INFECTION FROM OTHER AREAS: This is believed to be rare (less than one percent of PID), but actually, research is generally lacking on this topic. The idea is that infection of other organs or areas of the body, such as the appendix or bowel, may sometimes spread to the reproductive organs. Also, bowel bacteria, such as E-coli, can be spread to the vagina if a woman wipes from back to front after going to the bathroom. Once in the vagina, these bacteria can then attach to sperm and be transported into the reproductive organs, causing PID.
A little known example of infection spreading from another area of the body into the reproductive organs involves tuberculosis. The tubercular bacteria can infect the reproductive organs, and this sometimes happens when chest X-rays are normal. Tuberculosis is not common in Canada, so this is not a common cause of PID, but rates of tuberculosis are increasing with the AIDS epidemic, and in particular, antibiotic-resistant strains, which are harder to kill, are becoming more common.
How Does PID Affect A Woman's Reproductive Organs ?
PID can cause a significant amount of damage to the reproductive organs. This can be caused by the infection itself and or by the body's own response to infection.
DAMAGE CAUSED BY INFECTION: Infection can cause damage to the lining of the fallopian tube, to the cilia (small hairs which line the tube and move the fertilized egg through the tube), and/or to the ovary. Some bacteria, such as gonorrhea, actually produce a toxin which causes damage to tissue. Chlamydial infections cause a great deal of damage, partly because the chlamydia bacteria lives part of its life inside a person's cells; then at a certain stage in chlamydia's life cycle, it ruptures the host cell and destroys it, causing a significant amount of damage.
DAMAGE CAUSED BY THE BODY'S RESPONSE TO INFECTION: Inflammation occurs in the infected area as the body's defences (neutrophils, lymphocytes, etc,) rush to the area. Chlamydia infections, in particular, cause a lot of inflammation.
In addition, the body produces scar tissue to prevent the pelvic infection from spreading. Unfortunately this scar tissue can partially or completely block the fallopian tubes (causing tubal pregnancy or infertility), can bind organs together (causing pain and mobility restrictions), and can make it more difficult for antibiotics to kill infection (since the antibiotic also has to penetrate the tough scar tissue). This is one of the most important reasons why it is crucial to treat PID promptly. The body's response to infection happens quickly. Antibiotics can kill the bacteria causing the infection, but they cannot repair damage or remove scar tissue that has already formed. Chlamydial infections cause extensive scarring, especially with repeated infections, and this is another reason why infection with this bacteria causes so many problems such as infertility and tubal pregnancy.
Common Complications And Consequences Of PID
CHRONIC PAIN: About one in five women develops chronic abdominal pain after an episode of PID, although figures are actually higher in North America. Chronic pain after PID is believed to be caused by inflammation, scar tissue, and/or ongoing infection, although chronic pain is usually believed to be caused by scarring. Scarring can cause pain by binding organs together; scar tissue surrounding the ovary can also cause pain because the ovary enlarges during a woman's menstrual cycle, and if scarring restricts this enlargement, significant pain can result.
INFERTILITY: PID is the leading cause of preventable infertility in women. After an episode of PID, one in six women will be infertile. After a second episode, one in three will be infertile. And after three episodes, half will be infertile. Infection can cause infertility by damaging or blocking the fallopian tubes, ovaries, or endometrium; or by damaging the cilia (small hairs which line the fallopian tube and help move the ovum through the tube). The most common cause of infertility is partial or complete blockage of the fallopian tubes by scar tissue formed as part of the body's defense against infection. Scar tissue can also cause the fringed ends of the fallopian tube (fimbria) to stick together, making it difficult for the egg to be picked up by the tube, or scar tissue can cause the cilia lining the fallopian tube to stick together, making it difficult for the fertilized egg to travel through the tube.
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