Pelvic Inflammatory Disease (PID), Vaginal Discharge,

Pelvic Inflammatory Disease (PID), bacterial infection of the upper female genital tract, including the uterus, fallopian tubes, and ovaries. PID can be caused by several different aerobic (oxygen-requiring) and anaerobic (non-oxygen-requiring) bacteria. The two most important such bacteria are Neisseria gonorrhoeae, the bacterium that causes gonorrhea, and Chlamydia trachomatis, the bacterium that causes chlamydia. These bacteria are usually transmitted through sexual intercourse with an infected partner. In the United States approximately 1 million women receive treatment for PID each year. The incidence is highest among sexually active women under the age of 25.

The usual symptoms of acute PID are fever, chills, lower abdominal and pelvic pain, and vaginal discharge or bleeding. These symptoms often begin a few days after the start of a menstrual period (see Menstruation), particularly when Neisseria gonorrhoeae is the cause of infection. Infections due to Chlamydia trachomatis usually progress more slowly than those caused by Neisseria gonorrhoeae. On physical examination by a doctor, the uterus, ovaries, and fallopian tubes of the infected person are usually tender. In severe cases, an abscess may be present in the pelvis. Complications from PID occur in one out of four infected women and include tuboovarian abscess, Fitz-Hugh-Curtis syndrome (inflammation surrounding the liver), chronic pelvic pain, and occasionally death. In addition, PID is the single most important risk factor for ectopic pregnancy (see Pregnancy and Childbirth: Complications) and one of the most common causes of female infertility.

PID is usually diagnosed on the basis of existing symptoms, physical examination by a doctor, the presence of an elevated white-blood-cell count, and a positive bacterial culture of the cervical discharge. In some instances, PID may be confused with other illnesses, such as appendicitis and a twisted or ruptured ovarian cyst. In these situations, laparoscopy may be necessary to make the correct diagnosis. During this procedure, a fiber-optic telescope (see Fiber Optics) is placed through a small incision made beneath the navel, enabling the doctor to view the infected pelvic organs. Ultrasound may also be used to identify a pelvic abscess.

Antibiotic therapy is the usual treatment for PID. Most women take oral antibiotics such as intramuscular ceftriaxone, and oral doxycycline and metronidazole for a period of 10 to 14 days, after which they are cured. Women who are severely ill are usually treated with intravenous antibiotic therapy in the hospital. A woman's sexual partner should also be treated with antibiotics.

Because the potential complications of PID are so dangerous, preventing its onset is of great importance. Barrier contraception with spermicidal foam and condoms provides some protection against the infectious organisms that cause PID (see Birth Control: Birth Control Methods). However, abstinence or a monogamous sexual relationship with an uninfected partner are the most reliable means of avoiding sexually transmitted infections and their long-term complications.