Pelvic inflammatory disease (PID)

What is pelvic inflammatory disease (PID)?

Pelvic inflammatory disease (PID) is a severe inflammatory infection of the female reproductive organs, which includes the uterus, ovaries, and fallopian tubes. It is related to an untreated or unresolved sexually transmitted infection of the woman’s reproductive organs and is one of the causes of infertility. If pelvic inflammatory disease (PID) is left untreated, one can develop an abscess in the pelvic reproductive area and potentially develop a generalised infection, which can be life-threatening.

How common is pelvic inflammatory disease (PID) in Singapore?

In Singapore, pelvic inflammatory disease is commonly seen in women in the age group of 15-24 years old, with a general incidence of approximately 10 in every 1000 women [1].

What are the symptoms of pelvic inflammatory disease (PID)?

You may not be aware of pelvic inflammatory disease symptoms in milder cases, as one can present without any symptoms. Symptoms suggestive of PID include:

• Fever
• Nausea and vomiting
• Lower pelvic or abdominal pain
• Abnormal discharge from your vagina, including symptoms such as increased volume, abnormal colour, consistency, or odour
• Painful intercourse
• Bleeding in between your periods
• Irregular periods
• Painful or burning sensation upon urination

If you are experiencing any of the above symptoms or you are concerned about developing PID, you are advised to see your doctor for further evaluation of your condition and seek prompt and appropriate treatment.

What are the causes of pelvic inflammatory disease (PID)?

The cause of a person developing PID is commonly due to underlying sexually transmitted diseases (STDs) or reproductive organ infections that were left untreated.

Possible causes of pelvic inflammatory disease include [2-5]:

• Untreated STDs
• Having a history of PID or STDs
• Having multiple sexual partners or sexual partner(s) who have other/multiple sexual partners
• Young and sexually active before the age of 25
• Having an intrauterine device (IUD)
• Does not use barrier method contraception
• Douching habits
• Smoking

Speak to your doctor about ways to reduce the risk factors of developing PID, and consider STD screening if you are concerned about developing PID.

What is the association between PID and STDs?

STDs are known causes that can lead to PID if the infections are left untreated, as the bacteria can ascend from the vagina to the cervix and further up to the uterus or fallopian tube of the female’s reproductive organs [6].

STDs associated with PID include:

• Chlamydia Trachomatis
• Neisseria Gonorrhea
• Mycoplasma Genitalium (Mgen)
• Trichomonas Vaginalis

If you have been exposed to STDs/PID, speak to your doctor, consider STD testing, and seek treatment without further delay.

Is there a chance of acquiring PID without having any STDs?

Yes, a person can develop PID even without underlying STDs. Non-STD causes that can lead to PID include:

• Appendicitis complication with a ruptured appendix [7]
• Peritonitis
• Gastroenteritis
• Vaginal infections such as bacterial vaginosis [8] 
• Recent surgical procedures such as abortion, IUD medical insertion, or surgical D&C (dilatation and curettage procedure)

Please see a doctor if you are concerned about PID or experiencing symptoms that suggest PID.

If I don’t treat the STD, which part of my reproductive system can be affected by PID?

As the STD bacteria that are left untreated can ascend the female reproductive system, areas that can eventually develop inflammation or scarring in PID include:

• Uterus
• Fallopian tube
• Ovaries
• The lining of the abdomen (peritoneum)

How do I reduce the risk of acquiring PID?

You can reduce the risk of acquiring PID by:

• Practising safe sex and using barrier contraception the right way
• Practising abstinence
• Having monogamous relationships (though the risk is not completely eliminated)
• Going for regular STD testing and seeking prompt treatment if necessary
• Removing your IUD if your PID resulted from the insertion of the device 

When should I consider seeing a doctor for PID?

You should seek medical advice if you are presenting with PID symptoms or if you notice the following:

• Abnormal genital symptoms such as rash/ulcers/lumps and bumps or abnormal discharge
• You or your sexual partner has been exposed to STDs

How is pelvic inflammatory disease diagnosed?

PID is diagnosed based on your clinical symptoms and findings from gynaecological tests and examination.

Depending on individual conditions, your doctor may offer vaginal and cervix swab tests for laboratory investigation of STD/bacterial infection. Your doctor may offer tests such as blood tests, urine tests, pregnancy tests, and an ultrasound of the pelvis region to screen further for PID. 

In more severe cases, you may be advised to seek medical attention in the hospital and consider a laparoscopy procedure to investigate further for PID.

Can pelvic inflammatory disease (PID) be treated?

PID can be treated. However, the complications of PID, such as damage or scarring of the reproductive organ, may not be reversible with treatment. Treatment works to clear off the underlying infection(s) and avoid further irreversible complications from PID [9]. Your sexual partner(s) must also be treated to prevent re-infection of the condition.

In severe cases of PID, you may be admitted to the hospital for intravenous antibiotics treatment and monitoring.

What will happen if my PID is not treated?

Long term complication from PID includes:

• Scarring of the reproductive organ from prolonged inflammation, leading to fallopian tube blockages
• Infertility (inability to conceive)
• Chronic pelvic or abdominal pain
• Ectopic pregnancy

When can I resume sexual intercourse if I have PID?

You can consider resuming your sexual life after completing your antibiotics and resolving your symptoms. Your partner is advised to get screened and tested before resuming a sexual lifestyle with you.

In conclusion

PID is a treatable condition if it is managed promptly and appropriately. Hence, do not allow the infection to brew longer and worsen; consider early STD screening and treatment!

References

1. Women's Wellness Centre KK Women's and Children's Hospital. (2021). Pelvic Inflammatory Disease. Retrieved from HealthXchange.sg: https://www.healthxchange.sg/women/urology/pelvic-inflammatory-disease
2. AMY CURRY, T. W. (2019). Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention. American Family Physician, 357-364.
3. Roberta B. Ness, S. L. (2005). Douching, Pelvic Inflammatory Disease, and Incident Gonococcal and Chlamydial Genital Infection in a Cohort of High-Risk Women. American Journal of Epidemiology, 186-195.
4. Ross, J. D. (2002). An update on pelvic inflammatory disease. BMJ Journals, 18-19.
5. D Scholes, J. R. (1992). Current cigarette smoking and risk of acute pelvic inflammatory disease. American Journal of Public Health, 1352–1355.
6. Lindsey K. Jennings, D. M. (2023). Pelvic Inflammatory Disease. Florida: StatPearls.
7. PAILLIER-GONZALEZ, J. E., & FLOREZ-ARANGO, N. S.-M. (2021). Case report. Pelvic inflammatory disease as a complication of acute appendicitis. Iatreia, https://doi.org/10.17533/udea.iatreia.84.
8. Jacques Ravel, I. M. (2021). Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. American Journal of Obstetrics and Gynecology, 251-257.
9. Centers for Disease Control and Prevention. (2021, July 22). Pelvic Inflammatory Disease (PID) Treatment and Care. Retrieved from Pelvic Inflammatory Disease: https://www.cdc.gov/std/pid/treatment.htm