Pelvic Inflammatory Disease (PID)

Pelvic Inflammatory Disease (PID) is an infection in the pelvis. PID usually begins in the fallopian tubes and may infect the uterus and/or ovaries.

Most pelvic infections are contracted sexually, through the use of tampons, or during surgery or other medical intervention.

Intrauterine Devices (IUDs), uterine artery embolization, endometrial ablation, or any vaginal or pelvic surgery, gynecological exam, or procedure of the pelvis or vagina may introduce bacteria, strep, staph, or other organisms into the pelvis.

Harmless bacteria and a host of other naturally occurring microorganisms also reside within the human body. They are collectively known as the human flora. A majority of them present no known danger. For example, microorganisms such as gardnerella vaginalis occur naturally in the vagina and are part of the normal vaginal flora of women, including women who have not had sexual relations or medical intervention.

The composition of vaginal flora may change with age, stress, illness, medical intervention, and sexual activity. The number of microorganisms in the vaginal flora is kept in balance by your immune system, which ensures that bacteria, staph, and other microorganisms remain within healthy levels. An imbalance may allow vaginal bacteria and other organisms to multiply and be conducive to infection.

Vaginal infection may be pushed from the vagina into the uterus and fallopian tubes with douching or tampons. Dislodged from their natural habitat, these organisms may cause PID.

PID can also be sexually transmitted in the form of chlamydia, gonorrhea, HIV, or other sexually transmitted infection. These infections can be present for a number of years before being diagnosed.

Infections transmitted sexually can lie dormant for many years before being passed between you and a partner. If you or your partner contracted a transmittable infection when you were in your teens or twenties, but had no symptoms until the infection became active many years later, you might think your current partner is sexually involved with someone else. However, either of you may have contracted the infection many years ago, and it is only now becoming active. This can cause a lot of distrust and anxiety in a relationship, though it may not mean your partner is engaged in another current sexual relationship.

There are several types and locations of PID infections. Endometritis is an infection in the endometrium, the inside lining of the uterus. Salpingitis is an infection in one or both of the fallopian tubes. An abscess is a collection of pus that may cause swelling and inflammation around it, or it may be contained in a mass that does not affect the surrounding tissue. A tubo-ovarian abscess involves an ovary and its corresponding fallopian tube, for example an abscess that is in the right ovary and right fallopian tube. Pelvic peritonitis is an inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs.

PID may be latent (dormant) and may never cause any symptoms, or it may eventually become acute. Chronic PID often causes vague symptoms that may be present for months or years before you realize something is wrong. You may feel like you are coming down with a cold or the flu for a week or two, but then the symptoms vanish. In a few weeks the symptoms recur, and they may continue recurring off and on for years.

Acute PID means an active infection is present. Symptoms of acute PID include fever, a thick, yellowish vaginal discharge that may have a foul odor, painful intercourse, pelvic pain, and, occasionally, upper abdominal pain. Avoid the use of tampons if you have symptoms of chronic or acute PID because it may spread the infection.

Acute PID causes severe symptoms. Your body temperature may initially begin below normal but then rise to a low-grade fever (99°-100°). Nausea, vomiting, and fever above 102° often follow, accompanied by intense pelvic pain.

A complete blood count (CBC) will reveal if your white blood count (WBC) is elevated. An elevated WBC indicates there is an infection.

A normal WBC can range between 4,000 and 10,000- each laboratory sets its own norm. Even a WBC within a normal range, but higher than 6,000, may indicate that an infection is most likely brewing.

Along with an elevated WBC, if one or more of your other white blood cells (monocytes, lymphocytes, or neutrophils) are elevated it is an additional indication of infection.

A pelvic and transvaginal ultrasound may reveal whether there is an infection in a fallopian tube or an abscess, though it may not detect an infection elsewhere in the pelvis.

PID is usually first seen in an ultrasound as a hydrosalpinx. A hydrosalpinx is fluid in one or both of the fallopian tubes. A small amount of fluid may not cause pain, but if the amount of fluid increases it may cause aching or intense pelvic pain.

It is important to have a culture of the infection done before being treated with antibiotics. A culture can sometimes be obtained with hysteroscopy, where a long endoscope is inserted into the vagina and into the uterus. If the entrance to the tube is blocked, a culture can be done laparoscopically, with a long endoscope that is inserted into the navel, the belly button. For more on hysteroscopy and laparoscopy, see the corresponding links on the HERS Foundation’s website Home page.

It is important to culture the infection before taking any antibiotics. You may need to tell doctors that you want them to do a culture, if they do not suggest it. When the culture is done, it is important to wait until the doctor gets the results of the culture from the laboratory, which will take 5-7 days, before you begin taking antibiotics. Taking the wrong antibiotic may cause a low-level infection to continue to smolder without actually combating the infection. Taking the right antibiotic initially can be the difference between the infection completely going away or continuing at a low level indefinitely.

In addition to affecting surrounding healthy tissue and bones, one of the dangers of a long-term infection is that it may cause scar tissue and adhesions. For more on adhesions, click on Adhesions on the HERS Foundation’s website Home page.

Acute PID may become systemic if it is left untreated or if it is inadequately treated. A systemic infection is one that has spread throughout the bloodstream, creating a risk of sepsis. Sepsis is a condition where the bloodstream is overwhelmed by bacteria, which may cause septic shock or death.

Most PID will not be cured with oral antibiotics. An IV with triple antibiotics for two weeks or longer is usually required to effectively treat PID. With the high incidence of staph and MRSA infections in hospitals today, you may decide to have the IV antibiotics administered at home by a visiting nurse. This can be arranged by a doctor and your insurance company.

Although it feels good, applying heat to the pelvis may spread an infection.

If a pelvic abscess does not resolve with IV antibiotics, surgery may be the only means of removing it. The procedure listed on the surgical consent form should say only “removal of abscess.” If it says “removal of abscess and possible TAH/BSO,” cross out TAH/BSO, initial the change and ask the doctor to initial it as well. TAH is total abdominal hysterectomy. BSO is bilateral (both) salpingo (tube) oophorectomy (removal of the ovary).

The female organs have many important lifelong functions. The most consistent problems women experience after hysterectomy (surgical removal of the uterus), with or without oophorectomy (removal of the ovaries, castration), include a 25-pound average weight gain in the first year following the surgery, a loss of sexual feeling, a loss of vitality, joint pain, back pain, profound fatigue, and personality change.

For more information, watch the short video “Female Anatomy: the Functions of the Female Organs.”