most cases of PID, although other organisms are associated with some cases. The germs from these infections travel from the vagina and cervix into the upper genital tract.
Signs and Symptoms
In some cases, no signs or symptoms are present, but the infection can still harm the reproductive system. In most cases, however, PID causes persistent lower abdominal or pelvic pain and tenderness, with an intensity that can range from mild to severe. These symptoms often begin about a week after the onset of a period.
Additional symptoms may include:
- An abnormal vaginal discharge
- Irregular menstrual bleeding
- Right upper abdomen pain (uncommon)
When To Call Your Pediatrician
If your daughter complains of symptoms associated with PID, she should be seen by her pediatrician immediately, even if she denies sexual activity.
How Is the Diagnosis Made?
Pelvic inflammatory disease is not easy to diagnose. There is no single sign, symptom, or laboratory test that provides a definitive diagnosis of PID. Your doctor will make the diagnosis based on a physical examination and laboratory evaluations of cervical secretions. Sometimes the pediatrician may use an ultrasound or an examination of the abdominal and pelvic organs using a tiny flexible tube called a laparoscope. These methods can help distinguish PID from conditions with similar symptoms, such as appendicitis, a ruptured ovarian cyst, or ectopic (tubal) pregnancies.
Teenaged girls with PID should be tested for syphilis and gonorrhea as well as Chlamydia, hepatitis B, and HIV infections.
Oral antibiotic treatment, typically with more than one medicine, is prescribed for most cases of PID. Patients should be rechecked within a few days to make sure the treatment is working.
On occasion, especially when symptoms are severe or antibiotics need to be given intravenously rather than as pills, the patient must be hospitalized. Sexual partners within the previous 60 days of any girl with PID should be tested for chlamydial infection and gonorrhea, even if they have no symptoms.
What Is the Prognosis?
Antibiotic treatment successfully resolves most PID infections. As part of this treatment, the patient with PID should refrain from having sex until she and her sexual partner(s) have completed the course of the prescribed medications.
Complications may develop even if PID is treated. Some teenaged girls and adult women experience recurrent infections and chronic pelvic pain. Females with PID have an increased risk (6 times more likely) of an ectopic or tubal pregnancy, as well as a higher risk of infertility because of scarring of the fallopian tubes.
Teenagers should be instructed on how to practice safe sex to avoid STIs. Teenaged girls and young women can also lower their chances of developing PID by not using douches. Some research suggests that douching spreads bacteria into the upper genital tract.