PELVIC INFLAMMATORY DISEASE

Pelvic inflammatory disease (PID) is an infection of the fallopian tubes, uterus, or ovaries. Most girls with PID develop it after getting a sexually transmitted disease (STD), such as chlamydia or gonorrhea.

Girls who have sex with different partners or don't use condoms are most likely to get STDs and be at risk for PID. If PID is not treated, it can lead to internal scarring that might cause ongoing pelvic pain, infertility, or an ectopic pregnancy.

What Are the Symptoms of PID?

PID can cause severe symptoms or very mild to no symptoms. Girls who do have symptoms may notice:

• pain and tenderness in the lower abdomen
• bad-smelling or abnormally colored discharge
• pain during sex
• spotting (small amounts of bleeding) between periods
• chills or fever
• nausea, vomiting, or diarrhea
• loss of appetite
• backache and perhaps even difficulty walking
• pain while peeing or peeing more often than usual
• pain in the upper abdomen on the right

What Can Happen?

Any girl who has signs of an STD should get medical care as soon as possible. An untreated STD has a greater chance of becoming PID.

If PID is not treated or goes unrecognized, it can continue to spread through a girl's reproductive organs. Untreated PID may lead to long-term reproductive problems, including:

• Scarring in the ovaries, fallopian tubes, and uterus.Widespread scarring may lead to infertility (the inability to have a baby) and chronic pelvic pain. A teen girl or woman who has had PID multiple times has more of a chance of being infertile.
• Ectopic pregnancy. If a girl who has had PID does get pregnant, scarring of the fallopian tubes may cause the fertilized egg to implant in one of the fallopian tubes rather than in the uterus. The fetus would then begin to develop in the tube, where there is no room for it to keep growing. This is called an ectopic pregnancy. An untreated ectopic pregnancy could cause the fallopian tube to burst suddenly, which might lead to life-threatening bleeding.
• Tubo-ovarian abscess (TOA). A TOA is a collection of bacteria, pus, and fluid in the ovary and fallopian tube. Someone with a TOA often looks sick and has a fever and pain that makes it difficult to walk. The abscess will be treated in the hospital with antibiotics, and surgery may be needed to remove it.

How Is PID Diagnosed and Treated?

If you think you may have PID, see your gynecological health care provider (your family doctor or nurse practitioner, gynecologist, or adolescent doctor) right away. The longer a girl waits before getting treatment, the more likely it is that she will have problems.

If a doctor thinks a girl has PID, he or she will do a physical exam, including a pelvic exam. The exam can show if a girl has a painful cervix, abnormal discharge from the cervix, or pain over one or both ovaries.

The doctor may also take swabs of fluid from the cervix and vagina, and this fluid will be tested for STDs. He or she may also do a pregnancy test. Sometimes health providers take blood or do urine tests to look for signs of infection, including STDs like chlamydia and gonorrhea.

Sometimes doctors need an ultrasound or CAT scan of the lower abdomen to see what's going on with a girl's reproductive organs. Ultrasounds are often used to diagnose a TOA or ectopic pregnancy.

If doctors find that a girl has PID, they will prescribe antibiotics to take for a couple of weeks. It's vital to take every dose of the medicine to completely treat the infection, even if a girl's symptoms go away before she finishes the medicine. It's also important that girls with PID get rechecked 2–3 days after beginning treatment to make sure that they are improving. A girl who has taken all her medicine for PID but still isn't feeling better should follow up with her doctor. 

Girls with more severe cases of PID might have a fever or vomiting, and not respond to medicines by mouth. They, and girls with PID who are pregnant, often are treated in the hospital for a few days with antibiotics given directly into a vein through an IV. Surgery is sometimes needed if a girl has an abscess. Ectopic pregnancies can require emergency surgery.

If a girl has PID, her sexual partners should be checked for STDs right away so they can get treatment. And, a couple should hold off on having sex again until at least 7 days after both partners have finished treatment. An untreated partner is likely to reinfect a girl with the same STD again.

Can PID Be Prevented?

The best way to prevent STDs or PID is to not have sex (abstinence). For those who choose to have sex, it's important to use protection and to have as few sexual partners as possible. Using latex condoms properly and every time you have sex helps protect against most STDs. However, it's also very important to have regular checkups with your doctor. And if either partner has any symptoms of STDs, both partners should be tested and treated as soon as possible.

So when you're making choices about sex, be smart and be safe.