If You Take Birth Control Pills
When both you and your partner have finished your antibiotics, its OK to have sex. Use latex condoms to prevent future infections. Also, keep taking your birth control pills on schedule. Remember: Birth control pills help prevent pregnancy, but do not protect against sexually transmitted infections .
Does My Partner Need To Be Treated
Yes. Also, any other sexual partner within the previous six months should be tested for infection. If you have not had sex within the previous six months then your latest sexual partner should be tested and treated. A course of antibiotics is usually advised whether or not infection is found on testing. This is because:
- Many cases of PID are caused by chlamydia. It is often passed on during sex.
- Men often have no symptoms with chlamydia, but can still pass on the infection.
- The test for chlamydia is not 100% reliable. Treatment makes sure that any possible infection which may have been missed by the tests is cleared.
- If your sexual partner is infected and not treated, chlamydia may be passed back to you again after you are treated.
What Are The Symptoms
At first, PID may not cause any symptoms. Or it may cause only mild symptoms, such as bleeding or discharge from the vagina. Some women don’t even know they have it. They only find out later, when they can’t get pregnant or they have pelvic pain.
As the infection spreads, the most common symptom is pain in the lower belly. The pain has been described as crampy or as a dull and constant ache. It may be worse during sex, during bowel movements, or when you urinate. Some women also have a fever.
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Data Collection And Analysis
At least two review authors independently selected trials for inclusion, extracted data, and assessed risk of bias. We contacted investigators to obtain missing information. We resolved disagreements by consensus or by consulting a fourth review author if necessary. We assessed the quality of the evidence using GRADE criteria, classifying it as high, moderate, low, or very low. We calculated MantelHaenszel risk ratios , using either randomeffects or fixedeffect models and number needed to treat for an additional beneficial outcome or for an additional harmful outcome, with their 95% confidence interval , to measure the effect of the treatments. We conducted sensitivity analyses limited to studies at low risk of bias, for comparisons where such studies were available.
How Is Pelvic Inflammatory Disease Treated
Several types of antibiotics can cure PID. Antibiotic treatment does not, however, reverse any scarring caused by the infection. For this reason, it is critical that a woman receive care immediately if she has pelvic pain or other symptoms of PID. Prompt antibiotic treatment can prevent severe damage to the reproductive organs. The longer a woman delays treatment for PID, the more likely she is to become infertile or to have a future ectopic pregnancy because of damage to the fallopian tubes.
PID is usually treated with antibiotics to provide empiric, broad spectrum coverage of likely pathogens. Recommended regimens can be found in the 2021 STI Treatment Guidelines. Healthcare providers should emphasize to their patients that although their symptoms may go away before the infection is cured, they should finish taking all of the prescribed medicine. Additionally, a womans sex partner should be treated to decrease the risk of re-infection, even if the partner has no symptoms. Although sex partners may have no symptoms, they may still be infected with the organisms that can cause PID.
In certain cases, clinicians may recommend hospitalization to treat PID. This decision should be based on the judgment of the health care provider and the use of suggested criteria found in the 2021 STI Treatment Guidelines. If a womans symptoms continue, or if an abscess does not resolve, surgery may be needed.
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Treating Pelvic Inflammatory Disease With Medicines
As soon as pelvic inflammatory disease has been diagnosed, it needs to be treated with antibiotics. Two or more types of antibiotics may be taken at the same time. This ensures that all the bacteria are killed. It’s very important to take all of your medicine as prescribed, or the infection may not go away.
Are Some Women More Likely To Get Pelvic Inflammatory Disease
PID affects about 5 percent of women in theUnited States. Your risk for PID is higher if you:
- Have had an STI
- Have had PID before
- Are younger than 25 and have sex. PID is most common in women 15 to 24 years old.
- Have more than one sex partner or have a partner who has multiple sexual partners
- Douche. Douching can push bacteria into the reproductive organs and cause PID. Douching can also hide the signs of PID
- Recently had an intrauterine device inserted. The risk of PID is higher for the first few weeks only after insertion of an IUD. PID is rare after that time period. Getting tested for STIs before the IUD is inserted lowers your risk for PID.
Many women do not know they have PID, because they do not have any signs or symptoms. When symptoms do happen, they can be mild or more serious. Signs and symptoms include:
- Pain in the lower abdomen
- Vaginal discharge that may smell foul
- Painful sex
- Irregular periods
- Pain in the upper right abdomen
If you think that you may have PID, see a doctor or nurse as soon as possible.
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What Other Tests Might I Need To Diagnose Pid
Your provider may also order:
- Blood tests.
- Urine test to rule out a urinary tract infection, which causes similar pelvic pain.
- Ultrasound to get clearer images of the reproductive system.
In some cases, your provider may recommend:
- Endometrial biopsy to remove and test a small tissue sample from the endometrium, the lining of the uterus.
- Laparoscopy, a surgery using small incisions and a lighted instrument to look closely at reproductive organs.
- Culdocentesis, with a needle inserted behind the vagina to remove fluid for examination. This procedure is much more rare then it used to be, but is sometimes helpful.
Doxycycline And Metronidazole Trials
A few studies have further examined the outpatient combination regimen of doxycycline and metronidazole. In a randomized clinical trial of 40 patients with laparoscopically confirmed salpingitis, combined doxycycline-metronidazole treatment exhibited a low clinical cure rate of 35%, with a 50% clinical improvement rate . The low efficacy of this regimen was replicated in an observational study in the United Kingdom involving 135 women with PID, in which only 55% experienced a clinical cure 2 or 4 weeks after treatment . The addition of ceftriaxone to this regimen resulted in a higher but still suboptimal cure rate of 72% . Because combined doxycycline-metronidazole provides poor coverage against N. gonorrhoeae and was also associated with the lowest pooled clinical and microbiological cure rates in the meta-analysis conducted by Walker et al. , this is not considered to be an optimal regimen for treatment of PID.
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How Is It Treated
To treat PID, you will take antibiotics. Take them as directed. If you don’t take all of the medicine, the infection may come back.
If your infection was caused by a sexually transmitted infection, your sex partner will also need to be treated so you don’t get infected again. Do not have sex until both of you have finished your medicine. And be sure to follow up with your doctor to make sure that the treatment is working.
If you have a very bad case of PID or are also pregnant, you may need to stay in the hospital and get antibiotics through a vein . Sometimes surgery is needed to drain a pocket of infection, called an abscess.
What Tests May Be Done
If PID is suspected, a small sample of discharge is usually taken from the neck of your womb . This is to test for any germs . A swab from the urethra and blood and urine tests may also be taken. These are to look for infecting bacteria or the effects of infection.
Sometimes the swabs and tests may not show any bacteria. So to help confirm a diagnosis of PID, other tests may be needed. For example, a blood test may show up some inflammation/infection, or an ultrasound scan may be able to show inflamed Fallopian tubes. Other scans are sometimes done.
If your doctor has particular concerns, they may need to look inside your tummy to see your womb and tubes. Whilst you are under general anaesthetic a thin telescope is pushed through your tummy wall. This is called a laparoscopy. Laparoscopy is not routinely needed to diagnose PID.
PID may not be diagnosed for some time if symptoms are mild, or do not occur at first.
A pregnancy test is also usually done in women suspected of having PID. This is because an ectopic pregnancy can sometimes be confused with PID, as some of the symptoms are similar. An ectopic pregnancy is a pregnancy that develops in a Fallopian tube and can cause serious problems.
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What Are The Symptoms Of Pid
You may not realize you have PID. Symptoms might be mild or unnoticeable. But symptoms of PID can also start suddenly and quickly. They can include:
- Pain or tenderness in the stomach or lower abdomen , the most common symptom.
- Abnormal vaginal discharge, usually yellow or green with an unusual odor.
- Irregular periods or having spotting or cramping throughout the month.
- Pain in the right upper abdomen, less often.
Who Is Most Likely To Be Affected
Women are more likely to develop PID if they:
- are sexually active and under 25 years of age
- have several sexual partners
- do not use barrier contraceptives
- use a douche
A physician will ask about symptoms and carry out a pelvic exam to check for tenderness.
They will also test for chlamydia and gonorrhea.
A swab may be taken from the cervix, and maybe from the urethra, the tube from the bladder through which urine flows. There may be blood and urine tests.
An ultrasound scan may be used to check for inflammation in the fallopian tubes.
Sometimes, a laparoscope is used to view the area. If necessary, tissue samples can be taken through it.
Early treatment decreases the likelihood of developing complications, such as infertility.
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Treatment For Your Sex Partner
If your PID was caused by a sexually transmitted infection , anyone with whom you have had sex in the last 60 days should be checked and treated.
Having sex too soon after treatment could cause your infection to come back, so it’s important to wait. The amount of time you must wait depends on what type of treatment you have. Talk to your doctor to be sure.
If The Infection Returns
Even after treatment, PID can come back. This could happen if youre infected by another STI. But be aware that once youve had PID, bacteria that are normally harmless may be more likely to infect your upper genital tract. This means you could get PID again even without getting another STI. With each PID infection, the chances of complications go up.
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Quality Of The Evidence
Most of the 37 included studies had unclear or high risk of bias in most domains, and only three were at low risk of bias in most domains. The overall quality of the evidence ranged from very low to high, the main limitations being serious risk of bias , serious inconsistency and serious imprecision. The only high-quality evidence was for the sensitivity analysis regarding the use of nitroimidazole. There was moderate-quality evidence in the sensitivity analysis regarding the use of azithromycin in mild-moderate cases of PID, in comparisons between the use or not of nitroimidazole for curing mild-moderate or severe PID, and in comparisons between clindamycin plus aminoglycoside versus cephalosporins for curing severe PID.
How Is Pid Diagnosed
Your doctor will do a medical history and a physical and pelvic exam. Other tests may include:
Exam of vagina and cervix samples under a microscope
Pap test. For this test, cells are taken from the cervix and checked under a microscope. It’s used to find cancer, infection, or inflammation.
Ultrasound. This test uses high-frequency sound waves to make an image of the organs.
Laparoscopy. This is a minor procedure done using a laparoscope. That is a thin tube with a lens and a light. It is inserted into an incision in the abdominal wall to view the reproductive tract.
Culdocentesis. For this test, a needle is inserted into the pelvic cavity through the vaginal wall to get a sample of pus.
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What Are The Complications Of Pelvic Inflammatory Disease
Complications are more likely to arise if PID is not treated, or if treatment is delayed, or if there is a severe infection.
The complications of PID include:
- chronic or long-term lower abdominal pain
- scarring of the fallopian tube, which can cause infertility or ectopic pregnancy
- an abscess in or around the fallopian tube and/or ovary.
If you get PID more than once you are at greater risk of developing these complications. In many countries, it’s the most common preventable cause of infertility.
What Is The Treatment For Pelvic Inflammatory Disease
Your doctor or nurse will give you antibiotics to treat PID. Most of the time, at least two antibiotics are used that work against many different types of bacteria. You must take all of your antibiotics, even if your symptoms go away. This helps to make sure the infection is fully cured. See your doctor or nurse again two to three days after starting the antibiotics to make sure they are working.
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Can I Prevent Pelvic Inflammatory Disease
Sometimes, PID is not due to a sexually transmitted infection. It can come from normal vaginal bacteria traveling to your reproductive organs. Avoiding douching may lower the risk.
Most of the time, though, PID happens because of unprotected sex. Take steps to practice safe sex. Protect yourself from sexually transmitted infections that can cause PID:
- Limit sexual partners: Your risk increases if you have multiple partners.
- Choose barrier methods of birth control: These types of birth control include condoms and diaphragms. Combine a barrier method with spermicide, even if you take birth control pills.
- Seek treatment if you notice symptoms: If you notice signs of PID or other STIs, get treatment right away. Symptoms include unusual vaginal discharge, pelvic pain or bleeding between periods.
- Get regular checkups: Have regular gynecological exams and screenings. Often, providers can identify and treat cervical infections before they spread to reproductive organs.
Treatment Of Pid Related Pain
After PID has been treated, pelvic pain can remain for some women. Pain may be caused by adhesions and scar tissue, which is not treated by the antibiotics.
Surgery may be recommended to remove adhesions caused by PID, but unfortunately, this may not resolve your pelvic pain problems completely.
Other options for chronic pelvic pain treatment include over-the-counter pain relievers, antidepressants , hormonal treatments, physical therapy, acupuncture, transcutaneous electrical nerve stimulation , counseling, and trigger point injections.
In rare cases, hysterectomy may be used to treat chronic pelvic pain that does not resolve with other treatments. Surprisingly, even this may not cure your pelvic pain. It should only be a treatment of last resort.
Hysterectomy leads to sterility, and you will not be able to get pregnant or carry a baby afterward. If a hysterectomy is necessary, you should speak to your doctor about egg freezing or embryo cryopreservation before surgery, which together with a gestational surrogate, may allow you to have a biological child at a future date.
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History And Physical Examination
The history should focus on high-risk behaviors and symptoms. Risk factors for PID include age younger than 25 years young age at first sexual encounter use of nonbarrier contraception, especially IUD or oral contraceptives new, multiple, or symptomatic sex partners a history of PID or sexually transmitted infection or recent IUD insertion.9 Black women may be at higher risk of PID, although there are inconsistencies among physicians in their criteria for diagnosing PID and biases in reporting.1,10 Vaginal douching also may be a risk factor.11
Typically, women will present with some degree of lower abdominal or pelvic pain, although it may be mild. Other symptoms may include a new or abnormal vaginal discharge, fever or chills, cramping, dyspareunia, dysuria, and abnormal or postcoital bleeding. Some women also may have low back pain, nausea, and vomiting.6 It is less common for women to have no symptoms or atypical symptoms, such as right upper quadrant pain from perihepatitis . At-risk women who present with pelvic or lower abdominal pain and have no other identified etiology for their pain should be presumed to have PID if they have cervical motion, uterine, or adnexal tenderness. Additional diagnostic criteria are outlined in Table 1.5 The differential diagnosis also may include gastrointestinal conditions genitourinary conditions obstetric/gynecologic conditions or functional pelvic pain.
Clinical Diagnostic Criteria for PID
Information from reference 5.
What Are The Causes Of Pelvic Inflammatory Disease
Most cases of PID are caused by bacteria that spread from your vagina and cervix to your uterus and fallopian tubes. Image: Female reproductive organs. Source: Wikimedia Commons Many different types of bacteria can cause PID. The most common of these is an STI such as chlamydia and gonorrhoea. Other less common causes include:
- from a termination of pregnancy procedure
- after pelvic operations
- after an intrauterine device insertion
- the first few weeks after delivery of a baby
- from spread of infections from nearby organs, eg, appendicitis.
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