• Pelvic Inflammatory Disease: A Guide

    Pelvic inflammatory disease, often simply referred to as PID, is the name given to a complex infection that has an impact on the lives of millions of women all over the world. PID should be seen as a spectrum of infections of the reproductive tract, and considered to be a dynamic and progressive condition that is able to move from the cervix into the uterus in a rapid fashion, and which can also involve the ovaries and the fallopian tubes.

    Causes and consequences

    When the disease takes a progressive route, the results can be devastating for the reproductive tract, and the overall reproductive capabilities of those women who are affected by it. One of the biggest problems is that, on many occasions, there are no symptoms associated with the disease, which means that women will have no idea that they are even infected – let alone that their reproductive capability may have been seriously compromised. 

    The primary causes of the disease are Neisseria gonorrhoeae and Chlamydia trachomatis, pathogens that are transmitted by sexual activity. Micro-organisms connected to bacterial vaginosis and Mycoplasma genitalium also play a significant role in the development of pelvic inflammatory disease, and are increasingly sought after for the purposes of microbiological evaluations. 

    Because of the potential for extremely serious consequences of the disease, all medical staff involved in women’s healthcare, such as the likes of gynaecologists, general practitioners and obstetricians, but also residents in training and nurses, have a big role to play in helping with prevention, and offering appropriate treatment for pelvic inflammatory disease.

    Pelvic inflammatory disease: Epidemiology

    Because pelvic inflammatory disease does not meet the definition of a reportable disease, it can be hard to gain an accurate oversight of the amount of women who suffer from the condition on a yearly basis. In the USA, the Centers for Disease Control and Prevention use hospital discharge and outpatient codes for the purposes of analysis, and have determined that, on average, there are over 750,000 women experiencing at least one episode of acute pelvic inflammatory disease per annum.

    PID is also a very common reason for many emergency department visits in the United States, with 60,000 hospitalisations and 106,000 outpatient visits each year. There are substantial financial implications to the disease too, with therapy costs for every woman infected adding up to about $2000 and possibly even going as high as $6000, in cases which involve chronic pelvis pain. 

    Early detection would obviously be desirable, but the problem is there is no accurate, cheap and simple diagnostic test for pelvic inflammatory disease, nor is there a single infection as the cause, or pathognomonic symptoms and signs. The difficulty of detection is further increased by the fact that the female upper genital tract is inaccessible to large and routine diagnostic techniques. African-American women develop the disease at two or three times the rate of Caucasian women, a figure also consistent with the racial disparities noted for both chlamydia and gonorrhoea. However, the subjectivity that tends to go along with the diagnosis of PID means such data could be flawed. 

    Another rather crude marker of this phenomenon is the rate of hospital admissions in countries that are poor in resources. Between 17 and 40 percent of hospital admissions for gynaecological reasons in sub-Saharan Africa are attributable to PID, as are 37 percent in Southeast Asia, and between 3 and 10 percent in India.

    Risk factors

    Young women who have had multiple partners are at the greatest risk of developing pelvic inflammatory disease, with most cases seen in women between the ages of fifteen and 29. The risk of successive episodes also increases after previous instances of suffering the disease. 

    Intrauterine devices have long been considered as the primary cause of PID, but today it is known that the use of modern devices only carries it with a margin of additional risk. The risk of pelvic inflammatory disease developing is also increased by refraining from using barrier methods of contraception and condoms, with some studies also demonstrating that combined oral contraceptives can have a protective effect. Although current studies indicate they not cut down on the chances of developing PID, there is evidence to suggest that they considerably reduce the seriousness of the infection.