Pelvic Inflammatory Disease

This is an infection of the female reproductive organs. It usually occurs when sexually transmitted bacteria spread from your vagina to your uterus, fallopian tubes or ovaries. Many women who develop pelvic inflammatory disease either experience no signs or symptoms or don’t seek treatment. Pelvic inflammatory disease may be detected only later when you have trouble getting pregnant or if you develop chronic pelvic pain.

Symptoms

Signs and symptoms of pelvic inflammatory disease may include:

Pain in your lower abdomen and pelvis
Heavy vaginal discharge with an unpleasant odor
Irregular menstrual bleeding
Pain during intercourse
Fever
Painful or difficult urination
PID may cause only minor signs and symptoms or none at all. PID with mild or no symptoms is especially common when the infection is due to chlamydia.

When to see a doctor

Go to the emergency room if you experience the following severe signs and symptoms of PID:

Severe pain low in your abdomen
Vomiting
Signs of shock, such as fainting
Fever, with a temperature higher than 101 F (38.3 C)

If your signs and symptoms aren’t severe, but they’re persistent, see your doctor as soon as possible. Vaginal discharge with an odor, painful urination or bleeding between menstrual cycles can be associated with a sexually transmitted infection (STI). If these signs and symptoms appear, stop having sex and see your doctor soon. Prompt treatment of an STI can help prevent PID.

Causes

Pelvic inflammatory disease can be caused by a number of bacteria but are most often caused by gonorrhea or chlamydia infections. These bacteria are usually acquired during unprotected sex.

Less commonly, bacteria may enter your reproductive tract anytime the normal barrier created by the cervix is disturbed. This can happen after intrauterine device (IUD) insertion, childbirth, miscarriage or abortion.

Risk Factors of Pelvic inflammatory disease

A number of factors may increase your risk of pelvic inflammatory disease, including:

Being a sexually active woman younger than 25 years old
Having multiple sexual partners
Being in a sexual relationship with a person who has more than one sex partner
Having sex without a condom
Having had an IUD inserted recently
Douching regularly, which upsets the balance of good versus harmful bacteria in the vagina and may mask symptoms that might otherwise cause you to seek early treatment
Having a history of pelvic inflammatory disease or a sexually transmitted infection

Complications

Untreated pelvic inflammatory disease may cause scar tissue and collections of infected fluid (abscesses) to develop in your fallopian tubes and damage your reproductive organs. Complications may include:

Ectopic pregnancy. PID is a major cause of tubal (ectopic) pregnancy. In an ectopic pregnancy, the fertilized egg can’t make its way through the fallopian tube to implant in the uterus. Ectopic pregnancies can cause massive, life-threatening bleeding and require emergency surgery.
Infertility. PID may damage your reproductive organs and cause infertility — the inability to become pregnant. The more times you’ve had PID, the greater your risk of infertility. Delaying treatment for PID also dramatically increases your risk of infertility.
Chronic pelvic pain. Pelvic inflammatory disease can cause pelvic pain that may last for months or years. Scarring in your fallopian tubes and other pelvic organs can cause pain during intercourse and ovulation.

Tests and Diagnosis

Doctors diagnose pelvic inflammatory disease based on signs and symptoms, a pelvic exam, an analysis of vaginal discharge and cervical cultures, or urine tests.

During the pelvic exam, your doctor uses a cotton swab to take samples from your vagina and cervix. The samples are sent to a lab for analysis to determine the organism that’s causing the infection.

To confirm the diagnosis or to determine how widespread the infection is, your doctor may recommend other tests, such as:

Ultrasound. This test uses sound waves to create images of your reproductive organs.
Endometrial biopsy. During this procedure, your doctor removes a small piece of your uterine lining (endometrium) for testing.
Laparoscopy. During this procedure, your doctor inserts a thin, lighted instrument through a small incision in your abdomen to view your pelvic organs.

Treatment and Drugs

Treatment for pelvic inflammatory disease may include:

Antibiotics. Your doctor may prescribe a combination of antibiotics to start taking right away. After receiving your lab test results, your doctor may adjust the medications you’re taking to better match what’s causing the infection.

Usually, your doctor will request a follow-up visit in three days to make sure the treatment is working. Be sure to take all of your medication, even if you start to feel better after a few days. Antibiotic treatment can help prevent serious complications but can’t reverse any damage that’s already been done.

Treatment for your partner. To prevent reinfection with an STI, advise your sexual partner or partners to be examined and treated. Partners can be infected and not have any noticeable symptoms.
Temporary abstinence. Avoid sexual intercourse until treatment is completed and tests indicate that the infection has cleared in all partners.
More-serious cases

Outpatient treatment is adequate for treating most women with pelvic inflammatory disease. However, if you’re seriously ill, pregnant or haven’t responded to oral medications, you may need hospitalization. At the hospital, you may receive intravenous (IV) antibiotics, followed by antibiotics you take by mouth.

Surgery is rarely necessary. However, if an abscess ruptures or threatens to rupture, your doctor may drain it.

In addition, surgery may be performed on women who don’t respond to antibiotic treatment or who have a questionable diagnosis, such as when one or more of the signs or symptoms of PID are absent.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic (long-lasting) autoimmune disease that mostly affects joints. RA occurs when the immune system, which normally helps protect the body from infection and disease, attacks its own tissues. The disease causes pain, swelling, stiffness, and loss of function in joints.

Additional features of rheumatoid arthritis can include the following:

It affects the lining of the joints, which damages the tissue that covers the ends of the bones in a joint.

RA often occurs in a symmetrical pattern, meaning that if one knee or hand has the condition, the other hand or knee is often also affected.

It can affect the joints in the wrists, hands, elbows, shoulders, feet, spine, knees, and jaw.

RA may cause fatigue, occasional fevers, and a loss of appetite.

RA may cause medical problems outside of the joints, in areas such as the heart, lungs, blood, nerves, eyes, and skin.

Fortunately, current treatments can help people with the disease to lead productive lives.

Who Gets Rheumatoid Arthritis?

You are more likely to get rheumatoid arthritis if you have certain risk factors. These include:

Age. The disease can happen at any age; however, the risk for developing rheumatoid arthritis increases with older age. Children and younger teenagers may be diagnosed with juvenile idiopathic arthritis, a condition related to rheumatoid arthritis.

Sex. Rheumatoid arthritis is more common among women than men. About two to three times as many women as men have the disease. Researchers think that reproductive and hormonal factors may play a role in the development of the disease for some women.

Family history and genetics. If a family member has RA, you may be more likely to develop the disease. There are several genetic factors that slightly increase the risk of getting RA.

Smoking. Research shows that people who smoke over a long period of time are at an increased risk of getting rheumatoid arthritis. For people who continue to smoke, the disease may be more severe.

Obesity. Some research shows that being obese may increase your risk for the disease as well as limit how much the disease can be improved.

Periodontitis. Gum disease may be associated with developing RA.

Lung diseases. Diseases of the lungs and airways may also be associated with developing RA.

Symptoms of Rheumatoid Arthritis

Common symptoms of rheumatoid arthritis include:

RA affects people differently. In some people, RA starts with mild or moderate inflammation affecting just a few joints. However, if it is not treated or the treatments are not working, RA can worsen and affect more joints. This can lead to more damage and disability.

At times, RA symptoms worsen in “flares” due to a trigger such as stress, environmental factors (such as cigarette smoke or viral infections), too much activity, or suddenly stopping medications. In some cases, there may be no clear cause.

The goal of treatment is to control the disease so it is in remission or near remission, with no signs or symptoms of the disease.

Rheumatoid arthritis can cause other medical problems, such as:

Joint pain at rest and when moving, along with tenderness, swelling, and warmth of the joint.

Joint stiffness that lasts longer than 30 minutes, typically after waking in the morning or after resting for a long period of time.

Joint swelling that may interfere with daily activities, such as difficulty making a fist, combing hair, buttoning clothes, or bending knees.

Fatigue – feeling unusually tired or having low energy.

Occasional low-grade fever.

Loss of appetite.

Rheumatoid arthritis can happen in any joint; however, it is more common in the wrists, hands, and feet. The symptoms often happen on both sides of the body, in a symmetrical pattern. For example, if you have RA in the right hand, you may also have it in the left hand.

RA affects people differently. In some people, RA starts with mild or moderate inflammation affecting just a few joints. However, if it is not treated or the treatments are not working, RA can worsen

At times, RA symptoms worsen in “flares” due to a trigger such as stress, environmental factors (such as cigarette smoke or viral infections), too much activity, or suddenly stopping medications. In some cases, there may be no clear cause.

The goal of treatment is to control the disease so it is in remission or near remission, with no signs or symptoms of the disease.

Rheumatoid arthritis can cause other medical problems, such as:

Rheumatoid nodules that are firm lumps just below the skin, typically on the hands and elbows.

Anemia due to low red blood cell counts.

Neck pain.

Dry eyes and mouth.

Inflammation of the blood vessels, the lung tissue, airways, the lining of the lungs, or the sac enclosing the heart.

Lung disease, characterized by scarring and inflammation of the lungs that can be severe in some people with RA.

Causes of Rheumatoid Arthritis

Researchers do not know what causes the immune system 7to turn against the body’s joints and other tissues. Studies show that a combination of the following factors may lead to the disease:

Genes. Certain genes that affect how the immune system works may lead to rheumatoid arthritis. However, some people who have these genes never develop the disease. This suggests that genes are not the only factor in the development of RA. In addition, more than one gene may determine who gets the disease and how severe it will become.

Environment. Researchers continue to study how environmental factors such as cigarette smoke may trigger rheumatoid arthritis in people who have specific genes that also increase their risk. In addition, some factors such as inhalants, bacteria, viruses, gum disease, and lung disease may play a role in the development of RA.

Sex hormones. Researchers think that sex hormones may play a role in the development of rheumatoid arthritis when genetic and environmental factors also are involved. Studies also show:

Women are more likely than men to develop rheumatoid arthritis.

The disease may improve during pregnancy and flare after pregnancy.

Tests and Diagnosis

Rheumatoid arthritis can be difficult to diagnose in its early stages because the early signs and symptoms mimic those of many other diseases. There is no one blood test or physical finding to confirm the diagnosis.

During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she will also check your reflexes and muscle strength.

Blood tests

People with rheumatoid arthritis tend to have an elevated erythrocyte sedimentation rate (ESR, or sed rate), which indicates the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinate d peptide (anti-CCP) antibodies.

Treatment and Drugs

There is no cure for rheumatoid arthritis. Medications can reduce inflammation in your joints in order to relieve pain and prevent or slow joint damage.

Occupational and physical therapy can teach you how to protect your joints. If your joints are severely damaged by rheumatoid arthritis, surgery may be necessary.

Medications

Many drugs used to treat rheumatoid arthritis have potentially serious side effects. Doctors typically prescribe medications with the fewest side effects first. You may need stronger drugs or a combination of drugs if your disease progresses.

NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects may include ringing in your ears, stomach irritation, heart problems, and liver and kidney damage.

Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.

Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).

Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.

Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan) and tocilizumab (Actemra). Tofacitinib (Xeljanz), a new, synthetic DMARD, is also available in the U.S.

These drugs can target parts of the immune system that trigger inflammation that causes joint and tissue damage. These types of drugs also increase the risk of infections.

Biologic DMARDs are usually most effective when paired with a nonbiologic DMARD, such as methotrexate.