Pelvic Inflammatory Disease (PID) Treatment in Delhi, India

Pelvic Inflammatory Disease (PID) is a condition that specifically affects the female reproductive system. It involves inflammation and infection of the pelvic organs, including the uterus, fallopian tubes, ovaries, and surrounding tissues. PID is primarily caused by the spread of bacteria, often sexually transmitted, from the vagina and cervix into the upper reproductive tract. These bacteria can include common sexually transmitted infections (STIs) such as gonorrhoea and chlamydia.

Once the bacteria enter the upper reproductive organs, they can cause inflammation and irritation, leading to the development of PID. The inflammation can affect various structures within the pelvis, including the lining of the uterus (endometritis), the fallopian tubes (salpingitis), and the ovaries (oophoritis). In some cases, the infection may also spread to nearby tissues in the pelvis, causing more extensive damage.

Pelvic Inflammatory Disease (PID) can be categorised into two main types based on the duration and severity of the condition.

Acute Pelvic Inflammatory Disease (PID)

Acute PID refers to the sudden onset of inflammation and infection within the female reproductive organs. It typically presents with severe symptoms such as pelvic pain, fever, abnormal vaginal discharge, painful urination, and sometimes even nausea or vomiting. Acute PID often requires immediate medical attention and treatment with antibiotics to prevent the infection from spreading further and causing complications. Prompt diagnosis and treatment are crucial to manage acute PID effectively and reduce the risk of long-term consequences.

Chronic Pelvic Inflammatory Disease (PID)

Chronic PID is characterised by persistent or recurrent inflammation and infection of the pelvic organs over an extended period. Unlike acute PID, chronic PID may develop gradually and present with milder or intermittent symptoms. Women with chronic PID may experience ongoing pelvic discomfort, recurrent pelvic pain, abnormal vaginal discharge, and other symptoms. Chronic PID can be challenging to diagnose and treat effectively due to its prolonged nature. It may require long-term antibiotic therapy and management strategies to alleviate symptoms and reduce the risk of complications such as infertility or chronic pelvic pain.

Overall, both acute and chronic PID are serious health concerns that require medical attention. Timely diagnosis, appropriate treatment, and ongoing management are essential to prevent complications and promote women's reproductive health and well-being.

The symptoms of PID include:

• Vaginal discharge which is foul smelling, itchy profuse and persistent
• Pain in pelvis
• Lower abdominal pain
• Pain during intercourse
• Irregular menstrual bleeding
• Fever
• Cervical motion tenderness
• Frequent, Pain, or difficulty

The major causes of PID are:

• Gonorrhoea or chlamydia infections acquired through unprotected sexual intercourse.
• Disturbance of the normal cervical barrier during various events such as:
• Menstruation
• Childbirth
• Miscarriage
• Abortion
• Insertion of an intrauterine device (IUD), a form of long-term birth control.
• Medical procedures involving the insertion of instruments into the uterus.

• Having multiple sexual partners or engaging in unprotected sexual intercourse increases the risk of acquiring sexually transmitted infections (STIs) such as gonorrhoea and chlamydia, which are common causes of PID.
• History of previous pelvic inflammatory disease (PID) or other sexually transmitted infections (STIs).
• Young age, particularly adolescents, as they may be more likely to engage in high-risk sexual behaviours.
• Recent insertion of an intrauterine device (IUD) for contraception, especially if proper screening for STIs was not conducted before insertion.
• History of douching, as it can disrupt the natural balance of bacteria in the vagina and increase susceptibility to infections.
• Having a sexual partner with a history of STIs or multiple sexual partners, as this increases the likelihood of exposure to bacteria that can cause PID.
• Recent pelvic procedures or surgeries, such as abortion or gynaecological surgeries, which can introduce bacteria into the reproductive tract.
• Immunosuppression, which weakens the body's ability to fight off infections, making individuals more susceptible to PID.
• Lack of access to healthcare, including routine gynaecological care and STI screening, which may delay diagnosis and treatment of infections that can lead to PID.

Since there's no single definitive test for diagnosing Pelvic Inflammatory Disease (PID), doctors typically rely on a combination of the following:

Medical history and symptoms

Your doctor will ask about your medical history, including your sexual activity, past infections, and current symptoms.

Pelvic exam

During a pelvic exam, your doctor will visually examine your external genitalia and use a speculum to examine your cervix and vagina. They will also feel your uterus and ovaries for any tenderness or swelling.

Tests for sexually transmitted infections (STIs)

Due to the frequent association with STIs, your doctor may recommend testing for chlamydia and gonorrhoea, even if you don't suspect an STI. These tests can be conducted through:

• Urine sample: For both men and women
• Swab from the cervix: For women
• Vaginal fluid sample: For women

Other tests (depending on your situation)

• Ultrasound: Creates images of your reproductive organs to check for abnormalities like tubal swelling or fluid collection in the pelvis.
• Blood tests: Can check for signs of inflammation, like an elevated white blood cell count.
• Endometrial biopsy: In rare cases, a tissue sample from the uterine lining might be taken to look for specific signs of infection.

Prompt diagnosis and treatment are crucial for effectively managing Pelvic Inflammatory Disease (PID) and minimising long-term complications. Here's an overview of the typical treatment approach:

Antibiotics

The foundation of PID treatment is antibiotics. Your doctor will prescribe a combination of antibiotics to target a broad spectrum of bacteria potentially causing the infection. The specific antibiotics and duration of treatment (usually 14 days) will be determined by your doctor based on your individual case and the severity of the infection.

Note - Completing the entire course of antibiotics is crucial, even if symptoms improve earlier. Stopping them prematurely can lead to incomplete eradication of the bacteria and increase the risk of recurrence.

Pain Management

Medications like over-the-counter pain relievers (paracetamol or ibuprofen) can help manage pelvic pain and discomfort associated with PID. In severe cases, your doctor may prescribe stronger pain medication.

Rest and Recovery

Adequate rest is vital for allowing your body to fight the infection and recover. Limiting strenuous activities and prioritising sleep can support the healing process.

Sex Advice

Abstaining from sexual intercourse is recommended during treatment and until your doctor confirms the infection is resolved. This prevents further spread of the bacteria and allows for proper healing.

Partner Treatment

Sexual partners of individuals diagnosed with PID should also be treated for STIs, even if they are not experiencing any symptoms. This helps prevent reinfection and further transmission.

Follow-up Care

Regular follow-up appointments with your doctor are crucial to monitor your progress and ensure the infection is completely cleared. If symptoms persist or worsen, it's essential to seek immediate medical attention.

Pelvic Inflammatory Disease (PID) can lead to several complications, some of which can have serious long-term consequences if left untreated. These complications include:

• Chronic pelvic pain: PID can cause ongoing pelvic pain that may become chronic if the infection is not adequately treated. This pain can interfere with daily activities and significantly reduce quality of life.
• Infertility: One of the most serious complications of PID is infertility. The inflammation and scarring of the reproductive organs caused by PID can lead to blockages in the fallopian tubes, preventing eggs from reaching the uterus and sperm from reaching the eggs. This can make it difficult or impossible to conceive naturally.
• Ectopic pregnancy: PID increases the risk of ectopic pregnancy, where a fertilised egg implants outside the uterus, typically in one of the fallopian tubes. Ectopic pregnancies are dangerous and can lead to rupture of the fallopian tube, severe bleeding, and even death if not treated promptly.
• Chronic pelvic inflammatory disease: In some cases, PID may become a recurrent or chronic condition, with repeated episodes of infection and inflammation. Chronic PID can further increase the risk of complications such as infertility and chronic pelvic pain.
• Tubo-ovarian abscess: In severe cases of PID, a pus-filled abscess may develop in the fallopian tubes or ovaries. This can cause severe pain, fever, and other symptoms, and may require surgical intervention to drain the abscess.
• Adhesions and scarring: PID can lead to the formation of scar tissue (adhesions) within the pelvis, which can cause organs to stick together abnormally. Adhesions can contribute to chronic pelvic pain and may also increase the risk of complications during surgeries such as hysterectomy or caesarean section.
• Increased risk of pelvic infections: Women who have had PID are at higher risk of developing subsequent pelvic infections, as the inflammation and scarring associated with PID can create an environment conducive to bacterial growth.

Early diagnosis and prompt treatment of PID are essential to minimise the risk of these complications. If someone suspects having PID or is experiencing symptoms such as pelvic pain, abnormal vaginal discharge, fever, or pain during intercourse, they must seek medical attention promptly.

Preventing Pelvic Inflammatory Disease (PID) involves several strategies aimed at reducing the risk of sexually transmitted infections (STIs), which are the primary cause of PID. Here are some key preventive measures:

Practise safe sex: Consistently and correctly using condoms during sexual activity can help reduce the risk of acquiring STIs, including those that can lead to PID. Condoms provide a barrier that can help prevent the transmission of bacteria and other infectious agents.

Limit sexual partners: Having multiple sexual partners increases the risk of acquiring STIs, including those that can cause PID. Limiting the number of sexual partners and being selective about partners can reduce the risk of infection.

Get tested for STIs: Regular STI testing, especially for sexually active individuals and those with multiple partners, can help detect infections early and facilitate prompt treatment. Testing for STIs such as chlamydia and gonorrhoea is particularly important since these infections are common causes of PID and often present without symptoms.

Seek prompt treatment for STIs: If you are diagnosed with an STI, it's crucial to seek treatment promptly and ensure that your sexual partners are also tested and treated to prevent the spread of infection and reduce the risk of complications such as PID.

Avoid douching: Douching disrupts the natural balance of bacteria in the vagina and can increase the risk of vaginal infections, which may contribute to PID. It's best to avoid douching altogether.

Practise good hygiene: Maintaining good genital hygiene, including washing the genital area with mild soap and water, can help reduce the risk of infections that can lead to PID.

Consider vaccination: Vaccination against certain STIs, such as human papillomavirus (HPV) and hepatitis B, can help reduce the risk of acquiring these infections, which may indirectly lower the risk of PID.

Communicate with sexual partners: Open and honest communication with sexual partners about STIs, sexual health, and prevention strategies can help ensure that both partners are informed and can take steps to protect themselves and each other.

By adopting these preventive measures, individuals can reduce their risk of acquiring STIs and developing PID, thereby protecting their reproductive health and overall well-being.

How common is pelvic inflammatory disease?

Pelvic inflammatory disease (PID) is a relatively common condition, particularly among sexually active individuals. It's estimated that approximately 1 million women in the United States experience an episode of PID each year.

How do you get pelvic inflammatory disease?

PID is typically caused by bacteria that spread from the vagina and cervix to the reproductive organs, such as the uterus, fallopian tubes, and ovaries. The most common way to acquire PID is through sexually transmitted infections (STIs) such as chlamydia and gonorrhoea. However, other factors such as childbirth, abortion, or invasive procedures like insertion of an intrauterine device (IUD) can also increase the risk of developing PID.

Where does one feel pelvic inflammatory disease pain?

The pain associated with PID is typically felt in the lower abdomen and pelvis. It may be dull or sharp and can vary in intensity. Some individuals may also experience pain during sexual intercourse or urination.

How long does it take to have symptoms of pelvic inflammatory disease?

The time it takes for symptoms of PID to appear can vary. Some individuals may experience symptoms within a few days of being exposed to the bacteria that cause PID, while others may not develop symptoms until weeks or even months later. In some cases, PID may be asymptomatic, particularly in its early stages.

Is pelvic inflammatory disease contagious?

PID itself is not contagious, but the underlying infections that cause PID, such as chlamydia and gonorrhoea, are contagious and can be transmitted through sexual contact.

Does pelvic inflammatory disease show on ultrasound?

While pelvic inflammatory disease (PID) may not always be visible on ultrasound, certain findings may suggest the presence of PID, such as fluid-filled fallopian tubes or abscesses in the ovaries or fallopian tubes. However, PID is primarily diagnosed based on symptoms, medical history, and laboratory tests rather than imaging alone.

Can pelvic inflammatory diseases be found in a urine test?

PID itself cannot be diagnosed through a urine test. However, urine tests may be used to screen for sexually transmitted infections (STIs) such as chlamydia and gonorrhoea, which are common causes of PID. Diagnosis of PID typically involves a combination of medical history, physical examination, and laboratory tests such as urine tests, vaginal swabs, and blood tests.

How to test yourself for PID?

Self-testing for PID is not recommended. If you suspect you have PID or are experiencing symptoms such as pelvic pain, abnormal vaginal discharge, fever, or pain during intercourse, it's important to seek medical attention promptly. A healthcare provider can perform a thorough examination, order appropriate tests, and provide treatment as needed.

Can laparoscopy detect pelvic infection?

Yes, laparoscopy can be used to detect pelvic infection and assess the extent of inflammation and damage to the reproductive organs. During a laparoscopic procedure, a thin, flexible tube with a camera (laparoscope) is inserted into the abdomen through a small incision, allowing the surgeon to visualise the pelvic organs directly.

Is there a permanent cure for pelvic inflammatory disease?

PID can usually be cured with appropriate treatment, which typically involves antibiotics to eliminate the bacterial infection causing the inflammation. However, in some cases, PID may cause long-term complications such as infertility or chronic pelvic pain even after successful treatment. It's important to seek prompt medical attention if you suspect you have PID to reduce the risk of complications.

Can I get pregnant if I have had PID?

While PID itself does not directly cause infertility, it can lead to complications such as scarring and blockage of the fallopian tubes, which can make it more difficult to conceive naturally. However, many women with a history of PID are still able to conceive and carry a pregnancy to term, especially with appropriate medical care and treatment.

How does PID affect fertility?

PID can affect fertility by causing scarring and damage to the reproductive organs, particularly the fallopian tubes. Scarring and blockage of the fallopian tubes can prevent eggs from travelling from the ovaries to the uterus and sperm from reaching the eggs, making it difficult for pregnancy to occur. In some cases, PID may also increase the risk of ectopic pregnancy, which can be life-threatening.

If I had PID, when can I resume having sex?

It's important to wait until you have completed your full course of antibiotics and any symptoms of PID have resolved before resuming sexual activity. This usually takes at least one to two weeks after starting treatment. However, it's essential to follow your healthcare provider's recommendations and wait until you have been cleared by a healthcare professional before having sex again.

Can someone get PID without having an STD?

While sexually transmitted infections (STIs) are the most common cause of PID, it is possible to develop PID without having an STI. Other factors such as childbirth, abortion, or invasive procedures like insertion of an intrauterine device (IUD) can also increase the risk of developing PID.

Can women who have sex with women get PID?

Yes, women who have sex with women can still develop PID, although the risk may be lower compared to heterosexual women. PID can occur as a result of bacterial infections that are not necessarily sexually transmitted, such as those originating from the vaginal or rectal flora. Therefore, it's important for all sexually active individuals, regardless of sexual orientation, to practise safe sex and seek medical attention if they experience symptoms suggestive of PID.

What is the outlook/prognosis of pelvic inflammatory disease (PID)?

The outlook for PID depends on factors such as the severity of the infection, how promptly it is diagnosed and treated, and whether there are any complications. With early diagnosis and appropriate treatment, most cases of PID can be cured without long-term complications. However, untreated or severe cases of PID can lead to complications such as chronic pelvic pain, infertility, and ectopic pregnancy. It's important to seek medical attention promptly if you suspect you have PID to reduce the risk of complications and improve outcomes.

Reviewed By Dr Manju Wali, Associate Director Obstetrics And Gynaecology On 17 July 2024.