Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is infection of the upper female reproductive organs — uterus, fallopian tubes, ovaries. It is most often caused by sexually transmitted bacteria (Chlamydia, gonorrhoea), sometimes by other bacteria or tuberculosis. Untreated PID can cause chronic pelvic pain, tubal damage and infertility.

Symptoms

• Lower abdominal/pelvic pain.
• Abnormal vaginal discharge, often bad-smelling.
• Painful sex.
• Painful urination.
• Irregular or intermenstrual bleeding, or bleeding after sex.
• Fever, chills, feeling generally unwell.
• Many cases are mild or silent — and still cause tubal damage.

Red flags — hospital

• High fever with severe pain.
• Unable to keep down fluids, vomiting.
• Pregnancy with these symptoms.
• Severe one-sided pain — rule out tubo-ovarian abscess, ectopic pregnancy, appendicitis.

Diagnosis

Examination, pelvic ultrasound, STI tests, pregnancy test, blood tests. In India, pelvic TB is an important consideration in chronic or recurrent PID — specific tests (TB PCR, endometrial biopsy) may be needed.

Treatment

• Antibiotic courses targeted at likely organisms — may need combinations; full course is essential.
• Hospital admission for severe cases, pregnancy, or inability to tolerate oral treatment.
• Treat sexual partner(s) — otherwise re-infection is inevitable.
• Remove an IUD if present and the infection is severe, as advised.
• Abstain from sex until both partners have completed treatment.
• Anti-TB treatment if genital TB confirmed.
• Follow-up — review after 48-72 hours and completion.
• STI testing for HIV, syphilis, Hepatitis B — appropriate given the exposure pattern.

Prevention

• Condoms reduce risk of STIs that cause PID.
• Screen and treat STIs early and in both partners.
• Don't delay seeking care for pelvic symptoms.
• Vaccination for HPV and Hepatitis B.