I would like to get tested for
chlamydia just to be sure. how long
does it take before it causes
pelvic inflamatory disease or any
other problems if left untreated?
thanks!
Pelvic inflammatory
disease (PID) affects thousands of
women every
year, yet many
women have never heard of it. Caused by bacteria in the internal
reproductive organs,
PID can be
treated successfully with
antibiotics when dealt with quickly. Without prompt diagnosis and
treatment, however,
PID can lead to long-term complications, including
infertility,
chronic pain and recurring
PID. Unfortunately, there are often no obvious
symptoms and, even when there are,
women may be misdiagnosed or their
symptoms dismissed as 'normal'
period pain. These information pages explains what
PID is, what causes it, how to
treat it and what you can do to
help prevent it.
Pelvic inflammatory
disease (PID) is the
term used to describe any
infection in a woman’s upper genital tract or
reproductive organs. An
infection can
develop in the
fallopian tubes (salpingitis),
ovaries (oophoritis), lining of the womb (endometritis), the
pelvic tissue surrounding the
reproductive organs (peritonitis), or a combination of these. When
diagnosed early,
PID can be successfully
treated with
antibiotics and rest.
If
PID goes
untreated, it can lead to serious long-term complications, including
chronic pelvic pain, ectopic pregnancy (when an embryo begins to
develop in the
fallopian tube) or
infertility. Unfortunately, many
women don’t know they have
PID until permanent
damage has been done.
The
symptoms of
PID vary from
woman to
woman, and some
women have no obvious
symptoms at all. When
symptoms are present, they may include:
* dull
pain in the lower abdomen (on one
side or both) that may get
worse when you walk or
move about
*
pain during or after sex
*
bleeding between periods or after sex
* lower back
pain (either dull or
sharp)
* a sense of pressure or swelling in the lower abdomen
* fever (often with chills)
* feeling
tired or unwell
* abnormal vaginal
discharge
* nausea, vomiting and dizziness
* leg
pain
* increased
period pain
* increased
pain at ovulation
*
burning or
pain when urinating
urinating more frequently than
usual, or feeling that you can’t empty your bladder
Symptoms may appear suddenly, they may come and go, or they may be constant. Many
women first notice
symptoms of
PID during, or just after, their
period. If you are concerned that you may have
PID, or if you have more than one of the
symptoms listed above, talk to your doctor or go to a GUM (genito-urinary
medicine) clinic. See Resources for more information.
PID develops when bacteria (germs) get into a woman’s internal
reproductive organs. There are a number of ways this can happen. The internal
organs are usually protected by the
cervix, which blocks bacteria in the vagina from moving up into the womb. But when the
cervix is
open (e.g. during menstruation or at ovulation), or if the
cervix itself becomes infected, bacteria have a greater
chance of getting through and causing
infection. Bacteria may also get into the
reproductive organs during
pelvic surgery or invasive procedures that disrupt the
cervix, such as
abortion, childbirth or insertion of an IUD (intra-uterine device). Bacteria from severe appendicitis can lead to
PID if it spreads to the
pelvic tissues, but this is uncommon.
PID can be caused by many types of bacteria, but most cases are caused by the bacteria from
Chlamydia trachomatis and Neisseria
gonorrhoea, two sexually transmitted infections (STIs). Both infect a woman’s
cervix and can
damage its surface, making it easier for bacteria to get to the internal
reproductive organs.
Chlamydia —
Chlamydia is one of the most
common sexually transmitted infections in the world, and in the UK, it is the number one cause of
PID. It is estimated that as many as one in
ten sexually active
women under the age of 25 may be infected with
chlamydia, and while it is less
common in
older age groups, the number of cases in people over 25 is on the rise.
Chlamydia can
live in the
body without causing any
symptoms for
months or
years. Up to 70% of
women and 50% of
men with
chlamydia have no noticeable
symptoms, but when
symptoms are present, in
women they are:
*
pain or burning when urinating * abnormal vaginal discharge * bleeding between periods It is estimated that 40% of
women who have
chlamydia will
develop PID.
PID caused by
chlamydia often
produces very mild
symptoms, if any at all (called silent or subclinical
PID). This does not mean the
infection is less serious than other
forms of
PID, but does mean that the
infection may go undetected until permanent
damage has been done.
Gonorrhoea — Like
chlamydia,
gonorrhoea is found most commonly among teenagers and those in their 20s, but recent public health figures show an increase in
gonorrhoea among 35 to 44 year-olds. Up to 50% of
women (and 10% of
men) who become infected with
gonorrhoea have no
symptoms. But when
symptoms do occur, in
women they are:
*
yellow or
greenish vaginal
discharge
*
pain or
burning when urinating?
*
PID caused by bacteria from
gonorrhoea tends to cause sudden and severe
symptoms, including high fever and abdominal
pain (called
acute PID)
Other bacteria commonly found in the vagina can lead to
PID if they get past the
cervix and into the internal
reproductive organs. This is most likely to happen if your
cervix has been damaged, if you have had
PID before, or if your
cervix is opened during a surgical procedure.
Pelvic surgery — Any surgery carries the risk of
infection, and
pelvic surgery is no exception. Bacteria may be introduced from the outside or may be
spread internally from one organ to another.
diagram
showing IUD in place
IUD (intra-uterine device) — When the
cervix is opened to insert an IUD, bacteria from the vagina have an opportunity to get into the womb.
Studies show that the risk of developing
PID is increased for about one
month following IUD insertion.
Childbirth, miscarriage and
abortion — The
cervix is dilated (opened) during vaginal childbirth, miscarriage and
abortion, and this creates an opportunity for bacteria to make their way into the internal
reproductive organs.
Before undergoing any procedure that disturbs the
cervix, you should be screened for
chlamydia, even if you are in a monogamous
relationship or think you are unlikely to have
chlamydia.
Sexually active
women under the age of 25 have the highest risk of developing
PID, with most cases occurring in teenagers. This may be because young
women are more likely than
older women to have multiple sexual partners and practice unsafe sex – two high risk behaviours for getting
PID (see below). Another age-related factor that may influence the development of
PID is
cervical mucus. Thick
cervical mucus can protect the
cervix from some
forms of bacteria (such as
gonorrhoea), but young
women in their teens tend to have thin
mucus that is less protective.
Sexual activity — Having multiple sexual partners is one of the main risk factors for developing
PID. The more partners you have penetrative sex with, the more likely you are to be exposed to bacteria that can lead to
PID, particularly if you are not using barrier contraception – a condom, femidom, diaphragm or
cervical cap with spermicide. The rate of
PID is lower among
lesbians than heterosexual
women, and this is probably related to a lower incidence of the STIs that can lead to
PID. Some
studies suggest that having sex during your
period may increase your
chances of developing
PID. This is believed to be because the
cervix is
open during menstruation and the presence of
blood may
help some bacteria to multiply.
IUD — The IUD was once
thought to increase a woman’s risk of
PID significantly, but recent research suggests it may be the
process of inserting the IUD that increases risk, not the IUD itself. Current
studies show that risk is increased mainly during the
month following insertion, and after that, risk is related more to sexual activity and
exposure to STIs than to the use of an IUD.
The
Pill — There is conflicting information about whether the
Pill increases or decreases a woman’s risk of
PID. The
Pill does not protect against sexually transmitted infections, but it does have a thickening effect on
cervical mucus that may prevent some bacteria from getting through the
cervix.
Other risk factors — Once you’ve had
PID, you have an increased risk of getting it again. Smoking, douching and cocaine-use also have been linked to an increased risk of
PID, but more research is needed to investigate these links.
The best way to prevent
PID is to protect yourself from sexually transmitted infections.
Always use a barrier method of contraception during sex. Condoms and femidoms offer the most protection when used correctly and consistently. A diaphragm or
cervical cap (used with a spermicide) may also
help prevent
gonorrhoea and
chlamydia, but not other STIs.
Get regular sexual health check-ups. This will
help to ensure timely diagnosis and
treatment of STIs. Screening for
gonorrhoea and
chlamydia, however, is not always part of a routine check-up. Tell the doctor or nurse if you want to be tested for
chlamydia and
gonorrhoea.
Make sure you are tested for
chlamydia and
gonorrhoea before any procedure that opens the
cervix (for example:abortion, IUD insertion, vaginal childbirth).
Studies show that
treatment of
PID is most effective when
started early – within two
days of first noticing
symptoms. Unfortunately,
pelvic inflammatory
disease is difficult to diagnose and this often delays
treatment. There is no simple, standard procedure to
test for
PID, and because
symptoms may be mild or non-existent, it can go unnoticed for
months or
years. Even when there are
symptoms, many
women are so used to experiencing discomfort or
pelvic pain with their periods that abdominal
pain (the main symptom of
PID) may be dismissed – by themselves or their GPs – as nothing out of the ordinary. It may be only when
pain becomes severe or incapacitating that
women seek
help or are taken seriously.
Without a definitive
test for
PID, most cases are
diagnosed based on reported
symptoms (what you tell your doctor) and the results of an internal
pelvic examination. This involves the doctor inserting two fingers into your vagina while pushing gently on your abdomen with the other hand. If this is painful for you, it is considered highly likely that you have
PID.
You may be given
antibiotics immediately – a delay of just a few
days may be enough
time for the
infection to cause serious
damage. Your doctor may also want to confirm the diagnosis with other
tests.
This is done routinely at GUM clinics when
PID is suspected, but may not be done automatically by your GP. The doctor (or nurse) will take a sample (swab) of
mucus from your vagina,
cervix and/or urethra. Some clinics and GPs may offer
urine screening instead of, or in addition to, the
swab tests. If the
test results show signs of
chlamydia or
gonorrhoea, it will back up the initial diagnosis and mean you almost certainly have
PID. But even if the
test is negative, you may still have
PID caused by another type of, or undetected, bacteria.
Blood tests may be used to support a diagnosis of
PID. Some
tests look for increased
white blood cells – a sign that the
body is fighting an
infection. A
positive result, however, doesn’t mean you have
PID (your
body may be fighting a different type of
infection), and a negative result doesn’t mean you don’t have
PID (if your
body is fighting a very low-level
infection it may not show up on the
blood test). Another type of
blood test looks for signs of pregnancy. Some
symptoms of
PID are the same as those of an ectopic pregnancy and
misdiagnosis could be fatal.
In some cases, an ultrasound scan is used to look for swelling or an abscess (infected pocket of pus) in the internal
reproductive organs. An ultrasound uses sound waves to produce an image of your internal
organs and this may be done abdominally or vaginally. For an abdominal scan, the doctor simply moves the probe over your belly. The scan itself is not painful, but you need to have a full bladder during the procedure and this may be uncomfortable.
If you have a vaginal scan, a small probe will be put into your vagina. You do not need a full bladder for this type of ultrasound, but the procedure may be a little uncomfortable.
A laparoscopy is a minor surgical procedure that enables the doctor to look directly at the internal
organs, and if necessary, take a
tissue sample to
test for bacteria. Laparoscopy is considered the most reliable way to diagnose
PID, but is generally only used as a last resort, when
treatment is not working.
Laparoscopy is done in hospital under general or local
anaesthetic, and usually takes about 30 minutes. During the procedure, the doctor makes a small cut just below your belly button and inserts a very thin telescope (the laparoscope). Another small instrument is inserted to
move your
organs around. This may be inserted through a second incision above your pubic hair or through your vagina. The doctor can then look for signs of
infection, such as swelling, inflammation or
scar tissue. If a
tissue sample needs to be taken, this will be done through an additional incision. As laparoscopy examines the outside of the
organs, however, it may not detect infections
inside the womb or
low level infections that aren’t causing visible swelling.
A recent study in Finland suggests that magnetic resonance imaging may be able to diagnose
PID as accurately as laparoscopy, but without the need for surgery. MRI is not currently used to diagnose
PID, but if other
studies support its effectiveness, it may be a new way to
help diagnose
PID accurately and early.
If you think your
symptoms are not being taken seriously by your doctor, you may want to try a GUM clinic. They specialise in sexual health and genito-urinary
medicine and are likely to have more experience of dealing with
PID. See Resources for more information.
PID almost always involves more than one type of bacteria, and therefore is
treated with a combination of at least two
antibiotics. Specific combinations may vary, but
treatment is likely to be:
* a course of two or more
antibiotics taken orally twice a day for at least 14
days, or
* an injection of
antibiotics followed by a course of
antibiotics taken orally twice a day for 14
days.
Antibiotics prescribed for
PID include ofloxacin,
metronidazole, doxycycline, ceftriaxone (injection), and cefoxitan (injection) plus probenecid. There is some evidence to suggest that
treatment with doxycyline and
metronidazole only has lower
cure rates than other combinations. If you are allergic to any of these
antibiotics, tell your doctor.
For any
treatment to be effective, it is important to:
* Complete the full course of
antibiotics, even if you
feel better after a few
days.
* Tell your doctor if
symptoms haven’t improved within
2 or
3 days. She or he may change your
antibiotics or do further investigations to make sure you have been accurately
diagnosed.
* Get your sexual partner(s) to be tested and
treated for any bacteria that may re-infect you. If your partner(s) are not
treated, you will almost certainly be reinfected. If your
partner refuses to be tested, the only way to protect yourself from reinfection is to either use barrier contraceptives or stop having sex with that
person.
* Avoid sexual intercourse until you and your partner(s) have completed
treatment. Even safe sex can interrupt the
healing process by jarring the
pelvic area. It’s best to avoid all vigorous activity until you are finished with
treatment.
* Get a lot of rest. This may be difficult for many
women, but it is a key part of treating
PID. Try to
stay in bed for at least a few
days and then take it
easy for the next two to six weeks.
* Go to all follow-up appointments. This will give you an opportunity to tell your doctor how you
feel, and will give your doctor a
chance to check on the progress of
treatment.
Women who are HIV-positive tend to have more severe
symptoms of
PID, but
studies show that
treatment with a standard course of intravenous
antibiotics is just as effective as in
women who do not have
HIV.
Some
antibiotics may cause dizziness, nausea and headaches. Unfortunately there is not a lot you can do about this. Avoid alcohol and get as much rest as possible.
Antibiotics may also cause vaginal
thrush (yeast
infection).
Thrush can be
treated with vaginal creams or pessaries, or with capsules taken by mouth. For more information on the
treatment of
thrush please visit the Women’s Health pages on
Thrush.
Heat.
Heat may
help to relieve
pain and assist in the
healing process. Take a
hot bath or relax with a
hot water bottle or heating pad on your abdomen. (Wait to be
diagnosed before you apply
heat as it can be
dangerous if you have appendicitis.)
Raspberry leaf tea. Raspberry leaf tea (not raspberry tea) may strengthen the
reproductive system and
help fight infection.
Healthy diet. Eating well, avoiding alcohol and getting plenty of C, A, D and B vitamins will
help your
body fight infection.
Acupuncture. Some
women find that acupuncture helps relieve
pelvic pain. Try to find a practitioner who has experience treating
women with
PID.
Rest. Sleep and rest will
help you
recover from an episode of
PID.
Women with
PID may be told they are imagining their
symptoms or are overreacting to ‘normal’
period pains. This can be both physically and emotionally
damaging. It may
help to share your experiences with someone you trust.
PID — Complications and long-term problems
Many
women recover from
PID without any lasting problems, but if the
infection is not
treated early or entirely,
PID can lead to serious complications. Just one episode of
PID increases a woman’s risk of
chronic pelvic pain, ectopic pregnancy,
infertility, and getting
PID again.
Recurrent
PID — Some
women develop PID time after
time. This can happen if an
infection hasn’t been completely
cured or if you’ve been reinfected. Unfortunately, the more often you have
PID, the more likely you are to get it again. By keeping track of what is going on in your life when infections occur, however, you may be able to identify what triggers the attacks. Some
women, for example, tend to get
PID when they are very stressed or
tired, after a vaginal
infection (such as
thrush) or following sex. Once you’ve pinpointed possible triggers, you may be able to take steps to avoid further episodes.
Abscess — Sometimes
PID infections
develop into an abscess (a pocket of infected fluid). An abscess can be particularly
dangerous because it may not go away with antibiotic
treatment, and if it bursts (ruptures), it can be life threatening. If you have an abscess that does not go away with
antibiotics, your doctor may suggest surgery.
Ectopic pregnancy — When
PID develops in a woman’s
fallopian tubes, it can
turn the smooth lining of the
tubes into
scar tissue. This scarring can block the
tubes, making it difficult for an
egg to
pass through them. If a fertilised
egg gets
stuck in one of the
fallopian tubes, it may continue to grow as if it were in the womb. This is an ectopic pregnancy and is a potentially life-threatening situation. In some cases, the embryo may miscarry naturally, but if it continues to grow, the
fallopian tube will burst, causing internal
bleeding. The only way to stop this from happening is to terminate the pregnancy.
It is estimated that one in
ten pregnancies that occur after an episode of
PID will be ectopic. If you have had
PID and become
pregnant, tell your doctor right away, so she or he knows you are at risk.
Infertility — Scarring from
PID may be so severe that it blocks the
fallopian tubes entirely, making it virtually impossible for an
egg to get through. It is estimated that one in five
women who
develop PID will be
infertile as a result. When a
woman has more than one episode of
PID, her
chances of becoming
infertile are even higher. Some
women, however, have become
pregnant after being told their
tubes were
blocked, so if you don’t want to get
pregnant, you should continue to use birth control.
If you do want to have children, you may need to undergo in vitro fertilisation (IVF) and embryo
transfer. Sometimes
blocked or damaged
tubes can be repaired with surgery, but the results are mixed and it may actually cause further scarring.
Chronic pain — Scarring can cause
pelvic tissues and
organs to stick together, pulling and straining them, and this can be very painful. One in five
women who have had
PID develop chronic pelvic pain. The
pain may be caused by
scar tissue (adhesions) that developed before the
PID was
treated, or it may be that an
infection or inflammation has not been
cured completely. Some adhesions can be separated surgically and this may
help to ease
pelvic pain.
Surgery is generally not necessary to get
rid of
PID, but if you have
chronic PID or
pelvic pain your doctor may recommend removing the damaged or infected
organs. The procedures listed below are major operations and you may want to get a second opinion before going ahead with surgery. Ask your doctor for a full explanation of any suggested procedure, including risks, benefits and success rates.
This is the removal of one or both of the
fallopian tubes. It will only stop
PID if the
infection is confined to the tube(s), and you may still
develop PID in other
organs. Salpingectomy is major abdominal surgery and may cause additional
pelvic adhesions. If both
tubes are removed, you will no longer be able to get
pregnant naturally.
A
hysterectomy removes the uterus (womb) and usually the
cervix. A
hysterectomy may reduce
pelvic pain, and is likely to get
rid of
PID, but there is no guarantee. If the
infection or scarring is outside of the womb, for example, a
hysterectomy will be of no use.
If your doctor recommends a
hysterectomy, find out exactly which
organs she or he intends to remove. Sometimes the
fallopian tubes and
ovaries are taken out during a
hysterectomy and for many
women this is a terrible surprise. A
hysterectomy is major surgery and it will take a few
months to
recover fully. You will not be able to have children after a
hysterectomy. See the Women’s Health online leaflet
Hysterectomy for more information about this operation.
This is the removal of one or both
ovaries, and is sometimes done at the same
time as a
hysterectomy. If both
ovaries are removed, you will have a sudden, immediate menopause.
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