Pelvic Inflammatory Disease- Dr Adepiti Speaks
“The commonest problem that can follow chronic PID or even an acute PID when not properly managed is that the tubes can be damaged… In the case where they are totally damaged, then the woman would suffer from infertility because there’s no way the sperm that is coming from the man would meet the egg…” Dr Clement
Dr. Adepiti Clement is the Head of Department of Obstetrics and Gynecology, Ondo State Specialist Hospital, Akure. He has authored and co-authored some publications in local and international journals which have helped redirect the world population towards the path of achieving and sustaining a society free of killer diseases like cervical cancer. This erudite and humble gynecologist who has a special bias for gynecological oncology attended to some very pertinent questions about pelvic inflammatory disease (PID) and cervical cancer.
How can you describe pelvic inflammatory disease?
Strictly speaking, pelvic inflammatory disease is essentially the infection of the upper genital structures by ascending infections from the lower genital tract.1 But in broad terms, you can look at infections from all the adjoining structures from the pelvis including the intestines which can affect the upper reproductive system of a woman.
What are the causes of this disease?
The causes from the definition are ascending infections. Some of these infections move from the lower genital tract to the lining of the uterus, the tubes and the ovaries as well.
So, most of the times when a woman has infections like sexually transmitted infections (STIs) e.g. Gonorrhea and Chlamydia they could move upward to the upper genital tracts and result in PID.
Also, some of the normal bacteria that lives ordinarily in the vaginal environment which are generally referred to as normal flora (Gram-ve and Gram +ve anaerobes) could be taken up to the upper genital tracts through activities which could cause PID.
A woman who had gone through unsafe abortion is also at risk of developing PID, because the infection from the uterus can move up to the tubes and the other structures.
Sometimes also, when a woman has had pelvic surgery, infections from the surgery may affect the structures of the upper genital tracts. Women who also use intrauterine devices like copper T are also at risk because these devices sometimes helps to transmit infections from the lower genital tract to the upper genital tracts.
Does Syphilis cause PID?
No, syphilis does not cause PID. This is so because the organism that causes syphilis is not a bacterium in the strict sense of the word.1
Is PID infectious, what I mean is can it be transferred from one woman to another having in mind that some ladies could decide to use a public lavatory when they are pressed. So, if a lady uses the same toilet that a PID patient had used, would she contract the infection?
No. PID is not infectious, except when the organism causing it is a STI. That means they can be shared between sexual partners. In this case it could spread. But, when it is not caused by an STI, it cannot be spread.
How common is PID in Nigeria?
Well, I don’t have an updated national statistics of the burden of the problem at the moment but in this hospital alone about 40-45% women attending our gynaecology clinic have some degrees of chronic PID.
…in this hospital alone about 40-45% women attending our gynaecology clinic have some degrees of chronic PID. If we record that percentage of cases in our clinic, it will be fair enough to say that the disease is very common in the country and needs thorough attention.
Are there early symptoms a woman should look out for so as to nip this disease in the bud?
Essentially, PID can be classified into two types. We have the acute or sudden PID and then we have the chronic or ongoing PID.
In acute PID, the woman notices abnormal offensive vaginal discharge, lower abdominal pain and fever.
When this acute stage is not properly treated or is not treated at all, it may now progress to the chronic PID. Women with chronic PID experience abnormal vaginal discharge, dysmenorrhea i.e. painful menstrual cycle and dyspareunia (painful sex intercourse especially on deep penetration). Her menstrual flow might also become irregular, scanty or heavy. The woman at this stage may now begin to have problem with fertility because as the disease persists in the pelvis, the tubes might be partially or completely destroyed.
When the tubes are partially blocked and her egg gets fertilized, it could result in ectopic pregnancy. These are the likely symptoms and the complications as well. In severe circumstances, the woman might develop frozen pelvis in which case, all the pelvic organs are matted together.
What would your advice be to any woman who notices the symptoms which signals the possible presence of the acute phase of PID?
Any woman who have the initial symptoms of PID should immediately see a doctor, preferably a gynecologist because that’s his domain, so that she can once and for all have the appropriate care to prevent it from progressing to the chronic phase which would ordinarily be more difficult to treat and comes with a lot of sequelae that may affect a woman’s reproductive career.
What are the treatments available for this disease?
For the acute phase, the woman would need to come to the hospital and see a gynecologist for thorough examination and investigation and once the diagnosis is made and she is treated with the appropriate antibiotics, all the symptoms would regress and she will get better.
But in some circumstances, we may really need to admit the woman because there are outlined criteria for such management. Let me give you some instances: If a woman with acute PID has fever of more than 38.50C, has other systemic symptoms such as vomiting, if she is young and has never had a baby, if one suspects that she might not comply with her treatment or if she already has pelvic collection, for all these reasons she must be admitted for proper management.
Can a woman’s reproductive organs be reversed some years following a successful chronic PID treatment so that she can birth children or is it that once the reproductive organs are damaged, it is irreversible?
The commonest problem that can follow chronic PID or even an acute PID when not properly managed is that the tubes can be damaged. This is referred to as fallopian tubal damage and when this happens, two things come to play. It is either the tubes are totally damaged or they are partially damaged. In the case where they are totally damaged, then the woman would suffer from infertility because there’s no way the sperm that is coming from the man would meet the egg. There’s a barricade between them. If it is partially damaged, that means that part of the lumen is still opened but it is not a thoroughfare which means if the woman gets pregnant, the fertilized egg would be implanted in the tube resulting in ectopic pregnancy and that has its own medical consequences as well.
The best any woman could do is to see a gynecologist at the outset of the acute stage so that she could have the infection cleared up but if it becomes chronic, the consequences might persist long after the infection has been cleared.
Can a successfully treated PID come back again much later?
It all depends on the treatment given. If PID is properly treated there’s no way it can resurface again. But this does not mean it’s a life-long immunity if that is what the question implies. If she contracts the offending organisms again she might develop PID.
Some herbs handlers have made strong claims to having herbal mixtures that could cure PID on the go. What is your take on this?
I have seen labels on some herbal concoctions with these claims and even with more claims but most of these herbal peddlers are not out there for our common good. They are there to defraud the people and ultimately make money for themselves. We are in 21st century so people should not allow themselves to be exploited by these elements. If you notice that you have PID or any disease at all you should go to the hospital nearest to you for proper diagnosis and treatment.
How can PID be prevented?
The prevention of PID begins with the woman. Every woman who is sexually active should be very cautious of her sex life. Avoid unprotected sex and make sure you stick to one partner.