Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (PID) occurs when an infection spreads from the vagina to the cervix, endometrium (lining of the uterus) and fallopian tubes. The infection is usually sexually transmitted. It can also occur after a ruptured (burst) appendix or a bowel infection.

Some surgical procedures, such as abortion or insertion of an intrauterine device (IUD), can lead to PID. The infection usually occurs in three stages - the cervix is infected first, followed by the endometrium and then the fallopian tubes.

The silent epidemic

PID is often called the ‘silent epidemic’ because it is common among sexually active women but does not always cause symptoms. About 10,000 women in Australia are treated for PID in hospital each year. About 10 to 30 times that number are treated as outpatients. Women aged 20 to 29 have the highest reported incidence of PID.

Signs and symptoms that can occur

Signs and symptoms of PID that may occur include:

• Lower abdominal pain or tenderness
• Menstrual disturbances
• Burning pain when urinating (dysuria)
• A change in smell, colour or amount of vaginal discharge
• Deep pain during sexual intercourse
• Fever.

Female infertility can be a devastating consequence

Scarring and blockage of the fallopian tubes is the most frequent long term complication of PID. Infertility occurs because the fertilised egg cannot pass through the tube to the uterus:

• One episode of PID doubles the risk of tubal infertility.
• The risk of fallopian tube blockage rises to 75 per cent after three or more episodes of PID.
• The risk of ectopic pregnancy (where the fetus develops outside the uterus) after one episode of PID is increased seven fold.

Chlamydia and gonorrhoea are the most common causes of PID

Chlamydia is responsible for 50 per cent of PID cases while gonorrhoea is the cause in 25 per cent of cases. The risk of fallopian tube blockage is slightly higher for PID caused by gonorrhoea. Both are bacterial infections and are sexually transmitted diseases (STDs). Non-specific urethritis, the most common STD among men, is most often caused by chlamydia.

Diagnosing PID

Your doctor will test for possible causes like chlamydia and gonorrhoea. In some cases, laparoscopy is required to correctly diagnose PID. Laparoscopy involves inserting an endoscope (which is like a surgical video camera) into the abdomen to view the reproductive organs.

Without treatment, chronic pain may develop

Chronic pain and, sometimes, severe disability can occur if PID is not treated. This is usually due to extensive scarring. Treatment involves:

• Antibiotics that are active against a broad range of organisms - amoxycillin (a type of penicillin) and doxycycline are usually prescribed.
• Testing male partners and treating them, if necessary - symptoms may be mild or non-existent in men.
• Avoiding genital sexual contact until the treatment is complete and a negative test result is obtained.
• Surgery to remove scar tissue.

Women with severe episodes of PID must be hospitalised for treatment.

Protecting yourself from PID

To help prevent the transmission of the bacteria that can cause PID:

• Use condoms during vaginal or anal intercourse.
• Use condoms if you have an intrauterine device (IUD) inserted.

The string attached to the IUD can act as a wick for an infection from the vagina into the cervix and beyond. Women who use IUDs are 1.5 times more likely to develop PID. This may not apply to the new progesterone IUD (Mirena).

Use of the oral contraceptive pill may help

Sexually active women who are on the pill appear to have only one-third the risk of PID compared to women not on the pill. However, this data was collected in the 1970s and it is not known if the lower-dose pills more commonly used now have the same protective effect, although it is likely that they do.

Where to get help

• Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 or TTY (for the hearing impaired) (03) 9347 8619
• Your doctor
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)

Things to remember

• PID is known as the silent epidemic because it is common and often does not cause symptoms.
• The sexually transmitted diseases chlamydia and gonorrhoea are the most common cause of PID.
• PID can lead to scarring of the fallopian tubes and infertility.

You might also be interested in:

• Chlamydia.
  
• Gonorrhoea.
  
• Non-specific urethritis (NSU).
  
• Salpingitis.
  
• Sexually transmissible infections.
  
• Sexually transmissible infections - signs and symptoms.
  

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Royal Women's Hospital

Fact sheet currently being reviewed.
Last reviewed: May 2011

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<a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Pelvic_inflammatory_disease?open">Pelvic inflammatory disease (PID) - Better Health Channel</a><br/>
Pelvic inflammatory disease (PID) occurs when an infection spreads from the vagina to the cervix, endometrium (lining of the uterus) and the fallopian tubes. The infection is usually sexually transmitted. PID can lead to scarring of the fallopian tubes and infertility. Treatment may include antibiotics.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

For the latest updates and more information, visit www.betterhealth.vic.gov.au

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