Pelvic Inflammatory Disease

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Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection of any of a woman's pelvic organs including the uterus ovaries or fallopian tubes or the peritoneum the membrane covering the abdominal cavity. One million women are diagnosed with PID annually in the United States. 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. If not treated promptly PID can result in infertility and in rare cases death.

Signs and Symptoms

Acute PID is accompanied by the following signs and symptoms.

	Severe pain and tenderness in lower abdomen
	Vaginal discharge
	Fever

Chronic PID is accompanied by the following signs and symptoms.

	Mild recurrent pain in lower abdomen
	Backache
	Irregular menstrual periods
	Pain during intercourse
	Infertility
	Heavy unpleasant-smelling vaginal discharge

What Causes It?

PID occurs when bacteria from the vagina or cervix infiltrate the normally sterile pelvic organs.

Who's Most At Risk?

People with the following conditions or characteristics are at risk for developing PID.

	Frequent sexual encounters many partners
	History of sexually transmitted diseases or previous history of PID
	Young age (14 to 25 years old) particularly early age at first intercourse

What to Expect at Your Provider's Office

If you are experiencing symptoms associated with PID you should see your health care provider. A combination of a physical exam lab tests imaging and other procedures are used to make a diagnosis.

Treatment Options

Prevention

Barrier methods of birth control (condoms diaphragms 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.

Treatment Plan

Your health care provider may recommend hospitalization or outpatient treatment with follow-up. Outpatient therapy consists of rest and medications.

Drug Therapies

Your provider may prescribe the following antibiotics or combination of drugs.

	Cefoxitin
	Ofloxacin
	Clindamycin

Surgical and Other Procedures

Some conditions such as an abscess in the ovary or fallopian tube may make surgery necessary.

Complementary and Alternative Therapies

A comprehensive treatment plan for PID may include a range of complementary and alternative therapies.

Nutrition

	Eat whole foods such as fresh vegetables whole grains and essential fatty acids (nuts seeds and cold-water fish)
	Avoid sugar refined foods and saturated fats (animal products especially dairy)

Potentially beneficial nutrient supplements include the following.

	Vitamin C (1 000 mg three to four times per day) zinc (30 mg per day) selenium (200 mcg per day) vitamin E (400 IU per day) B-complex (50 to 100 mg especially folic acid 800 mcg per day) and vitamin A (25 000 IU one to two times per day) or beta carotene (50 000 IU one to two times per day)
	Bromelain (500 mg three times per day between meals)
	Anti-inflammatory oils (for example flax borage evening primrose) 1 500 mg two to three times per day
	Acidophilus (one capsule with meals)

Herbs

Herbal remedies may offer relief from symptoms. Herbs are generally available as dried extracts (pills capsules or tablets) teas or tinctures (alcohol extraction unless otherwise noted). Dose for teas is 1 heaping tsp. per cup of water steeped for 10 minutes (roots need 20 minutes).

	For acute infection combine half parts of yarrow (Achillea millefolium) pasque flower (Pulsatilla pratensis) marigold (Calendula officinalis) and poke root (Phytolacca americana) with one part each of coneflower (Echinacea purpurea) and goldenseal root (Hydrastis canadensis). Take 30 to 60 drops tincture every two to four hours. Use caution with poke root.
	For chronic infection combine equal parts of coneflower goldenseal licorice root (Glycyrrhiza glabra) myrrh gum (Commiphora molmol) wild indigo (Baptisia tinctoria) and red root (Ceonothus americanus). Take 30 drops tincture two to three times per day.
	Turmeric (Curcuma longa 500 mg three times per day). Use with bromelain to enhance anti-inflammatory effects.

Physical Medicine

Place a castor oil pack on the abdomen to reduce inflammation. Saturate a cloth with castor oil and apply directly to the skin placing a heat source such as a hot water bottle on top. Leave in place for 30 minutes or more. Use for three to four consecutive days per week. Packs may be used daily.

Acupuncture

Acupuncture may help enhance immune function and reduce pain and inflammation especially with chronic PID.

Prognosis/Possible Complications

In 85 percent of cases the initial treatment succeeds and in 75 percent of cases patients 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; and sexual dysfunction.

Following Up

Your health care provider will schedule a follow-up visit 48 to 72 hours after treatment is started. 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.

Supporting Research

Aral SO Brunham RC Cates W Jr et al. Pelvic Inflammatory Disease: Guidelines for Prevention and

Management. Publication of the Centers for Disease Control. 1991; 40:1-25. Available at: www.cdc.gov/epo/mmwr/preview/mmwrhtml/00031002.htm.

Branch WT Jr. Office Practice of Medicine. 3rd ed. Philadelphia PA: Saunders; 1994: 358-361.

Carr BR Blackwell RE. Textbook of Reproductive Medicine. Norwalk CT: Appleton & Lange; 1993: 88-90.

Fauci AS et al eds. Harrison's Principles of Internal Medicine. 14^th ed. New York NY: McGraw-Hill; 1996: 812-817.

Murray MT. The Healing Power of Herbs: The Enlightened Person's Guide to the Wonders of Medicinal Plants. Rocklin Calif: Prima Publishing; 1991: 181-187.

Murray MT Pizzorno JE. Encyclopedia of Natural Medicine. Rocklin Calif: Prima Publishing; 1998: 534-535.

Quilligan EJ Zuspan FP. Current Therapy in Obstetrics and Gynecology. 3^rd ed. Philadelphia PA: Saunders; 1990: 570-576.

Ryan KJ Berkowitz R Barbieri RL. Kistner's Gynecology. 5^th ed. Chicago IL: Year Book; 1990: 507-509.

Scalzo R. Naturopathic Handbook of Herbal Formulas. 2^nd ed. Durango Colo: Kivaki Press; 1994: 18 40.

Scott JR Disaia PH Hammond CB et al. Danforth's Obstetrics and Gynecology. 7^th ed. Philadelphia PA: Lippincott; 1994: 641-662.