Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is an infection in a woman's pelvic organs, including the:
- Fallopian tubes
- Peritoneum (the membrane covering the abdominal cavity)
PID usually results from a sexually transmitted infection, such as chlamydia or gonorrhea. It is the most common cause of female infertility and ectopic pregnancy. Acute PID comes on suddenly and tends to be more severe, whereas chronic PID is a low-grade infection that may cause only mild pain and sometimes backache.
Signs and Symptoms
People who have PID may not have any symptoms. When symptoms do occur, they range from nonspecific complaints, such as abdominal pain to high fever and vomiting.
Acute PID is accompanied by the following signs and symptoms:
- Severe pain and tenderness in lower abdomen
- Vaginal discharge
- Abnormal uterine bleeding or tenderness
- Nausea and vomiting
Chronic PID is accompanied by the following signs and symptoms:
- Mild, recurrent pain in the lower abdomen
- Irregular menstrual periods
- Pain during intercourse
- Heavy, unpleasant smelling vaginal discharge
What Causes It?
PID occurs when bacteria from the vagina or cervix infiltrate the normally sterile pelvic organs. PID is most commonly caused by sexually transmitted diseases (STDs), such as chlamydia trachomatis and Neisseria gonorrhoeae.
Who is Most At Risk?
People with the following conditions or characteristics are at risk for developing PID:
- Frequent sexual encounters, many partners
- History of STDs or previous history of PID
- Young age (14 to 25 years old), particularly early age at first intercourse
- Vaginal douching
- Previous episode of gonococcal PID
- Intrauterine devices may increase the risk of PID during the first 20 days after insertion
What to Expect at Your Provider's Office
If you are experiencing symptoms associated with PID, see your health care provider. You may receive a combination of:
- A physical exam
- Lab tests
- Imaging tests, including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI)
Your doctor may also perform other procedures to make a diagnosis. In some cases, your physician may order laparoscopic evaluation. Laparoscopy offers physicians the ability to diagnose and treat PID simultaneously.
Barrier methods of birth control (condoms, diaphragms, and vaginal spermicides) reduce the risk of PID. Rapid diagnosis and effective treatment of lower urinary tract infections can help prevent PID from developing. Experts recommend routine screening for infections in high risk individuals.
Your health care provider may recommend hospitalization or outpatient treatment with follow up. Outpatient therapy consists of rest and medications, usually antibiotics. People being treated for PID should abstain from sexual intercourse throughout the course of treatment. It is essential to evaluate and treat male sex partners. It's important to initiate treatment immediately after diagnosis to prevent long-term complications.
Your provider may prescribe the following antibiotics or combination of drugs:
- Doxycycline combined with metronidazole (DO NOT drink alcoholic beverages with this medication)
- Ofloxacin combined with metronidazole (DO NOT drink alcoholic beverages with this medication)
- Cephalosporin with doxycycline
Surgical and Other Procedures
Some conditions, such as an abscess in the ovary or fallopian tube, may require surgery.
Complementary and Alternative Therapies
A comprehensive treatment plan for PID may include a range of complementary and alternative therapies. PID can lead to serious complications. You should use complementary therapies only in conjunction with conventional medical interventions. Keep all of your prescribing doctors informed about any supplements or therapies you may be using.
Nutrition and Supplements
- Eliminate potential food allergens, including dairy, wheat (gluten), corn, soy, preservatives, and food additives. Your provider may want to test for food sensitivities.
- Eat calcium-rich foods, including beans, almonds, and dark green leafy vegetables (spinach and kale).
- Eat antioxidant-rich foods, including fruits (blueberries, cherries, and tomatoes) and vegetables (squash and bell pepper).
- Avoid refined foods, such as white breads, pasta, and sugar.
- Use healthy cooking oils, such as olive oil or coconut oil.
- Reduce or eliminate trans fatty acids, found in such commercially-baked goods as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
- Avoid coffee and other stimulants, alcohol, and tobacco.
- Drink 6 to 8 glasses of filtered water daily.
You may address nutritional deficiencies with the following supplements:
- A multivitamin daily: containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
- Omega-3 fatty acids: such as fish oil, 1 to 2 capsules or 1 tbsp. of oil, 1 to 2 times daily, to help reduce inflammation. Fish oils may increase bleeding in sensitive individuals, such as those taking blood-thinning mediations (including aspirin).
- Probiotic supplement (containing Lactobacillus acidophilus): 5 to 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. If you have a weakened immune system, or take immunosuppressive medications, speak to your doctor before taking probiotics. Some probiotic supplements may need refrigeration. Check the label carefully.
- Grapefruit seed extract (Citrus paradisi): 100 mg capsule, or 5 to 10 drops (in favorite beverage), 3 times daily, for antibacterial or antifungal activity and immunity. Grapefruit products may potentially interact with a variety of medications. Speak with your doctor.
- Methylsulfonylmethane (MSM): 3,000 mg twice a day, to help reduce inflammation. Work with a physician before taking such a high dose of this supplement.
Herbs are one way to strengthen and tone the body's systems. As with any therapy, you should work with your provider to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.
- Green tea (Camellia sinensis) standardized extract: 250 to 500 mg daily, for antioxidant effects. You may also prepare teas from the leaf of this herb.
- Cat's claw (Uncaria tomentosa) standardized extract: 20 mg, 3 times a day, for inflammation and antibacterial or antifungal activity. Cat's claw may interfere with certain medications, including blood pressure medications. There is some concern about taking Cat's claw if you have leukemia or an autoimmune disease. Speak with your doctor.
- Bromelain (Ananus comosus) standardized: 40 mg, 3 times daily, for pain and inflammation. Bromelain may increase bleeding in sensitive individuals, such as those on blood-thinning medications, including aspirin.
- Reishi mushroom (Ganoderma lucidum): 150 to 300 mg, 2 to 3 times daily, for inflammation and immunity. You may also take a tincture of this mushroom extract, 30 to 60 drops 2 to 3 times a day. In high doses, reishi may increase bleeding in sensitive individuals, such as those taking blood-thinning medications, including aspirin.
- Olive leaf (Olea europaea) standardized extract: 250 to 500 mg, 1 to 3 times daily, for antibacterial or antifungal activity and immunity. You may also prepare teas from the leaf of this herb. Olive leaf may lower both blood sugar and blood pressure; use caution if you have these conditions.
Castor Oil Packs
Dampen a cloth with castor oil, and apply to the abdomen. Cover with saran wrap, then apply a heating pad over this pack. Used for half an hour with a heating pad, or for up to 3 hours without a heating pad. Castor oil packs can reduce cramping and pain in some people. DO NOT use caster oil packs during the acute phase of PID. If you use castor oil packs more than 3 days in a row, you may want to take a day off before continuing. Work with a physician to determine the best schedule for you.Acupuncture
Acupuncture may help enhance immune function and reduce pain and inflammation, especially in women with chronic PID. Acupuncturists often target their protocols to draining what they call "Damp Heat" from the area. This is done using both acupuncture and Chinese herbal preparations.
Prognosis and Possible Complications
In 85% of cases, the initial treatment succeeds. In 75% of cases, people do not experience a recurrence of the infection. However, when there is a recurrence, the likelihood of infertility increases with each episode of PID. Potential complications from PID include:
- A tubo-ovarian abscess
- Fallopian tube obstruction, which can result in ectopic pregnancy or infertility
- Chronic pelvic pain
- Sexual dysfunction
- Heart attack, preliminary studies suggest that people with PID are at higher risk of a heart attack than those without PID.
Your health care provider will schedule a follow up visit 48 to 72 hours after treatment is started to assess your response to the medications. If you are diagnosed with PID, you should inform any sexual partners so that they can be examined and treated if the infection has been transmitted.
Bope and Kellerman: Conn's Current Therapy 2014. 1st ed. Philadelphia, PA: Elsevier Saunders. 2013.
Bouquier J, Fauconnier A, Fraser W, Dumont A, Huchon C. Diagnosis of pelvic inflammatory disease. Which clinical and paraclinical criteria? Role of imaging and laparoscopy? J Gynecol Obstet Biol Reprod (Paris). 2012; 41(8):835-49.
Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.
Crossman SH. The challenge of pelvic inflammatory disease. Am Fam Physician. 2006;73(5):859-64.
Cvetnic Z, Vladimir-Knezevic S. Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm. 2004;54(3):243-50.
Das M, Sur P, Gomes A, Vedasiromoni JR, Ganguly DK. Inhibition of tumor growth and inflammation by consumption of tea. Phytother Res. 2002;16 Suppl 1:S40-4.
Ferri: Ferri's Clinical Advisor, 2015. 1st ed. Philadelphia, PA: Elsevier Mosby. 2014.
Gonclaves C, Dinis T, Batista MT. Antioxidant properties of proanthocyanidins of Uncaria tomentosa bark decoction: a mechanism for anti-inflammatory activity. Phytochemistry. 2005;66(1):89-98.
Haggerty CL, Ness RB. Epidemiology, pathogenesis and treatment of pelvic inflammatory disease. Expert Rev Anti Infect Ther. 2006;4(2):235-47.
Hale LP, Greer PK, Trinh CT, James CL. Proteinase activity and stability of natural bromelain preparations. Int Immunopharmacol. 2005;5(4):783-93.
Heggers JP, Cottingham J, Gussman J, et al. The effectiveness of processed grapefruit-seed extract as an antibacterial agent: II. Mechanism of action and in vitro toxicity. J Altern Complement Med. 2002;8(3):333-40.
Heitzman ME, Neto CC, Winiarz E, Vaisberg AJ, Hammond GB. Ethnobotany, phytochemistry and pharmacology of Uncaria (Rubiaceae). Phytochemistry. 2005;66(1):5-29.
Ibarrola Vidaurre M, Benito J, Azcona B, Zubeldia N. Infectious pathology: vulvovaginitis, sexually transmitted diseases, pelvic inflammatory disease, tubo-ovarian abscesses. An Sist Sanit Navar. 2009;32,Suppl 1: 29-38.
Jaiyeoba O, Lazenby G, Soper DE. Recommendations and rationale for the treatment of pelvic inflammatory disease. Expert Rev Anti Infect Ther. 2011;9(1):61-70.
Jaiyeoba O, Soper DE. A practical approach to the diagnosis of pelvic inflammatory disease. Infect Dis Obstet Gynecol. 2011;2011:753037.
Lareau S, Beigi R. Pelvic Inflammatory Disease and Tubo-ovarian Abscess. Infectious Disease Clinics of North America. 22(4).
Lentz: Comprehensive Gynecology. 6th ed.Philadelphia, PA: Elsevier Mosby. 2012.
Liou TH, Wu CW, Hao WR, Hsu MI, Liu JC, Lin HW. Risk of myocardial infarction in women with pelvic inflammatory disease. Int J Cardiol. 2013; 167(2):416-20.
Long: Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Philadelphia, PA: Churchill Livingstone, 2008. Ch. 56.
Martinez F, Lopez-Arregui E. Infection risk and intrauterine devices. Acta Obstet Gynecol Scand. 2009;88(3):246-50.
Risser JM, Risser WL. Purulent vaginal and cervical discharge in the diagnosis of pelvic inflammatory disease. Int J STD AIDS. 2009;20(2):73-6.
Soper DE. Pelvic inflammatory disease. Obstet Gynecol. 2010;116(2 Pt1): 419-28.
Trent M, Haggerty CL, Jennings JM, Lee S, Bass DC, Ness R. Adverse adolescent reproductive health outcomes after pelvic inflammatory disease. Arch Pediatr Adolesc Med. 2011; 165(1):49-54.
Woods JL, Scurlock AM, Hensel DJ. Pelvic inflammatory disease in the adolescent: understanding diagnosis and treatment as a health care provider. Pediatr Emerg Care. 2013; 29(6):720-5.
Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.
Review Date: 12/9/2014
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.