elvicinflammatory disease is an infection of the upper female reproductiveorgans (the uterus, fallopian tubes, and ovaries).
The infection is usually transmitted during sexual intercourse with an infected partner.
Typically, women have pain in the lower abdomen, a vaginal discharge, and irregular vaginal bleeding.
The diagnosis is based on symptoms, analysis of secretions from the cervix and vagina, and sometimes ultrasonography.
Having sexual intercourse with only one partner and using barrier contraceptives (such as condoms) with spermicides reduces the risk of infection.
Antibiotics can eliminate the infection.
Pelvicinflammatory disease may be an infection of
The lining of the uterus (endometritis)
The fallopian tubes (salpingitis)
Ifthe infection is severe, it can
Spread to the ovaries (oophoritis)
Produce a collection of pus in the fallopian tubes (tubo-ovarian abscess)
TypicalSites for Pelvic Inflammatory Disease
Pelvicinflammatory disease is the most common preventable cause ofinfertility in the United States. Infertility occurs in about one offive women with pelvic inflammatory disease.
Aboutone third of women who have had pelvic inflammatory disease developthe infection again.
Pelvicinflammatory disease usually occurs in sexually active women. Itrarely affects girls before their first menstrual period (menarche)or women during pregnancy or after menopause. Risk is increased forthe following women:
Those who are sexually active and younger than 35
Those who do not use a barrier contraceptive (such as a condom or diaphragm)
Those who have many or new sex partners
Those who have a sexually transmitted disease or bacterial vaginosis
Those who have had pelvic inflammatory disease before
Those of lower socioeconomic status (who usually have less access to health care)
Pelvicinflammatory disease is usually caused by bacteria from the vagina.Most commonly, the bacteria are transmitted during sexual intercoursewith a partner who has a sexually transmitted disease. The mostcommon sexually transmitted bacteria are
Neisseria gonorrhoeae, which causes gonorrhea
Chlamydia trachomatis, which causes chlamydial infection
Thesebacteria typically spread from the vagina to the cervix (the lowerpart of the uterus that opens into the vagina), where they causeinfection (cervicitis). These infections may remain in the cervix orspread upward, causing pelvic inflammatory disease.
Pelvicinflammatory disease also commonly occurs in women who have bacterialvaginosis.The bacteria that cause bacterial vaginosis normally reside in thevagina. They cause symptoms and spread to other organs only if theyincrease in number (overgrow). Whether bacterial vaginosis issexually transmitted is unknown.
Lesscommonly, women are infected during a vaginal delivery, an abortion,or a medical procedure, such as dilation and curettage (D and C) orgynecologic surgery—when bacteria are introduced into the vagina orwhen bacteria that normally reside in the vagina are moved into theuterus.
Whetherdouching increases the risk of infection is unclear.
Did You Know…
The most common preventable cause of infertility is pelvic inflammatory disease.
Symptomscommonly occur toward the end of the menstrual period or during thefew days after it. For many women, the first symptom is mild tomoderate pain (often aching) in the lower abdomen, which may be worseon one side. Other symptoms include irregular vaginal bleeding and avaginal discharge, sometimes with a bad odor.
Asthe infection spreads, pain in the lower abdomen becomes increasinglysevere and may be accompanied by a low-grade fever (usually below102° F [38.9° C]) and nausea or vomiting. Later, the fever maybecome higher, and the discharge often becomes puslike andyellow-green. Women may have pain during sexual intercourse orurination.
Theinfection may be severe but cause mild or no symptoms. Symptoms dueto gonorrhea tend to be more severe than those of a chlamydialinfection or infection due to Mycoplasmagenitalium,which may not cause a discharge or any other noticeable symptoms.
Pelvicinflammatory disease can cause other problems, including thefollowing:
Blocked fallopian tubes
Peritonitis (a serious abdominal infection)
Fitz-Hugh-Curtis syndrome (a serious infection of tissues around the liver)
Adhesions (bands of scar tissue)
A tubal pregnancy
Sometimesinfected fallopian tubes become blocked. Blocked tubes may swellbecause fluid is trapped. Women may feel pressure or have chronicpain in the lower abdomen.
Peritonitisdevelopsif the infection spreads to the membrane that lines the abdominalcavity and covers the abdominal organs. Peritonitis can cause suddenor gradual severe pain in the entire abdomen.
TheFitz-Hugh-Curtissyndrome developsif infection of the fallopian tubes is due to gonorrhea or achlamydial infection and it spreads to the tissues around the liver.Such an infection may cause pain in the upper right side of theabdomen. The pain resembles that of a gallbladder disorder orgallstones.
Anabscessformsin the fallopian tubes or ovaries of about 15% of women who haveinfected fallopian tubes, particularly if they have had the infectiona long time. An abscess sometimes ruptures, and pus spills into thepelvic cavity (causing peritonitis). A rupture causes severe pain inthe lower abdomen, quickly followed by nausea, vomiting, and very lowblood pressure (shock). The infection may spread to the bloodstream(a condition called sepsis)and can be fatal.
Adhesionsareabnormal bands of scar tissue. They can develop when pelvicinflammatory disease produces a puslike fluid. This fluid irritatestissues and causes bands of scar tissue to form in the reproductiveorgans or between organs in the abdomen. Infertility and chronicpelvic pain may result. The longer and more severe the inflammationand the more often it recurs, the higher the risk of infertility andother complications. The risk increases each time a woman developsthe infection.
Atubalpregnancy (atype of ectopicpregnancy)is 6 to 10 times more likely to occur in women who have had pelvicinflammatory disease. In a tubal pregnancy, the fetus grows in afallopian tube rather than in the uterus. This type of pregnancythreatens the life of the woman, and the fetus cannot survive.
A doctor`s evaluation
Tests on a sample taken from the cervix
A pregnancy test
Sometimes ultrasonography or laparoscopy
Doctorssuspect the disease if women have pain in the lower abdomen or ifthey have an unexplained discharge from the vagina, particularly ifthey are of childbearing age. A physical examination, including apelvicexamination,is done. Pain felt in the pelvic area during the pelvic examinationsupports the diagnosis.
Asample is usually taken from the cervix with a swab and tested todetermine whether the woman has gonorrhea or a chlamydial infection.A pregnancy test is done to see whether the woman may have a tubalpregnancy, which could be the cause of the symptoms. Other symptomsand laboratory test results help confirm the diagnosis.
Ultrasonographyof the pelvis is done if pain prevents an adequate physicalexamination or if more information is needed. It can detect abscessesin the fallopian tubes or ovaries and a tubal pregnancy.
Ifthe diagnosis is still uncertain or if the woman does not respond totreatment, the doctor may insert a viewing tube ( laparoscope)through a small incision near the navel to view the inside of theabdomen and to obtain a sample of fluids for testing.
Preventionof pelvic inflammatory disease is essential to the health andfertility of a woman.
Abstainingfrom sex is a foolproof way to avoid sexually transmitted pelvicinflammatory disease. However, if a woman has sexual intercourse withonly one partner, the risk of pelvic inflammatory disease is verylow, as long as neither person is infected with the bacteria thatcause sexually transmitted diseases.
Barriermethods of birth control (such as condoms) and spermicides (such asvaginal foams) used with a barrier method can help prevent pelvicinflammatory disease. Barriermethodsmust be used correctly to be effective. If a barrier contraceptive isleft in the vagina too long, it can increase the risk of infection.
If needed, drainage of an abscess
Assoon as possible, antibiotics for gonorrhea and chlamydial infectionare usually given by mouth or by injection into a muscle. If needed,the antibiotics are changed after test results are available.
Mostwomen are treated at home. However, hospitalization is usuallynecessary in the following situations:
The infection does not lessen within 48 hours.
The woman has severe symptoms or a high fever.
The woman may be pregnant.
An abscess is suspected.
The woman is vomiting and thus cannot take antibiotics by mouth at home.
Doctors cannot confirm the diagnosis of pelvic inflammatory disease and cannot rule out disorders that require surgery (such as appendicitis) as possible causes.
Inthe hospital, antibiotics are given intravenously.
Abscessesthat persist despite treatment with antibiotics may be drained.Often, a needle can be used. It is inserted through a small incisionin the skin, and an imaging test, such as ultrasonography or computedtomography (CT), is used to guide the needle into the abscess. Aruptured abscess requires emergency surgery.
Womenshould refrain from sexual intercourse until antibiotic therapy iscompleted and a doctor confirms that the infection is completelyeliminated, even if symptoms disappear. All recent sex partnersshould be tested for gonorrhea and chlamydial infection and treated.If pelvic inflammatory disease is diagnosed and treated promptly, afull recovery is more likely.