Risk Factors for PID
Risk factors increase the chance of developing PID. For example, women who use an IUD as a form of birth control are at a greater risk for PID. This does not mean that IUDs cause PID, but that women who use them are more likely to develop the condition. Researchers have identified several risk factors for PID:
- History of STDs, especially gonorrhea and chlamydia
- Prior episodes of PID
- Age: Sexually active teens are 3 times more likely to develop PID than women 25 to 29 years old.
- Multiple sex partners: The greater the number of partners, the greater the risk, due to the increased risk for cervical infection. In one study, women who had 4 or more partners in 6 months were 3.4 times more likely to develop PID than women with one sexual partner.
- Frequent sex: Women who have frequent sexual intercourse are at increased risk for infection and PID.
- IUD: Women who use an IUD for birth control are 3.5 times more likely to develop PID, especially during the first 4 months after insertion. Some studies indicate that the increased risk exists only in women who are also at risk for STDs (e.g., women who have multiple partners). Experts advise that IUDs can be used safely in monogamous relationships.
- HIV infection: It is estimated that as many as 7 to 22 percent of the 1 million women who develop PID every year are also infected with HIV. Women with HIV are more susceptible to lower genital tract infections, which can spread into the pelvis, increasing the risk for PID.
PID is usually more severe and more difficult to treat in women with HIV infection because HIV hampers the immune system's ability to fight infection. HIV-infected women are more likely to require surgical treatment for PID. Women with HIV should have regular Pap smears to screen for vaginal and cervical infections.
Women infected with HIV should not use an IUD (intrauterine device), because the IUD provides a direct route for bacteria to enter the upper reproductive tract.
Signs and Symptoms of PID
The main symptom of PID is persistent moderate to severe lower abdominal pain. Other symptoms include the following:
- Increased or abnormal vaginal discharge, with or without odor
- Bleeding between periods and/or irregular periods
- Difficulty conceiving (infertility)
- Painful menstruation, with symptoms that worsen with consecutive periods
- Frequent, painful urination
- Pain during and after sexual intercourse
- Pain in the upper right abdomen
- Painful bowel movements
Many women, however, do not have symptoms and are unaware that PID is developing. This is especially common in PID resulting from chlamydial infection.
PID is difficult to diagnose because the symptoms may be caused by other conditions. Although laparoscopy is the definitive method for diagnosing PID, it is an invasive and often unnecessary surgical procedure. It is usually only done to confirm the diagnosis or to evaluate complications, such as a tuboovarian abscess. Most cases are diagnosed on the basis of a simple pelvic examination and cervical culture.
During a pelvic examination, the doctor or other health care provider tries to locate the pain and swelling. A sample ("culture") of fluids from the vagina and cervix is collected and sent to a laboratory to be examined for sexually transmitted infection, especially chlamydia or gonorrhea. Cervical and vaginal white blood cells in the culture can also indicate PID.
If the physical examination suggests PID, treatment should begin immediately.
Laparascopy is an exploratory surgical procedure that involves inserting a tube through a small incision in the lower abdomen. The tube is attached to an optical system that allows the surgeon to see internal abdominal and pelvic tissues. Instruments can be attached to take a biopsy. A biopsy is a very small sample of infected or inflamed tissue that is sent to a laboratory for microscopic evaluation.
Ultrasound may be used to locate suspected abscesses associated with PID.