Pelvic inflammatory disease
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.
- Reviewed last on: 6/23/2010
- Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
Supporting Research
Bope: Conn's Current Therapy 2010, 1st ed. Philadelphia, PA: Saunders Elsevier. 2009.Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr. 2006;25(2):79-99.
Crossman SH. The challenge of pelvic inflammatory disease. Am Fam Physician. 2006;73(5):859-64.
Cvetnic Z, Vladimir-Knezevic S. Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm. 2004;54(3):243-50.
Das M, Sur P, Gomes A, Vedasiromoni JR, Ganguly DK. Inhibition of tumor growth and inflammation by consumption of tea. Phytother Res. 2002;16 Suppl 1:S40-4.
Ferri: Ferri's Clinical Advisor, 2010, 1st ed. Philadelphia, PA: Mosby Elsevier. 2009.
Gonclaves C, Dinis T, Batista MT. Antioxidant properties of proanthocyanidins of Uncaria tomentosa bark decoction: a mechanism for anti-inflammatory activity. Phytochemistry. 2005;66(1):89-98.
Haggerty CL, Ness RB. Epidemiology, pathogenesis and treatment of pelvic inflammatory disease. Expert Rev Anti Infect Ther. 2006;4(2):235-47.
Hale LP, Greer PK, Trinh CT, James CL. Proteinase activity and stability of natural bromelain preparations. Int Immunopharmacol. 2005;5(4):783-93.
Heggers JP, Cottingham J, Gussman J, et al. The effectiveness of processed grapefruit-seed extract as an antibacterial agent: II. Mechanism of action and in vitro toxicity. J Altern Complement Med. 2002;8(3):333-40.
Heitzman ME, Neto CC, Winiarz E, Vaisberg AJ, Hammond GB. Ethnobotany, phytochemistry and pharmacology of Uncaria (Rubiaceae). Phytochemistry. 2005;66(1):5-29.
Ibarrola Vidaurre M, Benito J, Azcona B, Zubeldia N. Infectious pathology: vulvovaginitis, sexually transmitted diseases, pelvic inflammatory disease, tubo-ovarian abscesses. An Sist Sanit Navar. 2009;32,Suppl 1: 29-38.
Lareau S, Beigi R. Pelvic Inflammatory Disease and Tubo-ovarian Abscess. Infectious Disease Clinics of North America. 22(4).
Long: Principles and Practice of Pediatric Infectious Diseases, 3rd ed. Philadelphia, PA: Churchill Livingstone, 2008. Ch. 56.
Martinez F, Lopez-Arregui E. Infection risk and intrauterine devices. Acta Obstet Gynecol Scand. 2009;88(3):246-50.
Risser JM, Risser WL. Purulent vaginal and cervical discharge in the diagnosis of pelvic inflammatory disease. Int J STD AIDS. 2009;20(2):73-6.
Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.
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