PT Health Watch: What you should know about pelvic inflammatory disease and how to prevent it

Pelvic Inflammatory Disease (PID) is a common yet often underdiagnosed infection that affects the female reproductive system.

According to Medscape, an online platform that provides medical information for healthcare professionals, PID is an infectious and inflammatory disorder of the upper female genital tract, including the uterus, fallopian tubes, and adjacent pelvic structures.

The platform also noted that infection and inflammation may spread to the abdomen, including perihepatic structures (Fitz-Hugh−Curtis syndrome).

The Mayo Clinic also explained that PID may be triggered by non-sexually transmitted bacteria introduced during childbirth, miscarriage, abortion, or certain medical procedures such as IUD insertion, particularly in unsterile conditions.

Trichomoniasis, a common sexually transmitted infection (STI) among women of reproductive age, has also been reported to increase risk of developing PID.

According to the World Health Organisation (WHO), the infection- caused by the protozoan parasite Trichomonas vaginalis affected an estimated 156 million people globally in 2020.

Who is at risk?

PID primarily affects women of reproductive age, though some are at greater risk due to biological, behavioural, and socio-economic factors.

According to the UK National Health Service (NHS), sexually active women under the age of 25 are at increased risk of developing PID.

This heightened risk, the report said, is attributed to factors such as an immature cervix, which is more susceptible to infections, and behavioural aspects like having multiple sexual partners or inconsistent condom use.

The US Centres for Disease Control and Prevention (CDC) also notes that women who have an STI and do not get treated, have more than one sex partner, or have had PID before are more at risk.

A 2023 study conducted in North-Central Nigeria revealed that 86.4 per cent of PID cases occurred in women aged 25-29.

In an interview with Daily Trust, Nigerian medical doctor and health advocate, Aisha Muhammad, emphasised the critical importance of early intervention in managing PID.

Ms Muhammad explained that recognising symptoms early and seeking prompt medical care can significantly reduce the risk of severe reproductive health problems.

“If left untreated, PID can escalate, leading to severe complications such as infertility, ectopic pregnancy, and chronic pelvic pain,” she said.

She also highlighted the diagnostic process, noting that ultrasound scans can reveal features consistent with PID, while laboratory tests such as high vaginal swabs, microscopy, culture sensitivity (MCS), and endocervical swabs help to isolate causative microorganisms.

She stressed that treatment for PID varies depending on the infection identified and highlighted the importance of treating not only the patient but also their sexual partners.

Signs and symptoms of PID

PID can be present with a range of symptoms, varying from mild to severe. According to the Mayo Clinic, “The signs and symptoms of PID might be mild and difficult to recognise”.

Common signs include persistent lower abdominal or pelvic pain, unusual vaginal discharge with an unpleasant odour, irregular menstrual bleeding, pain during intercourse, and fever.

Some individuals may also experience discomfort or pain during urination. It’s important to note that these symptoms can overlap with those of other conditions, making early medical consultation essential for accurate diagnosis and appropriate treatment.

Complications and Long-Term Effects of PID

When left untreated, PID can lead to a range of serious and potentially life-threatening complications.

According to the Mayo Clinic, untreated PID can result in “scar tissue and pockets of infected fluid (abscesses) to develop in the reproductive tract” . These effects can cause lasting damage to a woman’s reproductive health.

One major complication is ectopic Pregnancy. PID is a leading cause of this condition, where a fertilised egg implants outside the uterus, most commonly in a fallopian tube.

Scar tissue caused by PID can block the normal movement of the egg, leading to implantation in the wrong location.

Another long-term effect is infertility. Repeated episodes of PID significantly increase the risk, with damage to the fallopian tubes making it difficult or impossible for an egg to reach the uterus.

The Mayo Clinic notes that the more times a person has had PID, the higher their risk of infertility — and delaying treatment further increases this risk.

Chronic pelvic pain is also a common outcome. Scarring of the reproductive organs can cause ongoing discomfort, particularly during ovulation or sexual intercourse, often lasting for months or even years.

How to Prevent Pelvic Inflammatory Disease

PID largely involves reducing the risk of contracting STIs, which are the primary cause of the condition. The US CDC has outlined several strategies to lower this risk.

Consistent and correct use of latex condoms during sexual activity can significantly reduce the chances of acquiring STIs, thereby lowering the risk of developing PID.

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Regular screening for STIs, particularly for sexually active individuals under the age of 25, is also strongly advised.

The CDC recommends annual testing for infections such as chlamydia and gonorrhoea within this age group to enable early detection and treatment, preventing the condition from progressing.

Limiting the number of sexual partners and maintaining mutual monogamy further helps to reduce exposure to infections.

Additionally, avoiding vaginal douching is important, as this practice can disrupt the natural bacterial balance of the vagina, increasing the likelihood of infections that may lead to PID.

Timely medical intervention for any symptoms of STIs, coupled with adherence to prescribed treatments, is also key to preventing PID.

According to the US CDC, treating not just the affected individual but also their sexual partners helps to prevent reinfection and curb the spread of disease.