Pelvic inflammatory disease, also commonly called "PID,” is an infection that affects a woman’s reproductive system. In a woman, the reproductive system includes: The uterus or womb (the organ that holds a baby when a woman is pregnant), the ovaries (the organs that release eggs), the fallopian tubes (which connect the ovaries to the uterus) and the vagina (which connects the uterus to the outside of the body).

Chlamydia and gonorrhea are two of the most common bacterial infections that lead to PID.

Gonorrhea and Chlamydia infections are usually spread from one person to another during unprotected sex. A man does not have to ejaculate to spread the infection. Research has shown that rarely can one become infected with these organisms by touching objects, like a toilet seat because for these organisms can only survive for only a very short time on the surface of the toilet seat and for the infection to occur, the germs would have to be transferred from the toilet seat to ones urethra or genital tract, or through an open cut or sore on the buttocks or thighs which is all possible but very unlikely to contract the disease from the toilet seats and other objects, unless of course they have unprotected sex on the toilet seat!.

Your risk of getting gonorrhea is greater if you have a new sexual partner, more than one sexual partner, or if you have had gonorrhea before.

PID occurs in highest frequency among those 15 to 25 years of age, with the incidence in women older than the age of 35 years being only one-seventh of that in younger women. Previous PID increases the risk for subsequent episodes, and approximately one in four women with PID will suffer recurrence.

PID does not always cause symptoms. When it does, the main symptom is pain in the lower belly. In some women, this pain gets worse during sex. Other symptoms can include; fever, chills, fluid leaking from the vagina (called "discharge’’ usually with a bad odour), bleeding or spotting from the vagina, painful and sometimes irregular periods, pain during a pelvic exam.

If chlamydia or gonorrhea is not treated, up to 30 percent of women may develop PID. PID can cause scarring of the fallopian tubes, which can lead to infertility and an increased risk of ectopic pregnancy (a pregnancy that develops in the fallopian tube rather than the uterus).People with these infections are at higher risk of becoming infected with HIV. Fortunately, these infections can be cured with antibiotics and early intervention will prevent these late complications of untreated PID!

The diagnosis of PID is made through thorough history taking of the patient’s symptoms, doing a proper pelvic exam. Some laboratory tests and radiology investigations can be done to confirm the disease or look out for any possible complication from the disease. A sample of urine and a swab of the fluid in one’s birth canal or cervix are usually taken off for analysis to look out for these organisms. An abdominal ultrasound scan can be done to look out for any inflammation of the reproductive organs as a result of the disease.

Once-yearly testing for chlamydia is recommended for all sexually active women who are younger than 25 years old, even in the absence of symptoms. This is because chlamydia is common in this age group and infection usually does not cause symptoms.

These infections are curable with antibiotics if taken as prescribed. Treatment is important for you and anyone you have had sex with recently. Your doctor might even ask you to tell your sexual partner(s) to be tested and in some cases, your doctor could give you a prescription for both you and your partner.

You should not have sex until both you and your partner have been treated. It is possible to be infected with gonorrhea more than once.

Since PID is caused by a germ that you get during sex, you can lower your risk of getting PID by; using a condom every time you have sex, one committed sexual partner, or abstaining from having sex.

Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospital