Pelvic inflammatory disease
“DOCTOR, I have been noticing a strange, bad-smelling discharge for the last two weeks and it has become very painful to have sex, but my boyfriend doesn’t have any symptoms. What could be causing this? I’ve never experienced anything like this before.”
This is a common complaint in our clinics across the island and is usually due to pelvic inflammatory disease (PID). PID is an infection of the female reproductive organs (the uterus, tubes and ovaries). It is most commonly caused by sexually transmitted infections (STI), in particular chlamydia and gonorrhoea, although other organisms can cause it also. It is a significant public health problem in Jamaica because of the potential for complications and long-term consequences.
Risk factors for PID include:
•Untreated STIs
•More than one sex partner, especially if they have other partners besides you
•Douching
•Unprotected intercourse
•HIV infection.
Symptoms may be mild or hardly noticed, which is a part of why it is such a problem. However, it commonly causes:
• Belly bottom pain
•Abnormal discharge, which may smell bad
•Fever
•Pain in the belly or bleeding during or after sex
•Burning urination
•Bleeding in between periods.
So what should you do if you have symptoms like these? Go to your doctor or clinic right away! The diagnosis is usually made based on the symptoms reported, examination findings, and occasionally from other investigations (especially if a complication is suspected). On examination, the doctor may see the discharge and find tenderness when moving the cervix or pressing on the areas over the tubes and ovaries. An ultrasound, blood count or tests for common STIs is done is special cases.
The treatment is made to cover the common causes with antibiotics. The antibiotics are usually tablets that are given for 10 to 14 days or as a single dose. If it is complicated or severe, then admission to hospital for IV antibiotics may be needed. The partner(s) should also be treated to prevent reinfection. He should be encouraged to be examined at the doctor and get proper treatment, as male partners are often asymptomatic or ignore their symptoms. If very complicated, surgery may be required.
So what are some of the long-term consequences of PID? It can cause scarring in the belly and in and around the tubes which can lead to:
•Chronic pelvic pain (pain all the time in the belly bottom)
•Infertility or difficulty getting pregnant
•Increased risk of ectopic pregnancy (pregnancy in the tubes).
Prevention of PID is the best course of action by ensuring a single, faithful sexual partner, protected sexual intercourse, and prompt treatment of all infections. Regular checks at the gynaecologist or clinic after an infection will ensure good health and decreased chances of complications.
Dr Anna-Kay Taylor Christmas is a consultant obstetrician and gynaecologist at the Obs and Gynae Centre, Winchester Business Centre. She can be contacted at drtaylorchristmas@gmail.com or 908-3263, 906-2265, 325-7362.
