Every year the Centers for Disease Control and Prevention (CDC) releases information and statistics about a variety of men’s and women’s health issues. In a recently released CDC fact sheet, new statistics about the rates of sexually transmitted diseases (STDs) in the United States show a troubling trend.
Since 2014, three of the most commonly reported STDs (chlamydia, gonorrhea, and syphilis) have each seen a marked rise in prevalence; cases of gonorrhea and syphilis have seen increases of 63% and 71%, respectively, over that five-year period. Chlamydia, second only to HPV in terms of the number of incidences, is now at an all-time high of nearly 1.8 million cases.
It isn’t entirely clear why the frequency of these diseases has seen such a sharp uptick in recent years, but some data suggests that it is a combination of factors, including cuts to STD programs and subsequently a reduced availability of care. Moreover, there appears to be a decrease in safe sex practices, particularly in young people who choose not to use condoms.
In spite of this general increase in the number of STDs and sexually transmitted infections (STIs) in the country at large, a condition closely related to STDs has actually seen a decline in the number of cases: pelvic inflammatory disease (PID).
What is Pelvic Inflammatory Disease?
Pelvic inflammatory disease is an infection of the female reproductive organs. Also known as pelvic inflammatory disorder, this condition can affect numerous reproductive organs, including the fallopian tubes, uterus, ovaries, and cervix. In most cases, this bacterial infection originates from another infection already present in the body.
Because of the nature of the condition and the complexity of diagnosing it, the full picture of its prevalence in the population may not be fully understood. However, statistics from the National Disease and Therapeutic Index (NDTI) have indicated that from 2007-2016 there was a 38% decline in the number of cases of PID. Even on the decline, though, it is still a serious condition that plagues many women.
Most estimates suggest that about 5% of the women in the United States are affected by PID. That includes the approximately 800,000 new cases diagnosed every year. The typical age for the disease is someone who is 15-24 years old and sexually active.
Causes and Risk Factors
Pelvic inflammatory disease begins with an infection of the lower part of a woman’s reproductive system, usually the vagina or cervix. The infection can then migrate to the upper genital tract and begin to affect the uterus, fallopian tubes, or ovaries.
The connection between PID and STDs is due to the type of bacteria that tends to be a factor. Though the initial infection that leads to PID can arise from a variety of different bacteria, the most common types are Chlamydia trachomatis and Neisseria gonorrhoeae. As the names imply, these are the two bacteria involved in the STIs chlamydia and gonorrhea.
There are some cases where the initial infection can happen after a medical procedure or event where the protection typically provided by the cervix is disrupted; this can happen, for example, after childbirth or miscarriage. Douching is another activity that can lead to an infection, and as a result gynecologists almost universally recommend that women not douche. In these situations, the bacteria is usually not one associated with an STD.
But even though these potential sources of infection are possible, the vast majority of PID cases happen because of sexual contact. This means that sexually active women who don’t use protection during sexual intercourse are the most at risk of PID and STDs in general. Some of the main risk factors for women include:
- Being sexually active and under 25 years old
- A habit of unprotected sex
- Having multiple sexual partners or a single sexual partner who has multiple sexual partners
- A prior history of PID or an STD
It is also possible to get an infection from a recently inserted intrauterine device (IUD). While relatively rare, a contaminated IUD could lead to an infection. Most doctors say that any risk of infection is in the few weeks immediately after insertion; after that, it is exceedingly rare to develop an infection.
Symptoms of Pelvic Inflammatory Disease
The symptoms of PID can be vastly different from one woman to the next. Some women don’t have any symptoms at all and the disease can go unrecognized for a long time. Other women have symptoms so mild that they are often dismissed or assumed to be related to a different condition.
For those women who have notable symptoms, however, the most common symptom is pain or discomfort in the lower abdomen. Sometimes it isn’t until a woman has been experiencing chronic pelvic pain for months or years that a diagnosis is made. These are some of the symptoms that are typically reported:
- Pelvic pain
- Foul-smelling and heavy vaginal discharge
- Pain during sexual intercourse
- Pain while urinating
- Abnormal menstrual periods
- Irregular vaginal bleeding, sometimes shortly after intercourse
- Fever with chills
When PID is caused by gonorrhea, the disease and associated symptoms can appear very quickly and can include severe pain, fever, or fatigue. Some of these symptoms may also resemble other conditions such as endometriosis or even appendicitis.
Perhaps the greatest risk associated with pelvic inflammatory disease is the chance that it can go unnoticed and therefore untreated. Untreated PID can cause a number of long term problems that damage the reproductive organs, especially as the resulting scar tissue can be an impediment to normal fertility.
The CDC estimates that 1 out of every 8 women who get PID will have difficulty getting pregnant. Indeed, pelvic inflammatory disease is the most common cause of acquired infertility. Additionally, the chances of becoming infertile increase when treatment is delayed or when a woman has PID more than once.
Another complication that can result from PID is an ectopic pregnancy. Also known as a tubal pregnancy, this happens when prior scarring of the fallopian tubes (in this case from PID) results in a fertilized egg being implanted in the fallopian tubes rather than in the uterus. Since the fetus cannot grow in the fallopian tubes, it can lead to miscarriage or rupture of the tube.
A tubo-ovarian abscess is another example of a complication that can arise from PID. As with any infection, the human body often responds to foreign agents by creating pus in the area of the infection. In patients with PID, pus can begin to fill the fallopian tubes and ovaries, and sometimes that pus can collect in an abscess. If not drained, these abscesses can rupture and cause sepsis.
Treatment for Pelvic Inflammatory Disease
If PID is detected early enough, especially before it can lead to any of the complications noted above, your doctor will prescribe a course of antibiotics to eliminate the infection. Since PID can sometimes involve more than one type of bacteria, the doctor may prescribe dual antibiotics to ensure that the cure is effective.
After a diagnosis of PID that is determined to be related to an STD, it is important for any sexual partners to be notified; they will also need to see a doctor and potentially require an antibiotics prescription. It is also important to abstain from sexual contact until the course of treatment has been completed.
If the infection hasn’t been detected early enough, and some of the potential complications are at play, more involved treatments may be necessary. In the case of a tubo-ovarian abscess, this would involve draining via laparoscopy or an ultrasound-guided needle. The treatment for ectopic pregnancy depends on many factors, but in later stages, it will require surgery.
Pelvic Inflammatory Disease Appointment
PID affects millions of women around the world, but it is both a very preventable and very treatable disease. If you have been experiencing some of the symptoms discussed here, or would like to speak to a caring physician about protecting yourself from STDs, contact The Woman’s Clinic to make a gynecology appointment.