What is Chronic Pelvic Inflammatory Disease (PID)?
Chronic infection and inflammation of the internal genital organs is known as chronic pelvic inflammatory disease (PID). PID often starts with an acute sexually transmitted infection such as gonorrhea or, more commonly, chlamydia. Chlamydia infection may go undiagnosed for years. While the infection is usually mild in terms of symptoms, it produces chronic inflammation of the pelvic organs with scarring, adhesions, and tubal blockage. The damaged organs also become vulnerable to infection by other bacteria, so chronic PID often involves multiple bacteria. Even with effective antibiotic treatment, long-term resolution of chronic PID is difficult to achieve because the damaged tissues are easily re-infected. In some cases, the scarred tissue contains tiny collections of pus that are inaccessible to antibiotics and cause a recurrent exacerbation of the disease.
Typically, chronic PID results in the formation of adhesions, frequently massive, between pelvic organs. This includes the uterus, fallopian tubes, ovaries, bowel, and pelvic side walls. The ovaries are frequently encased in scarring and tend to develop cysts. The tubes are typically blocked at their terminal end (hydrosalpinx) and tend to be enlarged, with thick and inflamed walls. Because of bowel involvement in pelvic adhesions, bowel symptoms such as abdominal cramps and constipation are frequent. Pelvic pain of variable pattern and severity is common including severe generalized or localized pain which is crampy or constant. There is a tendency for heavy periods or intermenstrual irregular bleeding. Infertility is the rule with chronic PID. Intermittently, the chronic infection is complicated by acute episodes of the disease characterized by fever and severe pain.
What are the Treatment Options for Pelvic Inflammatory Disease (PID)?
Acute PID is usually accompanied by severe pain and fever and is treated with high-dose antibiotics, often given through an intravenous infusion. Occasionally a mass-like collection of pus forms, known as a pelvic abscess. In the past, such an abscess was usually treated surgically by removing the involved fallopian tube and possibly the ovary as well. In recent years, more pelvic abscesses are successfully treated by drainage of the abscess with a catheter or by means of laparoscopy.
Chronic PID, especially when accompanied by severe chronic pain or by recurrent episodes of acute pain and fever is a debilitating condition. Commonly this condition is treated by surgical removal of both ovaries and fallopian tubes, with or without hysterectomy, especially if future pregnancy is not an issue. Occasionally the uterine cervix becomes scarred and narrowed; this may result in recurrent pyometra (pus accumulation inside the uterus) which may be treated by means of cervical dilation and antibiotics.
But if childbearing is not an issue, the most common approach to chronic PID is the surgical removal of the uterus, ovaries, and fallopian tubes. In my experience, the great majority of patients with chronic pelvic inflammatory disease can be successfully treated without a hysterectomy. First, the patient is treated with a long course (6-8 weeks) of antibiotics and anti-inflammatory steroids (prednisone). Prednisone helps resolve the inflammatory process and increases the efficiency of the antibiotics in reaching pockets of infection within scarred tissues. Next, surgery is performed. Using meticulous microsurgical technique all adhesions are removed, the fallopian tubes are repaired and their patency is re-established. However, not infrequently, one tube (or less frequently both tubes) is destroyed beyond repair and must be sacrificed to ensure complete eradication of the chronic infection. Following such treatment, most patients are free of pain and many go on to a successful pregnancy.