Imagine you have just been to a clinic and been told you have PID – Pelvic Inflammatory Disease. You have probably never even heard of the condition. You are probably frightened, and very unhappy.
So here are some factors about PID that might help you to understand the condition, and ensure it is properly treated.
What is pelvic inflammatory disease? – a simple explanation
Even doctors don’t understand PID very well! The name – PID - is pretty nonspecific. This means inflammation of the tissues and organs in your pelvis - that is the womb (the uterus), the neck of the womb (the cervix) , the Fallopian tubes and the ovaries.
What is inflammation?
Inflammation means redness and swelling. For example, if you burn your finger it becomes red, hot, swollen and painful. This is similar to what is happening to your female organs. There is inflammation in the womb, cervix, Fallopian tubes and ovaries. These organs are fixed in position inside your pelvis by layers of tissue.
When tissue is inflamed, this is your body producing an inflammatory response. Large numbers of white blood cells rush to the area to produce antibodies to fight the infection. There is also an accumulation of tissue fluids, with resultant swelling, as well as production of fibrous tissue that will eventually form a scar. This fibrous tissue when produced in the pelvic organs, may cause sticky bands to develop - known as adhesions. This means that sometimes the tubes, ovaries and the abdominal wall, may stick together in a sort of clump.
What are the signs and symptoms of inflammation in the body?
You are likely to have lower tummy pain, back pain and feel unwell. In chronic infection, the bands of scar tissue described above, may cause painful sex.
Pressure on the cervix from the penis during sex, can cause pain, which may last after sex for some time. There may also be bleeding during or after sex.
The womb lining - the endometrium - is shed every month when you have a period. If you have PID, the endometrium is inflamed, hence it is thicker, and monthly bleeding can be heavier and more painful. You may also bleed in between your periods or after sex.
PID affecting the Fallopian tubes - is called ‘salpingitis’. Inflammation can cause tubal swelling and production of fibrous tissue. If this is not properly treated, this may result in tubes becoming blocked, infertility, and/or ectopic pregnancy.
PID affecting the ovary, may result in ovarian swelling, cyst formation and even bleeding or rupture of cysts. The tubes can become filled with pus and occasionally need surgical drainage.
PID symptoms may be mild and disappear quickly with treatment. Occasionally PID can be severe and requires hospital admission for intravenous antibiotics and fluids.
Strangely, many women have PID and have no symptoms at all! In the infertility clinic, a woman may be found to have tubal blockage, but no knowledge of ever being infected. This is why screening for chlamydia is so important.
Information, advice and guidance
· Knowing the diagnosis of PID is good. Now you can be treated.
· Most (not all) PID is caused by the Sexually Transmitted Infections (STI’s) chlamydia and gonorrhoea. These infections do not always cause symptoms. Your current or most recent partner may not know they have it.
· Most PID will clear up promptly with the correct antibiotic regime - usually three types of antibiotic: doxycyline, ceftriazone and metronidazole. (There are alternatives - your doctor will choose those most appropriate).
· You should have a full testing for sexually transmitted infections, including an HIV and syphilis test, and microscopy of your vaginal and cervical secretions – this is done in a specialist Sexual Health Clinic.
· Other tests may be needed e.g. a pregnancy, urine and a blood test.
· Start antibiotics before these results are known. Remember the infection is up inside your pelvis and it is only possible to swab the cervix – swabs cannot be taken from inside your pelvis. These tests may be negative, but that doesn’t mean you haven’t got PID! Take the antibiotics even if your test results are negative.
· Any partners in the past six months should have at a course of antibiotics to treat chlamydia, even if they test negative. Tests are not 100% accurate.
· No sex on treatment, not even oral sex or sex with a condom - for the two weeks while on antibiotics. Also until your test results are known and you have been reviewed in the clinic.
· Rest, take regular painkillers such as ibuprofen and paracetamol, and drink plenty of fluids.
· You should be followed up, after 72 hours, and then after 2-4 weeks. Usually symptoms resolve quickly if you follow this advice.
· Do not stop your contraception. If you have an intrauterine device (IUD) fitted the doctor will discuss this. Most studies show the outcome is no different if the IUD is removed. It is rarely the cause of the infection, especially if it has been in place for the longer term. If the coil has recently been inserted (within the past 20 days) and your symptoms are severe, the doctor may advise removal.
· The most important thing about PID is to try not to get it again! The risk is associated with having multiple partners, overlapping partners, or with not using barrier contraception.
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What is an inflammation?
UK National Guideline for the Management of Pelvic Inflammatory Disease 2011 (updated June 2011) Clinical Effectiveness Group British Association for Sexual Health and HIVhttps://www.bashhguidelines.org/media/1143/pid-2012.pdf