• Dr Peter Chew

Can fertility be restored in pelvic infection?

Some months ago, I had a call from the emergency department of the hospital. My patient L, 30, was admitted with a high fever of 40 degree Celcius  and with severe lower abdominal pain for a day.

She was rolling in pain on her bed when I saw her. Her face was red and flushed and her pulse rate was rapid at 100 per minute. Her lower abdomen was tense and tender. When I examined her, there was a small amount of foul smelling discharge from her cervix (neck of the womb). Vaginal examination was extremely tender. Blood tests and pelvic ultrasound examination suggested that she had a severe pelvic infection. She was given a strong antibiotic intravenously (through a vein) immediately. Her fever subsided and her condition improved dramatically the next day. She was discharged after 3 days in the hospital.

As pelvic infection is usually transmitted sexually, I called L’s husband discretely. He admitted sheepishly that he had a “one-night stand" in a foreign country during a business trip a few weeks ago.

"Doc, how can it be since I had used a condom and my blood tests done after that were OK?” he asked. I explained to him patiently that using a condom and having normal blood test results did not mean he did not have sexually transmitted infections (STDs). He finally agreed albeit reluctantly to have the antibiotic treatment.

Pelvic infection, also known as pelvic inflammatory disease (PID), is one of the most common infections in women of reproductive age. It infects female reproductive organs including the cervix, uterus, fallopian tubes and ovaries. It is more common among younger women (less than 25 years) and those with more than one sexual partner. Women with a previous history of STDs or whose husbands are promiscuous have increased risks of contracting PID. 

More than 85% of infections are sexually transmitted and caused by organisms like chlamydia or gonorrhoea. It can also occur after an abortion or insertion of an intrauterine contraceptive device (IUCD).

In the early stage, the symptoms and signs may be minimal. When the infection gets worse, the following symptoms may be present:

· Pain in lower abdomen  and pelvis

· Smelly vaginal  discharge

· Bleeding between periods

· Pain during sex

· Fever and chills

· Pain when passing urine

The infection if left untreated can cause the fallopian tubes to become scarred and narrowed, leading to partial or complete obstruction. The surrounding pelvic organs may also develop adhesions. This may lead to long term complications such as chronic pelvic pain, infertility and ectopic pregnancy.

Diagnosis of PID is usually made based on clinical symptoms and signs. However, it may not always be easy as the site of infection cannot be assessed easily and the symptoms sometimes mimic those of other conditions, such as appendicitis, or a twisted or ruptured ovarian cyst.

Blood tests, ultrasound examinations and other imaging procedures and laparoscopy may be helpful in making the diagnosis.

The mainstay for the treatment of PID is antibiotics. Very often it is caused by more than one type of microorganisms. Multiple antibiotics may be necessary. Antibiotics can be taken by mouth or intravenously in severe case. Surgery may be required if pus accumulates in the swollen tube.

L had been married for 7 months. She was keen to start a family. I advised her to wait for 2 months after treatment to make sure that she had recovered fully and there was no relapse. On her follow-up visit 6 months later, she walked into my clinic smiling. She had missed her period. She was very happy when I showed her the baby’s heart beating on the ultrasound examination. She was full of gratitude that her fertility was unaffected by the severe bout of pelvic infection as her condition was treated promptly.

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