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Pelvic inflammatory disease

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By Isatou Nyang, 5th year medical student

UTG Medical Students’ Association

Pelvic inflammatory disease (PID) is an infection of one or more of the upper reproductive organs, including the uterus, fallopian tubes and ovaries. It affects women and people assigned females at birth. Untreated can cause scar tissue to develop in the reproductive tract, which can cause permanent damage. PID develops when certain types of bacteria spread from your vagina to your reproductive organs.

The signs and symptoms of pelvic inflammatory disease can be subtle or mild. Some women don’t experience any signs or symptoms. As a result, you might not realise you have it until you have trouble getting pregnant or you develop chronic pelvic pain.

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Symptoms and signs

You may not realise you have PID. Symptoms might be mild or difficult to recognise. Symptoms of PID can also start suddenly. They can include:

o          Pain or tenderness in your stomach or lower abdomen (belly), the most common symptom.

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o          Abnormal vaginal discharge, usually yellow or green with an unpleasant odor especially during and after sex.

o          Chills or fever.

o          Nausea and vomiting.

o          Pain during sex.

o          Burning when you urinate.

o          Irregular periods or having spotting or cramping throughout the month.

How long does it take to have symptoms of PID?

It can take anywhere from a few days to a few weeks to develop PID if untreated gonorrhea or chlamydia is the cause. If you get PID from something else, it may take several months to develop it.

What causes PID?

Most cases of PID are caused by a bacterial infection that’s spread from the vagina or the cervix to the reproductive organs higher up. Many different types of bacteria can cause PID. In many cases, it’s caused by a sexually transmitted infection (STI), such as chlamydia or gonorrhoea. These bacteria are usually acquired during unprotected sex. In many other cases, it’s caused by bacteria that normally live in the vagina.

Risk factors

o          A number of factors might increase your risk of pelvic inflammatory disease, including:

o          Being sexually active and younger than 25 years old.

o          Having multiple sexual partners.

o          Being in a sexual relationship with someone who has more than one sex partner.

o          Having sex without a condom.

o          Douching regularly, which upsets the balance of good versus harmful bacteria in the vagina and might mask symptoms.

o          Having a history of pelvic inflammatory disease or a sexually transmitted infection.

How do you get PID?

o          Most people get PID through unprotected sex. Sex lets bacteria enter your reproductive system, where they can infect your organs.

o          Childbirth.

o          Pelvic surgery.

o          Miscarriage.

o          Getting an intrauterine device (IUD) as a mode of contraception.

Does douching cause pelvic inflammatory disease (PID)?

 Douching is washing or cleaning out the vagina with water or other mixtures of fluids. Most studies report only an association between douching and PID. What can be said is that douching can lead to bacterial vaginosis infections, but there’s only a potential association between douching and PID. Most healthcare providers advise against douching.

Complications of Pelvic Inflammatory Disease

o          Ectopic pregnancy

 PID is a major cause of tubal (ectopic) pregnancy. An ectopic pregnancy can occur when untreated PID has caused scar tissue to develop in the fallopian tubes. The scar tissue prevents the fertilized egg from making its way through the fallopian tube to implant in the uterus. Instead, the egg implants in the fallopian tube.

o          Infertility

 Damage to your reproductive organs may cause infertility — the inability to become pregnant. The more times you’ve had PID, the greater your risk of infertility.

o          Chronic pelvic pain

Pelvic inflammatory disease can cause pelvic pain that might last for months or years. Scarring in your fallopian tubes and other pelvic organs can cause pain during intercourse and ovulation.

o          Tubo-ovarian abscess

PID might cause an abscess — a collection of pus — to form in your reproductive tract. Most commonly, abscesses affect the fallopian tubes and ovaries, but they can also develop in the uterus or in other pelvic organs. If an abscess is left untreated, you could develop a life-threatening infection.

Prevention

To reduce your risk of pelvic inflammatory disease:

o          Practice safe sex

Use condoms every time you have sex, limit your number of partners and ask about a potential partner’s sexual history.

o          Talk to your health care provider about contraception. Using barrier methods, such as a condom, helps to reduce your risk. Even if you take birth control pills, use a condom every time you have sex with a new partner to protect against STIs.

o          Get tested. If you’re at risk of an STI (sexual transmitted infection). Early treatment of an STI gives you the best chance of avoiding PID.

o          If you have pelvic inflammatory disease or an STI, advise your partner to be tested and treated. This can prevent the spread of STIs and possible recurrence of PID.

o          Don’t douche. Douching upsets the balance of bacteria in the vagina.

o          Have regular gynecological exams and screenings.

Treatment for pelvic inflammatory disease (PID)

If diagnosed at an early stage, PID can be treated with a course of antibiotics, which usually lasts for 14 days.

You’ll be given a mixture of antibiotics to cover the most likely infections, and often an injection as well as tablets.

It’s important to complete the whole course and avoid having sexual intercourse during this time to help ensure the infection clears.

Your recent sexual partners also need to be tested and treated to stop the infection coming back or being spread to others.

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