Most often, PID does not produce any signs and symptoms in the early stages. When the disease progresses to more advance stages, the following symptoms are evident [7]:

• Fever
• Pain during intercourse
• Heavy menstrual bleeding
• Irregular menstrual cycle
• Foul smelling vaginal discharge
• Pain in the pelvic and lower abdomen
• Pain while urinating 
• Increase in the frequency of urination 

In addition to the above mentioned symptoms, affected women would also experience nausea, vomiting, tiredness, bleeding after intercourse and poor appetite [8]. 

Various tests are indicated to confirm PID as well as to evaluate the extent of spread of the disease condition. The following methods are carried out to diagnose the condition [9]:

• Physical examination: A preliminary physical examination to study the signs and symptoms of the disease is done. A thorough pelvic examination is also carried out to study tenderness in the uterus, ovaries or fallopian tubes. Pelvic examination would also reveal bleeding from the cervix, pain in the cervix and presence of fluid discharge from the area.
• Laboratory tests: Samples from the cervix and vagina are collected through swabs to test for the type of organism involved. In addition, various laboratory tests such as WBC count, erythrocyte sedimentation rate and C-reactive protein tests will be conducted to check for signs of infections.
• Ultrasound: Imaging studies such as ultrasound examination would provide knowledge on the extent of spread of the infection to the reproductive organs.
• Endometrial biopsy is done for further analysis of PID.

The following methods are employed for treatment of PID [10]:

• Antibiotic medications: Upon diagnosis, the patient is put on an antibiotic regime. Based on the lab results confirming the causative organism, the dosage or the type of antibiotic to be administered is decided.
• Partner’s treatment: The partner of the affected woman would also require treatment. This is essentially done to prevent reinfection of the disease. 
• Practice abstinence: It is necessary to avoid sexual intercourse until laboratory tests reveal that both the partners are not carrying any more pathogenic organisms.
• Surgery is rarely indicated in patients with PID. However when antibiotics fail to work or an abscess ruptures then surgery may be necessary.

The prognosis of the condition would gravely depend on when the diagnosis was made and treatment initiated. Many women with PID are completely unaware of the fact that they are living with a disease condition unless they experience severe symptoms. In such conditions, PID progresses to the advance stages causing chronic pelvic pain, infertility or ectopic pregnancy [6].

Sexually transmitted infections are the most common cause of PID. The bacteria responsible for causing such a kind of infection are gonorrhea and chlamydia. Statistical data has shown that, 10 to 20% of untreated infections caused by gonorrhea and chlamydia can progress to pelvic inflammatory disease [2]. However, these bacteria can also gain entry to the body during the process of childbirth, abortion, miscarriage and endometrial biopsy. Women who get an intrauterine device (IUD) inserted are also at an increased risk of contracting infection from the bacteria [3].

In addition to gonorrhea and chlamydia, other organisms that are responsible for causation of PID include streptococcus agalactiae, trichomonas vaginalis, ureaplasma urealyticum, mycoplasma hominis and herpes simplex virus 2 to name a few.

The incidence of pelvic inflammatory disease is on the rise owing to increase in number of cases related to sexually transmitted diseases. It has been estimated that about 1 in every 8 women who are younger than 20 years and are sexually active will develop PID. In the United States, about 1 million women suffer from PID each year. The disease causes about 2.5 million outpatient visits and 125,000 to 150,000 hospitalization every year. The rate of pelvic inflammatory amongst the high income population is known to be about 10 to 20 per 1000 women in the reproductive age group. The annual expense of PID has been calculated to be about $2 billion [4].

Pelvic inflammatory disease is thought to occur in 2 distinct stages. The primary stage, wherein the vaginal infection is acquired through sexually transmitted disease. In the secondary stage, the bacteria travel from the vagina to the reproductive organs causing infection and inflammation of the concerned organs. The exact mechanism that triggers such sequence of events is still not well understood.

Under normal conditions, the travel of the bacteria or spread of the infection to the upper genital tract is prevented by the mucus barrier of the cervix. However, certain factors such as vaginal inflammation and hormonal changes that occur during menstruation may decrease the effectiveness of the functional barrier of the cervical mucus [5].

Following are the several ways by which the risk of contracting PID can be significantly reduced:

• Women are advised to practice safe sex and limit number of partners. Use of proper contraception can also help decrease the risk of contracting infections.
• Women who are sexually active should regularly get screened for sexually transmitted diseases. They should also get their partners regularly tested for sexually transmitted infections. This would go a long way in prevention of PID.
• Douching upsets the balance of vaginal microflora. Such a practice should therefore be discouraged.

Pelvic inflammatory disease (PID) occurs when sexually transmitted disease is left untreated as a result of which an infection spreads from the vagina to the uterus, fallopian tubes and ovaries. The disease seldom produces any signs and symptoms and is diagnosed in the later stages when the affected woman complains of pelvic pain or is facing difficulty in conceiving [1].

Definition

Pelvic inflammatory disease (PID) is defined as a condition wherein the female reproductive organs undergo inflammation due to infection. It is a common phenomenon for sexually active females under 20 years of age. Sexually transmitted infections can predispose women to contract PID.

Cause

Bacterial infections responsible for causing sexually transmitted diseases are the most common cause of PID. Bacteria such as gonorrhea and chlamydia cause PID.

Symptoms

Symptoms of PID include pelvic pain, pain in the lower abdominal region, foul vaginal discharge, increased urge to urinate, pain during urination, pain during intercourse and irregular menstruation. In addition, affected women also suffer from fever, nausea and loss of appetite.

Diagnosis

Preliminary examination of pelvic region through imaging studies and physical examination is required to evaluate the underlying condition. Laboratory tests and swabs from cervix are carried out to determine the causative organism.

Treatment

PID is treated through antibiotic course. Surgery is seldom required, but in case when antibiotics did not work or an abscess has ruptured it becomes a necessity.

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