ECTOPIC PREGNANCY: PID is the leading cause of ectopic pregnancy. An ectopic pregnancy is a pregnancy which occurs outside of the uterus, usually in the fallopian tube (tubal pregnancy). An ectopic pregnancy is a serious medical emergency because the fallopian tube is not elastic like the uterus and the fallopian tube cannot stretch to accommodate the growth of the embryo. Also, a massive hemorrhage can result because the surface of the tube is not designed to nurture the embryo like the lining of the uterus.

After an episode of PID, ectopic pregnancies result for most of the same reasons as infertility. Conception is successfully completed, but the fertilized egg cannot successfully travel to the uterus because of damage to the hairs lining the fallopian tube or to the surface of the tube, or because passage is partially or completely blocked by scarring or infection. After PID, women have a ten-fold increased risk of ectopic pregnancy. In fact, one in every 63 pregnancies is now ectopic in Canada, a two to three-fold increase mainly due to PID.

RECURRING INFECTION: Recurrences of PID are common, but entirely preventable. After PID, one in four women will have at least one other episode, half within the first year of the first episode.

There are believed to be three reasons for recurrences:

1. Failure to treat the woman's partner (ie the woman is reinfected).

2. Incomplete or inadequate treatment (ie the infection was never really eradicated).

3. An increased vulnerability to infection (some change in the fallopian tubes which may make them more susceptible to future infection).

However, by far the most common cause of recurrence is failure to treat the woman's partner. Both the Canadian and U.S. Guidelines for the Treatment of PID clearly state that partners must always be treated, regardless of whether the partner appears to have infection. In the words of the U.S. Centers for Disease Control: "Treatment for sex partners of women with PID is imperative. The management of women with PID should be considered inadequate unless their sex partners have been appropriately evaluated and treated." (Centers for Disease Control, PID Management Guidelines, 1991, p18) Another PID researcher notes: "If the male partner is not treated, the PID will recur in the woman. In fact, due to the lack of treatment of the male partner, PID is often seen as a recurrent or chronic disease." (Mohanty, 1989).

In Sweden, where health authorities have implemented careful follow-up of sex partners since 1977, the rate of repeated episodes of PID has dropped from 22 percent to four percent. Unfortunately, in North America, this practice may not always be followed, resulting in serious health problems for many women.

CHRONIC PID: Chronic PID is a vague term. It usually means an ongoing chronic pelvic infection, but sometimes the term is also used to refer to chronic pain after an episode of PID. Although chronic PID is common (20 to 30 percent of women with PID in Canada and the U.S. are diagnosed with chronic PID), there hasn't been any research on this condition, so basic information about chronic PID and the most effective treatment has not been developed. A woman can develop chronic infection if an episode of PID is never diagnosed or treated, or a woman can develop chronic infection if an episode of PID is not treated thoroughly.

It used to be believed that chronic infection was rare, and that women who appeared to still have PID after treatment really only had adhesions or inflammation. However, recent research has established that chronic pelvic infection is much more frequent than previously believed, especially if chlamydia is involved. Women who have very mild or no symptoms are less likely to have their pelvic infections diagnosed, and may be more likely to develop chronic infection. This is called "Silent PID" and is especially likely if chlamydia is involved, as chlamydial infections usually cause very mild or no symptoms.

How Can A Woman Tell If She Has PID ?

This is one of the main problems with PID. PID is extremely difficult to diagnose accurately unless surgery is done. One of the reasons for this is that the reproductive organs lie within the body and can't be seen without surgery. Also, there is no specific blood test or other office test that can be done to show if infection is present in the reproductive organs. Thus if a practitioner tries to diagnose PID without surgery (called a clinical diagnosis), she/he has to rely on indirect information such as general blood tests, symptoms, general signs of infection (eg fever), or tests for infection in other areas of the body (eg the cervix).