Pelvic inflammatory disease (PID) is an infection that travels upward within the female reproductive system, affecting structures above the cervix. It is recognized as one of the most severe sexually transmitted diseases (STDs) affecting women, second only to HIV. PID's symptoms include fever, a foul-smelling discharge, severe pain—especially during intercourse—and vaginal bleeding. The condition can cause scarring of the fallopian tubes, ovaries, and surrounding tissues, potentially leading to ectopic pregnancies, infertility, chronic pain, and other severe complications.The bacteria responsible for PID move from the vagina and cervix into the upper reproductive tract. While various organisms can cause PID, it is often linked to gonorrhea and chlamydia, two prevalent STDs. Gonorrhea, caused by Neisseria gonorrhoeae, can reach the fallopian tubes, causing cell damage and invasion. This can result in widespread inflammation and scarring as the infection progresses to other organs. Normally, a mucus plug prevents bacteria from reaching the upper genital tract, but its effectiveness decreases during intercourse and menstruation. During menstruation, the backward flow of blood can carry the bacteria into the fallopian tubes, often resulting in PID symptoms shortly after a period.Women with STDs are at an elevated risk of developing PID. Having had PID previously increases this risk, as initial infections can compromise the body's defenses. Sexually active teenagers are more susceptible to PID than older women, and having multiple sexual partners further increases this risk. Women who douche regularly might also be more prone to PID, as the practice can push bacteria into the upper genital tract and may mask symptoms, delaying treatment.Diagnosing PID can be challenging. If a woman experiences lower abdominal pain, a physical exam can help identify the source and check for abnormal discharge or signs of chlamydia or gonorrhea. Additional tests, such as a sonogram or endometrial biopsy, may be necessary to differentiate PID from other conditions with similar symptoms.Because isolating bacteria from the upper genital tract is difficult and multiple organisms may cause PID, treatment typically involves prescribing at least two antibiotics effective against a wide range of pathogens. Symptoms might improve before the infection is fully resolved, but completing the full course of medication is crucial. A follow-up with a healthcare provider two to three days after starting treatment ensures the antibiotics are effective.Approximately 25% of women suspected of having PID require hospitalization. This may be necessary if the patient is very ill, unable to take oral medication, pregnant, an adolescent, or if the diagnosis is uncertain and could involve an abdominal emergency. Additionally, sexual partners of women with PID, even if asymptomatic, should be treated to prevent reinfection. Consistent and correct use of latex condoms can prevent gonorrhea transmission and offer partial protection against chlamydia.
