TREATMENT OF CHRONIC INFECTION: Women can develop chronic infection from PID, either because the infection has gone on for a long time before it was diagnosed, or because the initial treatment was incomplete. This is a common diagnosis, but we really don't know much about the most effective treatment for chronic infection. To our knowledge, no research has been done on this topic. One researcher in France, Jeanine Henry-Suchet, suggests very long antibiotic treatment of two to three months for chronic infection, but again, this suggestion is not based on research. We just don't know for sure what would be most effective.

Prevention

This is the most important part of this chapter. PID is extremely difficult to diagnose accurately, and much of the damage has already been done to pelvic organs by the time antibiotic treatment has been started. Prevention is the most effective treatment for PID. Here are the basic steps to prevention.

PREVENT CERVICAL STD INFECTIONS: These are the most common cause of PID. The use of condoms or diaphragms with spermicide can protect women from STD's which may lead to PID. These methods are only effective if they are used properly. Research indicates that women who consistently use condoms or diaphragms with spermicide have much lower rates of PID. Women who use condoms or diaphragms also have lower rates of infertility and ectopic pregnancy, common consequences of PID.

STOP CERVICAL INFECTIONS BEFORE THEY PROGRESS TO PID: Preventive measures include regular STD checkups, especially if the woman is not using a barrier method of birth control, if she is very young, if she has a new partner, or if the partner has a new partner. It is also important to watch for symptoms of STD's such as frequent or painful urination, itching or discharge from the vagina, abnormal periods, pain or bleeding during or after sex. However, it is important to remember that many women have cervical or vaginal infections with no symptoms.

REDUCE THE RISK OF PID FROM ANY PROCEDURE OR PROCESS THAT OPENS THE CERVIX: Before undergoing childbirth or any medical procedure which opens the cervix, a woman should see her doctor to insure that she doesn't have a cervical or vaginal infection. If an infection is present, it should be treated beforehand. Also, the use of preventive or prophylactic antibiotics given before the procedure can reduce the risk of infection from insertion of an IUD or from a therapeutic abortion.

After a procedure or process that opens the cervix, nothing should be inserted into the vagina until after the cervix has completely closed (at least six to eight weeks). Also, women should watch for any signs of infection after childbirth or any medical procedure which opens the cervix, and go promptly to a physician if any signs of infection are present.

PREVENT VAGINAL INFECTIONS WHICH CAN LEAD TO PID: Bacteria grow better in warm, moist environments, so it is important to keep the vaginal environment cool and dry (ie loose cotton underwear, etc). Also, recent research indicates that a healthy vagina is acidic, and has lots of helpful bacteria called lactobacilli, which help prevent vaginal infection. Lactobacilli produce substances such as lactic acid and hydrogen peroxide, which make it difficult for other bacteria or yeast to grow. Research on what women can do to keep their vaginas healthy is only just beginning, but some studies have indicated that inserting capsules of lactobacilli or yogurt may be helpful, although it is not clear how long-lasting this effect will be. Women should also be aware that it is easy for a physician to check to see if a woman's vagina is healthy (acidic, with lots of lactobacilli). Therefore, regular checkups are an important part of prevention.

STOP VAGINAL INFECTIONS FROM PROGRESSING TO PID: Bacterial vaginosis, a common vaginal infection which can lead to PID, is easy to diagnose. The physician can check the vaginal PH, can look for signs that lots of bacteria are present (clue cells), can check for the presence or absence of helpful bacteria like lactobacilli, and can check the odour. A fishy odour indicates that bacterial vaginosis may be present. Treatment of bacterial vaginosis is still being studied, but generally clindamycin cream has been found to be effective. Treatment with acidophilus capsules or vinegar douches, although still experimental, has also been found to be successful for some women. Long-term studies have yet to establish the most effective treatment.

PREVENT BOWEL BACTERIA FROM ENTERING THE VAGINA: Bowel bacteria, such as E-coli, can cause PID. These bacteria may be transferred into the vagina if a woman wipes from back to front after going to the bathroom. Prevention involves wiping from front to back after going to the bathroom, and ensuring that vaginal intercourse never follows anal intercourse.