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All you need to know about Pelvic Inflammatory Disease and possible causes

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A friend, who will be anonymously referred to as Alice Brown, recently shared with me how she was diagnosed with a disease she is unaware of. She reported that a hospital’s laboratory attendant informed her after taking a test that she had PID, which she later discovered was sexually transmitted. 

This finding confused Ms Brown because she was not sexually active. She thought it must have been a mistake as she pondered the possible causes.

What is PID?

PID stands for Pelvic Inflammatory Disease, an infection of the female reproductive organs. The pelvis is in the lower abdomen that includes the fallopian tubes, ovaries, cervix and uterus.

Causes of PID

Several types of bacteria can cause PID, including the same bacteria that cause sexually transmitted infections (STIs), gonorrhoea and chlamydia. This happens when the bacteria enters the vagina, resulting in an infection. With time, this infection can then move into the pelvic organs. If the infection spreads to the blood, PID can become extremely dangerous, even life-threatening.

The risk for PID increases if there is already a cause of gonorrhoea or chlamydia. However, you can develop PID without ever having an STI.

All you need to know about Pelvic Inflammatory Disease and possible causes
Picture of the Female Pelvis. Image source: Healthwise.

What increases the risk of having PID

  • Sexual activity

The risk factor for PID includes having a partner with a history of PID or a sexually transmitted infection. 

  • Douching 

Douching is the process of intravaginal cleansing with a liquid solution. It alters the typical vaginal environment, and the organisms naturally give way to harmful ones. Douching could introduce the infection to the upper genital tract.

  • Gastroenteritis

Another risk factor is Gastroenteritis, a short-term illness triggered by the infection and inflammation of the digestive system. 

  • Use of Public Toilets

Another risk factor is public toilets. It is possible to contract germs when the toilet seat is contaminated. Contracting bugs such as E-coli or Salmonella in public restrooms is also possible. Diseases contracted in public toilets include gastroenteritis, diarrhoea and worm infestation. Some of these diseases can lead to PID when left untreated in women. 

Symptoms of PID

Pelvic inflammatory disease can cause mild or moderate pain. While some women with PID don’t have symptoms, those who do experience pain in the lower and upper abdomen, fever, painful sex and urination, irregular bleeding, tiredness and increased or foul smell from the vaginal discharge.

When it is severe, some women experience fainting, sharp pain in the abdomen, vomiting and high fever. It is advisable to see a doctor immediately because the infection can spread to the bloodstream or other body parts. 

Tests for PID

To test for PID, your doctor may diagnose PID after hearing your symptoms, but in most cases, your doctor will run tests to confirm the diagnosis.

These tests include pelvic exams to check the pelvic organs, cervical culture to check your cervix for infections, and urine tests to check your urine for signs of blood, cancer and other diseases.

Treatment for PID

The treatment of PID addresses the relief of acute symptoms, eradication of current infection and minimisation of the risk of long-term sequela. Most women with a clinical diagnosis of PID have mild to moderate severity symptoms that usually respond well to outpatient oral antibiotic therapy. 

Hospitalisation is usually warranted for women who are more severely ill or patients in whom surgical emergencies (e.g., appendix) cannot be excluded. It is also needed for pregnant patients who have not responded well to outpatient oral therapy. Patients with tubo-ovarian abscesses are often hospitalised.

Expert Opinion

According to Jeremiah Agim, a gynaecologist and senior consultant at the National Hospital Abuja, a person can contact PID in other ways. 

He noted that finding fluid in the pouch of Douglas on ultrasound does not always translate to the presence of PID. The fluid could come from the mature egg during egg release at ovulation, or it could also be menstruation. 

“Most PID cases are caused by sexually transmitted pathogens or bacterial vaginosis-associated pathogens. Sexually transmitted organisms do not cause a smaller proportion of acute PID cases; instead, they are associated with pathogens from the intestine that have colonised the lower genital tract or respiratory pathogens.” He added that PID frequently involves multiple bacterial infections. 

Another gynaecologist at Garki Hospital, Doctor Sunday Idoko, added that for PID to occur, something must carry the infection from the lower genital tract to the upper genital tract. So the risk factor includes sexual intercourse, multiple sexual partners, douching, immunosuppression, and septic abortion. 

When asked if it’s possible for someone who has never had sex to get infected, he said: “In PID, the single most important risk factor is sexual intercourse, but PID has also been reported in virgins.”

Conclusion

Apart from sex being the most prevalent cause of PID, published research and oral evidence from experts have shown that multiple bacteria can also cause PID. 

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