This week the Health Capsule has made arrangements to take the readers through a somewhat ‘shady’ topic related to the female reproductive tract. We call it shady because Pelvic Inflammatory Disease (PID) may go untreated for years. This is because the symptoms are generalized and in many cases, mild. But the repercussions of PID are severe, being a leading causative factor for sub fertility as well as ectopic pregnancies.   

The female reproductive system consists of upper and lower parts. The lower reproductive tract includes the external genitalia, called the vulva, the vagina and the cervix, the tube-like structure that connects the vagina with the uterus. Upper female genital tract comprises the uterus; the sac that holds a fetus, ovaries, and the fallopian tubes which carry the ovum released by ovaries to the uterus. PID is the inflammation of the female reproductive organs due to infective organisms spreading upwards through cervix, uterus, fallopian tubes and ovaries.   

PID is generally transmitted sexually, with Chlamydia and gonorrhea infections being the commonest. The prevalence of the disease is high amoung young, sexually active women, women with multiple sexual partners and women in a sexual relationship with a person who has more than one sexual partner.   

In addition, women who have undergone childbirth or miscarriage are also more susceptible to PID. The entrance to the cervix from the vagina is usually closed with a ring of tissues which prevents pathogenic organisms from travelling upwards. This barrier opens up during child birth to let the fetus come out and the infective organisms can travel up through the cervix into the uterus, spreading the infection upwards.   

Symptoms   
Presentation of the disease varies from each woman. Some have severe symptoms while the majority has mild symptoms or no symptoms at all. The commonest symptoms are lower abdominal pain and/or tenderness. Pain during sexual intercourse, pain when passing urine and difficulty in passing urine, foul vaginal discharge can also be present. Unusual vaginal bleeding including bleeding between two periods, and heavy menstrual bleeding can also occur.   

Symptoms presenting outside of the reproductive system includes nausea, vomiting and fever.   

Complications   
PID, when untreated, is a principle cause of infertility and sub-fertility in women. The infection, when persistent, disturbs the surface of the tract, causing the formation of adhesions or strictures, obstructing the tract. PID can also increase the risk of ectopic pregnancy, meaning that the fetus is implanted in a site outside of the uterus. The fetus is almost always unviable and in case of tubal ectopic pregnancy, where the fetus is implanted in the narrow fallopian tubes, the tube can rupture with the growth of the fetus. This condition may be fatal to the mother as well.   

Abscess formation or formation of pockets full of pus in the tract can also be present. If these pockets burst, releasing its content to the outside abdominal cavity, it may lead to a serious condition called peritonitis or the inflammation of the abdominal coverings.   

PID may also give rise to chronic pelvic pain in some women. These symptoms may be worse during the end of a menstrual period and the few days following the period.   

Diagnosis and treatment   
Diagnosis is done after extensive history-taking and examination. Investigations like blood tests,  ultra-sound scan and laparoscopy will also aid in coming to a diagnosis.   

PID can be caused by various and sometimes more than one pathogen. Therefore your doctor will prescribe you with antibiotics with a broad coverage for pathogens. You may start feeling better after two or three days of treatment, but it’s crucial that you finish the course of antibiotic because there’s a high chance of recurrence otherwise. Severe disease may rarely 
require hospitalization.   

Prevention   
Practicing safe sexual intercourse is crucial in preventing PID, the ideal situation being both partners being exclusive.   

Using of condoms when practicing unsafe sex will reduce the risk of having PID. If you think you are at risk for PID, get tested regularly so the disease can be diagnosed early, preventing further complications.   

 If you are diagnosed as having PID, ask your partner to get screened, since re-infection can occur from the partner after being cured.   

Practicing hygienic methods will also reduce your chances of getting PID.   

Seek immediate medical care if you have these symptoms:   

• Severe abdominal pain   
• Persistent high fever   
• Severe nausea and vomiting   

Most women are unaware about PID, since this condition typically doesn’t have severe symptoms and is usually non fatal. But the high prevalence of long term complications associated with the disease proves that the public should be made aware on PID and it’s impact, which will have a significant influence in the quality of life in women.