Treatment
Antibiotics
PID is treated immediately with antibiotics for at least 1 week. Sometimes PID is caused by more than one type of bacteria and a combination of antibiotics that are effective against a range of bacteria are usually prescribed. PID may require hospitalization.
Patients should:
- take all medicine as prescribed, even if the symptoms go away;
- return for a follow-up visit 2 or 3 days after treatment is started to make sure that the antibiotics are working; and
- return within 7 days of finishing the antibiotics to make sure that the infection is gone.
If there is no improvement after the initial treatment, another antibiotic is prescribed. In severe cases, the patient is hospitalized and antibiotics are administered intravenously.
Because of the risk for irreversible damage and death, if not treated immediately, about 25% of women with PID must be hospitalized. Hospitalization is necessary if the patient:
- is severely ill with fever, chills, and sweats;
- cannot take oral medication and requires intravenous antibiotics;
- does not respond to oral antibiotics;
- may have an abscess; or
- the diagnosis is uncertain and the patient may have another medical emergency (e.g., appendicitis).
Women should do the following while being treated for PID:
- Remove an IUD before beginning treatment.
- Stay in bed until the fever has subsided.
- Refrain from vigorous pelvic activity (e.g., sex) that can spread the infection and slow healing.
- Inform sex partners for examination and treatment, if necessary, even if the partners do not have symptoms of an STD. Otherwise, the patient may be reinfected. The patient should not have sex until the partner has been cleared of STDs.
Complications include infertility, tubal pregnancy, chronic pain, recurrences, and abscesses.
If left untreated, PID can cause scarring and obstruction in the fallopian tubes, which blocks the normal passage of the egg into the uterus and prevents fertilization. PID is a major cause of infertility in women of reproductive age.
About 20% of women who have PID become infertile. In the United States, PID causes an estimated 100,000 cases of female infertility every year. The greater the number of episodes of PID, the greater the risk for infertility.
Many women who are infertile as a result of PID never have symptoms and do not know that they have or have had PID until they have an infertility work-up. This is particularly true of PID caused by chlamydial infection.
A tubal pregnancy occurs when the fertilized egg is not able to pass through the fallopian tubes to the uterus and attaches to and develops in the fallopian tube. The egg can not develop normally in a fallopian tube. Tubal pregnancies are almost always fatal for the fetus and are life-threatening for the mother. Tubal pregnancies are the major cause of pregnancy-related deaths among women in the United States.
Women who have had PID are 6 to 10 times more likely to have a tubal pregnancy. There is an estimated 13% risk of tubal pregnancy after one episode of PID and 70% risk after three episodes. In the United States, PID leads to 70,000 tubal pregancies every year.
The scarring that results from untreated PID leads to chronic pelvic pain in about 20% of women. The pain can sometimes be relieved with surgery, but otherwise it is difficult to treat.
If musculoskeletal dysfunction (e.g., tightened muscles, scarring) is causing or contributing to the chronic pain, physical therapists who specialize in PID can help alleviate and sometimes eliminate this pain.
About one-third of women with PID experience at least one additional episode.
An abscess, also known as tubo-ovarian abscess (involves a fallopian tube and ovary), is a collection of infectious pus. If the abscess ruptures, the infection may spread to the peritoneum (lining of the abdomen) and cause peritonitis. Peritonitis is a medical emergency that often requires surgery.
Fortunately, most women seek early medical care because of pain associated with acute PID. Also, advances in diagnosis and treatment have lowered mortality rates for PID peritonitis dramatically. Mortality rates for peritonitis are about 5-6%.
- Seek medical advice for abnormal vaginal discharge, abnormal odor, fever, and bleeding between periods. Early treatment can prevent the development of PID.
- Use barrier methods of birth control (i.e., condoms) to prevent the transmission of STDs.
- Do not use an IUD if you have had PID or are susceptible to STDs.
- Have an IUD routinely checked by a health care provider.
- Contact all sex partners and make sure they are tested for infection and treated if necessary.
- Wipe from front to back after a bowel movement to prevent bacteria such as Bacteroides from entering the vagina (Bacteroides may cause PID).
- Have a gonorrheal or chlamydial culture done as soon as possible following exposure to these bacteria.
Physician-developed and -monitored.
Original Date of Publication: 03 Nov 2001
Reviewed by: Amy Stein Wood, MPT, BCIA-PMDB, Stanley J. Swierzewski, III, M.D.
Last Reviewed: 24 Jun 2008
Pelvic Inflammatory Disease (PID), Treatment, Complications, Prevention reprinted with permission from womenshealthchannel.com
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