What are the types of Pelvic Inflammatory Disease?

Acute Pelvic Inflammatory Disease

Pelvic inflammatory disease may present as an acute illness with fever, severe lower abdominal pain, accompanied by a yellow or blood-stained, non-irritant vaginal discharge and vomiting, which usually prompts the woman to seek urgent medical attention.

Subacute Pelvic Inflammatory Disease

More commonly, the onset of PID is gradual, less severe, and often goes unnoticed until superimposed acute PID occurs or chronic, incapacitating symptoms prompt the woman to seek medical attention.

Chronic Pelvic Inflammatory Disease

Chronic PID is a consequence of untreated or unsuccessfully managed acute and/or subacute PID. The woman usually presents with symptoms of pelvic pain, heavy and painful menstrual periods, pain with intercourse (dyspareunia) and/or infertility that triggers an evaluation that reveals extensive pelvic scar tissue.

Sexually Transmitted Pelvic Inflammatory Disease

Gonorrhea and Chlamydia are by far the most common causes of PID. The infections can rapidly invade via the cervix and uterus into the fallopian tube(s).  These pencil length passages are highly specialized to promote the active passage of sperm traveling up from the uterus to meet up with an egg released by the ovary. After fertilization, which typically occurs near the site of egg release, the resulting embryo will slowly travel back to the uterus-a journey that normally takes about 5 days. The fallopian tubes are lined with cells whose function is to protect and nurture eggs, sperm and embryos during their journey.  At their ends, the fallopian tubes have small delicate finger-like projections (fimbriae) that draw close to, envelop, and “pick-up” the egg from the ovary at the time of ovulation.

Inflammation due to Chlamydia Trachomatis or Neisseria Gonorrhea damages and often permanently destroys the specialized lining of the fallopian tube(s).  In severe cases, it can result in fusion of the fimbriae, thereby blocking the ends of the tube(s) and compromising their mobility and their potential to facilitate timely passage of eggs, sperm and embryos.  Pus that has accumulated inside the tube(s) often passes into the pelvic cavity, producing peritonitis and resulting in the formation of scar tissue (adhesions) which further disrupts normal pelvic anatomy as well as the relationship between the tubes and the ovaries.  This may prevent the fallopian tubes from collecting the eggs during ovulation.

In cases where the ends of the fallopian tubes are blocked, pus may collect and distend the tube(s).  The pus is usually absorbed over time and replaced by clear, straw-colored fluid.  The resulting occluded, fluid-filled, distended, and often functionless fallopian tube(s) is referred to as a hydrosalpinx.

Sexually transmitted PID almost invariably affects both fallopian tubes.  Even in cases where a dye x-ray test (hysterosalpingogram) or laparoscopy (a procedure where a telescope-like instrument is passed through the belly button to visualize the pelvic structures) indicates that only one fallopian tube has been infected, the other tube is almost invariably involved.  A new procedure called tuboscopy (where a thin fiberoptic telescope is passed into the fallopian tube(s) to evaluate the inner structure) has confirmed that the tubes of PID victims, who seemingly have normal pelvic anatomy, oftentimes have internal scarring and/or adhesion.  This could account for the low success rate seen with tubal reparative surgeries and the high ectopic pregnancy rate (8-15%) in PID patients who subsequently conceive.