KADIE
There is no specific test for pelvic inflammatory disease.
• Pro Health •
“WHEN PELVIC INFLAMMATORY DISEASE GOES UNDIAGNOSED or there is a delay in treatment, infertility can result.” -Chandra Graham-Parker, M.D.
Based on a nationally representative sample from 2006–2010, approximately 4.2 percent of U.S. women have reported being treated for PID in their lifetime.” More than 60,000 women were hospitalized for PID in 2010, the most recent year for which figures are available. Not every woman with PID knows she has it. The disease can be asymptomatic, according to GrahamParker. Those with symptoms often run a fever, experience pain in the lower abdomen and have an abnormal vaginal discharge. Pelvic inflammatory disease shares symptoms with other ailments. “It’s important to rule out things that mimic PID, such as appendicitis or infections in the bladder or kidneys,” said Wexler. There is no specific test for PID. Diagnosis is heavily dependent on the patient’s medical history and a pelvic exam. “We move the cervix from side to side, looking for signs of tenderness,” said Wexler. Other indicators that support the diagnosis are elevated levels of C-reactive protein, produced by the liver in greater quantities when inflammation is present, and white blood cells. While not commonly used, according to Wexler, laparoscopy can provide visual confirmation. During the operation, a surgeon inserts a tiny, flexible tube with a lighted end through a small cut below the navel to examine the organs inside the abdomen. Antibiotics are the treatment of choice for PID. Because it’s not always possible to identify the bacteria responsible for the infection, patients often take at least two antibiotics to combat a wide range of
pathogens, according to the U.S. government’s Office on Women’s Health. “Most infections are treated on an outpatient basis,” said GrahamParker. “If the initial treatment is not successful or if the patient is pregnant with a high fever or is nauseous and vomiting and can’t keep down anything, we’ll admit her to the hospital.” The initial treatment is successful in 85 percent of cases, according to the University of Maryland Medical Center. And 75 percent of patients are able to avoid a recurrence of PID, a good thing as the likelihood of complications increases with each episode. It is the scarring of fallopian tubes, the result of inflammation, that can cause infertility or ectopic pregnancies among PID patients. These scars may causes blockages that prevent the fertilization of eggs or trap a fertilized egg in the fallopian tubes where it begins to grow. An ectopic pregnancy is not sustainable and can be life-threatening. The chance of having an ectopic pregnancy is as much as six times higher for women who have had PID than those who have not, according to data from oft-cited studies of Scandinavian inpatients with the disease. Infertility rates range from 8 percent after the first episode of PID to as high as 40 percent after the third episode. The highest infertility rate, 85 percent to 90 percent, is among PID patients who develop a pelvic abscess. Tubo-ovarian abscesses—pockets of pus, bacteria and fluid— form on the reproductive organs of about 15 percent of women with PID, according to a 2010 study by researchers | continued on 15
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Fall 2014 | Gazette Health 13