Introduction:

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, usually resulting from a sexually transmitted infection such as chlamydia or gonorrhea. 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
• Abnormal uterine bleeding
• Fever
• Nausea and vomiting

Chronic PID is accompanied by the following signs and symptoms:

• Mild, recurrent pain in the 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. PID is most commonly cause by sexually transmitted diseases (STDs), such as Chlamydia trachomatis and Neisseria gonorrhoeae.

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 - 25 years old), particularly early age at first intercourse
• Vaginal douching
• Previous episode of gonococcal PID
• Intrauterine devices may increase the risk of PID during the first 20 days after insertion

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, including ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). Other procedures may also be performed to make a diagnosis. In some cases, your physician may order laparoscopic evaluation.

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. Patients being treated for PID should abstain from sexual intercourse throughout the course of treatment. It is essential to evaluate and treat male sex partners.

Drug Therapies

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

• Doxycycline combined with metronidazole (do not drink alcoholic beverages with this medication)
• Ofloxacin combined with metronidazole (do not drink alcoholic beverages with this medication)
• Cephalosporin with doxycycline

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. PID can lead to serious complications. Complementary therapies should be used only in conjunction with conventional medical interventions. Keep all of your prescribing doctors informed about any supplements or therapies you may be using.

Nutrition and Supplements

• Eliminate potential food allergens, including dairy, wheat (gluten), corn, soy, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
• Eat calcium rich foods, including beans, almonds, and dark green leafy vegetables (such as spinach and kale).
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell pepper).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans fatty acids, found in such commercially baked goods as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tbsp. of oil 1 - 2 times daily, to help decrease inflammation. Fish oils may increase bleeding in sensitive individuals, such as those taking blood thinning mediations (including aspirin).
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements may need refrigeration. Check the label carefully.
• Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) 3 times daily, for antibacterial or antifungal activity and immunity.
• Methylsulfonylmethane (MSM), 3,000 mg twice a day, to help decrease inflammation.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant effects. You may also prepare teas from the leaf of this herb.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg 3 times a day, for inflammation and antibacterial or antifungal activity. Cat's claw may interfere with certain medications, including blood pressure medications. Speak with your doctor.
• Bromelain (Ananus comosus) standardized, 40 mg 3 times daily, for pain and inflammation. Bromelain may increase bleeding in sensitive individuals, such as those on blood thinning medications, including aspirin.
• Reishi mushroom (Ganoderma lucidum), 150 - 300 mg 2 - 3 times daily, for inflammation and for immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops 2 - 3 times a day. In high doses, reishi may increase bleeding in sensitive individuals, such as those taking blood thinning medications, including aspirin.
• Olive leaf (Olea europaea) standardized extract, 250 - 500 mg 1 - 3 times daily, for antibacterial or antifungal activity and immunity. You may also prepare teas from the leaf of this herb. Olive leaf may lower both blood sugar and blood pressure.

Castor Oil Packs

Dampen a cloth with castor oil, and apply to the abdomen. Cover with saran wrap, then apply a heating pad over this pack. Used for 1 - 3 hours, castor oil packs can reduce cramping and pain in some patients. Do not use caster oil packs during the acute phase of PID.

Acupuncture

Acupuncture may help enhance immune function and reduce pain and inflammation, especially with chronic PID. Acupuncturists often will gear their protocols at draining what they call “Damp Heat” from the area. This is done using both acupuncture and Chinese herbal preparations.

Prognosis and Possible Complications:

In 85% of cases, the initial treatment succeeds. In 75% 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
• Sexual dysfunction

Following Up:

Your health care provider will schedule a follow up visit 48 - 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.