Pelvic Inflammatory Disease - Causes, Symptoms, Diagnosis & Treatment

Introduction 

Pelvic inflammatory disease, or PID, is a medical condition that affects the reproductive organs of a female. Common symptoms of pelvic infection (PID symptoms) range from mild to moderate pain in the abdominal area to problems related to the menstrual cycle. If you don't get PID treatment on time, these PID symptoms can worsen and ultimately develop into complications of PID. Hence it is important to have a brief understanding of the PID causes, symptoms, treatment options, and the possible complications. 

What is Pelvic Inflammatory Disease? 

Pelvic inflammatory disease, shortly PID, causes redness and swelling in the upper part of the genital tract of a woman, leading to the symptoms of pelvic infection. The disease usually starts from the lower genital tract and gradually spreads to the upper parts, affecting important female reproductive organs like—

• Uterus
• Fallopian tubes
• Ovaries

In most cases, PID symptoms start appearing after a person makes sexual contact. This means that sexually transmitted infections (STIs) are generally one of the major PID causes. 

A PID diagnosis is recommended for females showing the general symptoms of pelvic infection. These include—

• Pain in the lower abdominal area
• Pelvic pain
• Tenderness in the genital tract

Causes of Pelvic Inflammatory Disease (PID) 

The primary cause of PID is the presence of a bacterial infection in your reproductive tract. This can happen through—

1. Sexually Transmitted Infections (STIs): The Main PID Cause

The following STIs are the leading cause of PID symptoms—

• Chlamydia
• Gonorrhoea
• Mycoplasma genitalium

How Do STIs Cause PID? 

These bacteria initially enter through the vagina and move to the cervix, causing an infection. When the cervical (related to the cervix) or vaginal infection remains untreated, it moves and spreads to the pelvic area. With time, it develops into a pelvic infection, ultimately resulting in PID symptoms. 

2. Pregnancy-Related PID Causes

Other than sexually transmitted infections that develop as a result of known bacteria, sometimes even those types of bacteria that are naturally and harmlessly present in the vagina can also lead to pelvic infection causes. This happens when these unknown bacteria move through your vagina, spread across different reproductive organs, and finally reach the pelvic area to give birth to PID symptoms.

Thus, one of the possible pelvic infections causes related to the spread of such unknown bacteria is damage to your cervix. In this situation, the PID symptoms can appear as an after-effect of pregnancy-related PID causes like—

• Childbirth
• Miscarriage

3. Undergoing A Procedure That Involves the Cervix 

Surgical procedures in which your cervix is opened can also give rise to PID symptoms because the chances of bacterial invasion increase in this case, too. Hence, PID causes can arise from surgeries that involve—

• Placement of an intrauterine device or IUD (it is a type of birth control device) 
• Examining the uterus (womb)
• Abortion

4. Having A History of PID Symptoms

If you have had PID infection symptoms in the past, you are more likely to suffer from pelvic inflammatory disease again in the future. ⁴

Symptoms of Pelvic Inflammatory Disease (PID) 

PID symptoms are not clearly visible and easily identifiable in all cases of pelvic inflammatory disease. Hence, because of the absence of the symptoms of pelvic infection, some women can keep on living without a PID diagnosis. This increases the chances of pelvic inflammatory disease risk factors as well as the development of complications of PID.  

However, in the case of women where the PID symptoms can be identified, they can be mild to severe depending on the woman's personal situation. These PID infection symptoms can appear as—

Mild To Moderate PID Symptoms

The mild to moderate PID symptoms include those symptoms of pelvic infection that are painful but do not cause extreme and unbearable pain. Such pelvic infection symptoms include—

• Experiencing pain in your lower abdominal area (below the stomach) is usually one of the earliest PID symptoms.
• Pain in the upper abdominal area (areas that comprise organs like your stomach, liver, pancreas, gallbladder, etc)
• Fever
• Tiredness
• Pain during sex
• Pain while urinating ⁵

Apart from these, other symptoms of pelvic infection can also include vaginal discharge-related problems like—

Abnormal Vaginal Discharge:

Pelvic infection causes your vaginal discharge to become—

• Foul-smelling
• Yellow in colour 
• Green in colour 
• Increase unusually

Bleeding Problems:

Pelvic infection causes changes in your regular menstrual cycle, leading to bleeding problems like—

• Heavy blood flow during periods 
• Painful periods
• Bleeding between periods 

Apart from this, some women might also experience bleeding after sex. ⁶

Severe PID Symptoms

Severe PID symptoms include those symptoms of pelvic infection that cause high-intensity pain and require immediate medical attention. These include— 

• Intense abdominal pain
• A high fever that exceeds the temperature of 38.3 degrees Celsius (101°F)
• Fainting 
• Vomiting 

It is best to get the PID treatment as soon as possible when these severe PID infection symptoms occur. This is because any delay in the PID treatment can lead to complications of PID, and in some cases, it can even be life-threatening. 

Pelvic Inflammatory Disease (PID) Diagnosis 

After learning about your PID symptoms, a healthcare professional will perform several tests on your body as part of the PID diagnosis. These tests help identify the main PID causes so that you can get the correct PID treatment as per your needs. 

Generally, a PID diagnosis involves the following tests—

1. A Pelvic Exam

A pelvic exam includes examining your reproductive organs like—

• Uterus
• Cervix
• Ovaries
• Fallopian tubes
• Vagina

2. A Cervical Culture

During the PID diagnosis, a cervical culture is used to detect the presence of infections in your genital tract (cervix).

3. A Urine Test

The urine test involves checking your urine to find out if there are any signs that indicate blood cancer or any other medical condition which might be causing your PID symptoms. 

4. Additional Tests for PID Diagnosis

Based on the results of the above-mentioned PID diagnosis tests, you might require further examination and other additional tests to detect pelvic inflammatory disease. These tests can provide a more accurate PID diagnosis and ultimately help your healthcare provider plan your PID treatment accordingly. Such tests include—

• Pelvic ultrasound: A pelvic ultrasound test provides pictures of the internal parts of your reproductive organs to support PID diagnosis. 
• Endometrial biopsy: The lining of your uterus is called endometrium. During an endometrial biopsy, a part of the tissue from this uterus lining is taken out using surgery and analysed to identify PID causes. 
• Laparoscopy: This is a minimally invasive procedure in which a small camera called a laparoscope is inserted through your abdomen by making a small cut into it. This camera takes more detailed pictures of the organs involved in your reproductive functioning as well as the pelvic organs to assist in better PID diagnosis. 

Remember that there are many different types of bacteria which can cause PID. Hence, giving an accurate PID diagnosis (which can clearly mention which bacteria has exactly caused PID in your case) can sometimes be challenging for healthcare providers. 

Treatment Options for Pelvic Inflammatory Disease or PID 

Here is an overview of the options for PID treatment: 

1. Antibiotics For Pelvic Inflammatory Disease:  Initial PID Treatment

Pelvic inflammatory disease antibiotics are the first line of drugs given during the PID treatment. One course of these antibiotics usually lasts for a period of two weeks (14 days).  

During PID treatment with pelvic inflammatory disease antibiotics, your healthcare provider may give you a combination of two antibiotics to treat different types of bacteria which might be responsible for your pelvic infection causes (PID causes)  

Commonly used pelvic inflammatory disease antibiotics include—

• Metronidazole
• Cefoxitin
• Ceftriaxone
• Doxycycline

Regardless of the type of pelvic inflammatory disease antibiotics that are suggested for your PID treatment, it is important that they start showing effect within 3 days of consumption. After 3 days, if there is still no improvement in your PID symptoms, you might require chronic PID treatment.

2. Follow-Up Procedures

Follow-ups are one of the most crucial components of the PID treatment because they help to track improvements in your PID symptoms. They also help determine whether you need chronic PID treatment or not. This becomes especially necessary after you have taken some doses of pelvic inflammatory disease antibiotics.  

Hence, follow-ups are scheduled 3 days after starting your PID treatment with pelvic inflammatory disease antibiotics. ⁷

3. Chronic PID Treatment

Chronic PID treatment is required for women who are—

• Pregnant 
• Showing highly painful and severe PID infection symptoms

Apart from this, when pelvic inflammatory disease antibiotics do not show any positive results even after 3 days, chronic PID treatment may be required. Depending on the individual situation of the patient, this kind of PID treatment can involve—

• Hospitalisation
• Surgery ⁸

4. PID Treatment for The Partners of The Women Showing PID Symptoms

The bacteria that grow as an after-effect of PID causes can spread from one person to another through sexual contact. Therefore, it becomes important for the sexual partners of the women showing PID symptoms to get the PID treatment as well. 

Complications of Untreated Pelvic Inflammatory Disease (PID) 

When the PID symptoms remain untreated for a long time, short-term or long-term complications of PID can develop depending on the duration of the delay you make in getting a PID treatment. 

Pelvic abscess is the short-term complication of PID.  

Long-term complications of PID include—

• Infertility:  PID and infertility are directly related to each other because pelvic inflammatory disease affects female reproductive organs, which can ultimately make you infertile if PID treatment is not given on time. 
• Ectopic pregnancy:  This is one of the most dangerous complications of PID because, in this case, pregnancy occurs outside of the uterus (womb,) which is not normal. 
• Severe pelvic pain:  PID causes extreme pain in your abdominal area, which can even lead to the scarring of your fallopian tubes, along with negatively affecting other pelvic parts as well. 

Preventing Pelvic Inflammatory Disease 

Pelvic inflammatory disease risk factors can be prevented by—

• Practicing safe sex
• Avoiding douching
• People who are involved in sexual activities should get tested for STIs regularly 

Apart from this, it is equally important to avoid sex in the initial days following—

•  Childbirth
•  Miscarriage
•  Or termination of pregnancy due to any other reason

Conclusion

All in all, PID can have a long-lasting impact on the overall reproductive health of a woman. That is why, as soon as you notice any of the PID symptoms, getting a PID diagnosis followed by PID treatment should be your priority. This is important because even in the cases of mild PID symptoms, opting for early PID treatment can help prevent the complications of PID.