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MoonDragon's ObGyn Information
PELVIC INFLAMMATORY DISEASE
(PID; Salpingitis)




BASIC INFORMATION


"For Informational Use Only"
For more detailed information contact your health care provider
about options that may be available for your specific situation.


DESCRIPTION

Pelvic Inflammatory Disease (PID) is a general term that refers to an infection of the female internal reproductive organs. PID may be used synonymously with the following terms:
  • Salpingitis (inflammation of the fallopian tubes).
  • Endometritis Inflammation of the inside lining of the body of the uterus).
  • Tubo-ovarian abscesses (abscesses in the tubes and ovaries).
  • Pelvic peritonitis (inflammation inside of the abdominal cavity surrounding the female reproductive organs).

It is a common and serious contagious if it is caused by a sexually transmitted organism (STDs). PID can involve the fallopian tubes, cervix, uterus, ovaries, and urinary bladder and can cause serious damage if left untreated.

It affects sexually active females after puberty, especially late teens and early 20's. Each year in the United States, it is estimated that more than 1 million women experience an episode of acute PID. More than 100,000 women become infertile each year as a result of PID, and a large proportion of the ectopic pregnancies occurring every year are due to the consequences of PID. Annually more than 150 women die from PID or its complications.





FREQUENT SIGNS & SYMPTOMS

Symptoms of PID vary from none to severe. When PID is caused by chlamydial infection, a woman may experience mild symptoms or no symptoms at all, while serious damage is being done to her reproductive organs. Because of vague symptoms, PID goes unrecognized by women and their health care providers about two thirds of the time.

Early symptoms (up to 1 week):
  • Pain in the lower pelvis on one or both sides, especially during menstrual periods. Menstrual flow may be heavy. Pain in the right upper abdomen (rare).


  • Pain with intercourse.


  • Bad-smelling vaginal discharge.


  • General ill feeling.


  • Backache.


  • Low fever.


  • Frequent, painful urination.


  • Irregular menstrual bleeding.

Later symptoms (1 to 3 weeks later):
  • Severe pain and tenderness in the lower abdomen.


  • High fever.


  • Increased bad-smelling, vaginal discharge.




CAUSES

  • Bacterial infection ( chlamydial, gonorrheal, or mycoplasmal) or a virus. This may be transmitted by an infected sexual partner.


  • The two major organisms that cause STDs are Neisseria gonorrheae and Chlamydia trachomatis. The main symptom of N. gonorrheae infection (gonorrhea) is a vaginal discharge of mucus and pus. Sometimes bacteria from the colon normally in the vaginal cavity may travel upward to infect the upper female genital organs, facilitated by the infection with gonorrhea. Infections with C. trachomatis and other nongonoccal organisms are more likely to have mild or no symptoms.

    Although PID is unusual in women who are not sexually active, disease organisms other than the gonococcus and C. trachomatis can occasionally gain entrance to the upper female reproductive tract and cause PID. Cases have been reported from Canada, Norway, and South America of PID caused by pinworms, pneumococci, and Entamoeba histolytica, a pathogenic amoeba.

    Normally the cervix produces mucus that acts as a barrier to prevent disease-causing microorganisms, called pathogens, from entering the uterus and moving upward to the tubes and ovaries. This barrier may be breached in two ways. A sexually transmitted pathogen, usually a single organism, invades the lining cells, alters them, and gains entry. Another way for organisms to gain entry happens when trauma or alteration to the cervix occurs.

    Recent evidence suggests that bacterial vaginosis (BV), a bacterial infection of the vagina, may be associated with PID. BV results from the imbalance of normal organisms in the vagina-by douching, for example. While the balance is altered, conditions then favor the overgrowth of anaerobic bacteria that thrive in the absence of free oxygen. A copious discharge is usually present. Should some trauma occur in the presence of anaerobic bacteria, such as menses, abortion, intercourse, or childbirth, these organisms may gain entrance to the upper genital organs.

  • Childbirth, spontaneous or induced abortion, or use of an intrauterine contraceptive device (IUD) are all conditions that may alter or weaken the normal lining cells, making them susceptible to infection, usually by several organisms. During menstruation, the cervix widens and may allow pathogens entry into the uterine cavity.
    • Infections occur much more frequently in hospital births than in birthing center births, and infections rarely occur as a result of childbirth at home. Hospitals are notorious for life-threatening infections, such as a Staph infection. Hospital Infections

  • Pelvic surgery.


  • Sometimes PID can occur after the cervix is treated because of an abnormal Pap smear. However this is not common.


  • IUDs - The use of intrauterine devices, or IUDs, has been strongly associated with the development of PID. Bacteria may be introduced to the uterine cavity while the IUD is being inserted or may travel up the tail of the IUD from the cervix into the uterus. Surrounding uterine tissue may show areas of inflammation, increasing its susceptibility to pathogens. Some researchers, however, maintain that the connection between IUDs and PID has been exaggerated and that further research is necessary.





  • RISK INCREASES WITH

    Susceptibility to STDs involves many factors, some of which are not known. The ability of the organism to produce disease and the circumstances that place the organism in the right place at a time when a trauma or alteration to the lining cells has occurred are factors. The woman's own immune response also helps to determine whether infection occurs.

  • Lifestyle choices. These include such high-risk behaviors as drug and alcohol abuse; early age at first intercourse; a high number of sexual partners; and smoking all are associated with a higher risk of developing PID. Multiple sexual partners, or exposure to a single partner who is infected. The more sex partners a woman has, the greater her risk of developing PID. Also, a woman whose partner has more than one sex partner is at greater risk of developing PID, because of the potential for more exposure to infectious agents.


  • Specific sexual practices. Intercourse during the menses and frequent intercourse may offer more opportunities for the admission of pathogenic organisms to the inside of the uterus.


  • Use and method of contraception. Induced abortion, use of an IUD, non-use of such barrier contraceptives as condoms. Use of an intrauterine contraceptive device (IUD). Women who have an intrauterine device (IUD) inserted may have a slightly increased risk of PID near the time of insertion compared with women using other contraceptives or no contraceptive at all. However, this risk is greatly reduced if a woman is tested and, if necessary, treated for STDs before an IUD is inserted.


  • Previous history of PID, sexually transmitted diseases (STDs) or cervicitis. The presence of a sexually transmitted disease. Sixty to seventy-five percent of PID cases are associated with STDs. A prior episode of PID increases the chances of developing subsequent infections.


  • The incidence of PID is very high in younger women and decreases as a woman ages. Sexually active women in their childbearing years are most at risk, and those under age 25 are more likely to develop PID than those older than 25. This is because the cervix of teenage girls and young women is not fully matured, increasing their susceptibility to the STDs that are linked to PID.


  • Women who frequently douche may have a higher risk of developing PID compared with women who do not douche. Research has shown that douching changes the vaginal flora (organisms that live in the vagina) in harmful ways, and can force bacteria into the upper reproductive organs from the vagina.


  • The incidence of PID is 8-10 times higher in non-whites than in white races.


  • The higher incidence of PID in women of lower socioeconomic status is due in part to a woman's lack of education and awareness of health and disease, and due in part to barriers to her accessibility to medical care.





  • PREVENTIVE MEASURES

    STD (mainly untreated Chlamydia or gonorrhea) is the main preventable cause of PID. Women can protect themselves from PID by taking action to prevent STDs or by getting early treatment if they do get an STD. The surest way to avoid transmission of STDs is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

  • Use latex condoms. Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of chlamydia and gonorrhea. spermicidal creams or sponges to help prevent sexually transmitted infections.


  • Oral contraceptives may appear to decrease the risk.


  • Seek routine medical check-ups for sexually transmitted diseases if you have multiple sexual partners. CDC recommends yearly chlamydia testing of all sexually active women age 25 or younger and of older women with risk factors for chlamydial infections (those who have a new sex partner or multiple sex partners). An appropriate sexual risk assessment by a health care provider should always be conducted and may indicate more frequent screening for some women. Any genital symptoms such as an unusual sore, discharge with odor, burning during urination, or bleeding between menstrual cycles could mean an STD infection. If a woman has any of these symptoms, she should stop having sex and consult a health care provider immediately. Treating STDs early can prevent PID. Women who are told they have an STD and are treated for it should notify all of their recent sex partners so they can see a health care provider and be evaluated for STDs.


  • Have your sexual partner evaluated and treated if necessary. Do not resume sexual activity with your partner until his/her tests show no infection, or he/she has been treated. Sexual activity should not resume until all sex partners have been examined and, if necessary, treated.





  • EXPECTED OUTCOME

    PID can be cured if the initial infection is treated immediately. If infection is not recognized, as frequently happens, the process of tissue destruction and scarring that results from inflammation of the tubes results in irreversible changes in the tube structure that cannot be restored to normal.

    In 85 percent of cases, the initial treatment succeeds, and in 75 percent of cases, patients do not experience a recurrence of the infection. However, when there is a recurrence, the likelihood of infertility increases with each episode of PID. Subsequent bouts of PID increase a woman's risk of complications. Thirty to forty percent of female infertility cases are due to acute salpingitis.

    Potential complications from PID include a tubo-ovarian abscess; fallopian tube obstruction, which can result in ectopic pregnancy or infertility; chronic pelvic pain; and sexual dysfunction.

    With modern antibiotic therapy, death from PID is almost nonexistent. In rare instances, death may occur from the rupture of tubo-ovarian abscesses and the resulting infection in the abdominal cavity. One recent study has linked infertility, a consequence of PID, with a higher risk of ovarian cancer.

    PID is Usually curable with early treatment and avoidance of further infection. The illness lasts from 1 to 6 weeks, depending on its severity and the organisms involved. Poorer prognosis if treated late and unsafe lifestyle continues.





    POSSIBLE COMPLICATIONS

    Prompt and appropriate treatment can help prevent complications of PID. Without treatment, PID can cause permanent damage to the female reproductive organs.

  • Pelvic abscess and rupture. This can be life-threatening.


  • Adhesions (bands of scar tissue) inside the pelvis.


  • Female infertility. Infection-causing bacteria can silently invade the fallopian tubes, causing normal tissue to turn into scar tissue. This scar tissue blocks or interrupts the normal movement of eggs into the uterus. If the fallopian tubes are totally blocked by scar tissue, sperm cannot fertilize an egg, and the woman becomes infertile. Infertility also can occur if the fallopian tubes are partially blocked or even slightly damaged. About one in eight women with PID becomes infertile, and if a woman has multiple episodes of PID, her chances of becoming infertile increase.


  • Ectopic pregnancy. In addition, a partially blocked or slightly damaged fallopian tube may cause a fertilized egg to remain in the fallopian tube. If this fertilized egg begins to grow in the tube as if it were in the uterus, it is called an ectopic pregnancy. As it grows, an ectopic pregnancy can rupture the fallopian tube causing severe pain, internal bleeding, and even death.


  • Miscarriage if you are already pregnant. Scar tissue inside uterus and/or recurring uterine infection could result in Habitual Miscarriages (more than one miscarriage).


  • Recurrence, re-infection may occur if both partners are not treated for infecting organisms.


  • Chronic pelvic pain. Scarring in the fallopian tubes and other pelvic structures can also cause chronic pelvic pain (pain that lasts for months or even years). Women with repeated episodes of PID are more likely to suffer infertility, ectopic pregnancy, or chronic pelvic pain.




  • TREATMENT


    GENERAL MEASURES

    DIAGNOSIS

    PID is difficult to diagnose because the symptoms are often subtle and mild. Many episodes of PID go undetected because the woman or her health care provider fails to recognize the implications of mild or nonspecific symptoms. Because there are no precise tests for PID, a diagnosis is usually based on clinical findings. If symptoms such as lower abdominal pain are present, a health care provider should perform a physical examination to determine the nature and location of the pain and check for fever, abnormal vaginal or cervical discharge, and for evidence of gonorrheal or chlamydial infection. If the findings suggest PID, treatment is necessary.

    If you have symptoms such as lower abdominal pain, your health care provider will perform a physical exam, including a pelvic (internal) exam, to find out the nature and location of the pain. Your health care provider also will check for:
    • Abnormal vaginal or cervical discharge.
    • Masses near your ovaries and tubes.
    • Tenderness or pain of your abdomen, cervix, uterus, and ovaries.

    The health care provider may also order tests to identify the infection-causing organism (e.g., chlamydia, gonorrhea, syphilis infection) or to distinguish between PID and other problems with similar symptoms. You might be tested for HIV (human immunodeficiency virus) infection.

    Diagnostic tests may include:
    • Laboratory blood studies and culture of the vaginal discharge. Two blood tests may help to establish the existence of an inflammatory process. A positive C-reactive protein (CRP) and an elevated erythrocyte sedimentation rate (ESR) indicate the presence of inflammation.


    • A newer diagnostic technique that has dramatically improved the accuracy of laboratory testing for PID and other STDs is the ligase chain reaction (LCR) technique. The LCR technique detects DNA from N. gonorrhoeae and C. trachomatis in a patient's urine sample. LCR technology is less invasive as well as more accurate.

    • Pregnancy test to determine if you are currently pregnant.


    • Pelvic Ultrasound. A pelvic ultrasound is a helpful procedure for diagnosing PID. An ultrasound can view the pelvic area to see whether the fallopian tubes are enlarged or whether an abscess is present.

    Surgical diagnostic procedures, such as:

  • Laparoscopy (a telescopic instrument with fiber optic light is used to examine the abdominal cavity). In some cases, a laparoscopy may be necessary to confirm the diagnosis. A laparoscopy is a minor surgical procedure in which a thin, flexible tube with a lighted end (laparoscope) is inserted through a small incision in the lower abdomen. This procedure enables the health care provider to view the internal pelvic organs and to take specimens for laboratory studies, if needed. The health care provider may take fluid from the cavity surrounding the ovaries called the cul de sac; this fluid may be examined directly for bacteria or may be used for culture.


  • Culdocentesis (passage of a needle through the cervix into the peritoneal cavity to obtain a fluid sample).


  • TREATMENT

    Treatment may be done on an outpatient basis if infection is mild. It is important to adhere to your treatment and medication schedule. Close medical follow-up care is necessary.

    PID can be cured with several types of antibiotics. A health care provider will determine and prescribe the best therapy. However, antibiotic treatment does not reverse any damage that has already occurred to the reproductive organs. If a woman has pelvic pain and other symptoms of PID, it is critical that she seek care immediately. Prompt antibiotic treatment can prevent severe damage to reproductive organs. The longer a woman delays treatment for PID, the more likely she is to become infertile or to have a future ectopic pregnancy because of damage to the fallopian tubes.

    Because of the difficulty in identifying organisms infecting the internal reproductive organs and because more than one organism may be responsible for an episode of PID, PID is usually treated with at least two antibiotics that are effective against a wide range of infectious agents. These antibiotics can be given by mouth or by injection. The symptoms may go away before the infection is cured. Even if symptoms go away, the woman should finish taking all of the prescribed medicine. This will help prevent the infection from returning. Women being treated for PID should be re-evaluated by their health care provider two to three days after starting treatment to be sure the antibiotics are working to cure the infection. In addition, a woman's sex partner(s) should be treated to decrease the risk of re-infection, even if the partner(s) has no symptoms. Although sex partners may have no symptoms, they may still be infected with the organisms that can cause PID.

  • Hospitalization may be required if severe illness, further diagnostic studies, suspected abscess or appendicitis, or patient's failure to comply or to respond to outpatient therapy, or in case of pregnancy. Hospitalization to treat PID may be recommended if the woman:
    (1) Is severely ill (e.g., nausea, vomiting, and high fever);
    (2) Is pregnant;
    (3) Does not respond to or cannot take oral medication and needs intravenous antibiotics; (4) Has an abscess in the fallopian tube or ovary (tubo-ovarian abscess).
    (5) Under the age of 18.
    (6) Have the human immunodeficiency virus (HIV).

    If symptoms continue or if an abscess does not go away, surgery may be needed. Complications of PID, such as chronic pelvic pain and scarring are difficult to treat, but sometimes they improve with surgery.


  • Surgery to drain a pelvic abscess (sometimes) may be necessary.


  • Hysterectomy may be recommended for older patients who desire no more children.


  • Psychotherapy or counseling, if infertility occurs.


  • HOME TREATMENT WHILE ON ANTIBIOTICS

    After you have started medical treatment for PID, your health professional will give you specific instructions for home care. Be sure to follow those instructions and keep all follow-up appointments. Use the following home treatment measures to support your recovery.

  • Take regular doses of a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, for pain. If pain does not improve within 48 to 72 hours after you start treatment, tell your health professional.


  • Use heat to relieve pain, such as warm baths. This may, also reduce the bad odor of the vaginal discharge, as well as relax the muscles and relieve discomfort. Sit in a tub of warm water for 10 to 15 minutes as often as needed. A hot water bottle or heating pad on the pelvic area may help relieve pain.


  • Use sanitary pads to absorb the discharge or menstrual flow; do not douche during treatment and do not use tampons.


  • Do not have sexual intercourse during treatment. Avoid sex until you have taken all antibiotic medication, your pain is gone entirely, and you feel completely well. Also avoid sex until your partner or partners have finished treatment for any sexually transmitted diseases (STDs). Do not have sex with a partner who has not been treated. Your sex partner(s) should be treated even if they do not have symptoms.


  • Drink lots of water and eat a balanced diet, which will help your body fight the infection.


  • Rest as much as possible until your symptoms start to get better (usually a couple of days), then return to your usual activities slowly.


  • Make and keep follow-up appointments. Your health professional will want to see you 2 to 3 days after you've started antibiotics to make sure they are working. You may also be seen for follow-up 7 to 10 days later to make sure you are getting better and to talk about how to avoid another infection. You may have an additional follow-up exam at 4 to 6 weeks to see whether you've fully recovered.


  • Call your health professional if your symptoms get worse or come back.


  • RESEARCH

    Although scientists have learned much about the biology of the microbes that cause PID and the ways in which they damage the body, they still have much to learn. Scientists supported by the National Institute of Allergy and Infectious Diseases (NIAID) are studying the effects of antibiotics, hormones, and substances that boost the immune system. These studies may lead to insights about how to prevent infertility and other complications of PID.

    Scientists are developing rapid, inexpensive, and easy-to-use diagnostic tests to detect chlamydia and gonorrhea. A study conducted by NIAID-funded researchers demonstrated that screening and treating women who did not know they had chlamydia reduced cases of PID by more than half. Researchers also are developing topical microbicides and vaccines that prevent gonorrhea and chlamydia. Others are investigating whether other microbes such as Mycoplasma genitalium cause PID and are developing diagnostic tests and treatments for this infection. Meanwhile, researchers continue to search for better ways to detect PID itself, particularly in women who have PID without symptoms.

    ALTERNATIVE-COMPLEMENTARY THERAPY

    Alternative therapy should be complementary to antibiotic therapy. Because of the potentially serious nature of this disease, a patient should first consult an allopathic physician to start antibiotic treatment for infections. Traditional medicine is better equipped to quickly eradicate the infection, while alternative treatments can help the body fight the disease and relieve painful symptoms associated with PID. Some of the alternative treatments include diets, nutritional supplements, herbal remedies, homeopathy, acupressure, and acupuncture.





    MEDICATION

  • Intravenous or intramuscular antibiotics to fight infection.


  • Early or mild PID may be treated with oral antibiotics.


  • Your provider may prescribe the following antibiotics or combination of drugs.
    • Cefoxitin
    • Ofloxacin
    • Clindamycin

  • Pain relievers.





  • ACTIVITY

    Avoid sexual intercourse until healing is complete. Both patient and her partner should be treated for PID infections. They should also avoid sexual activity until their infections are completely eradicated.

    Rest in bed until any fever subsides. Patients need to rest and reduce physical activity to help the body recuperate faster. Sit and lie in different positions until you find one that is comfortable for you. Allow several weeks for recovery.

    Healthy diet. Diet should include a variety of fresh fruits and vegetables. These foods contain high amount of phytonutrients and essential vitamins that help keep the body strong and stimulate the immune system to fight infections.





    DIET & NUTRITION

    Proper nutrition is important to combat infection. A good diet is essential to help build and maintain a good immune system.

  • Eat whole foods such as fresh vegetables, whole grains, and essential fatty acids (nuts, seeds, and cold-water fish).


  • Avoid sugar, refined foods, and saturated fats (animal products, especially dairy).





  • BENEFICIAL NUTRITIONAL SUPPLEMENTS

    Potentially beneficial nutrient supplements include the following.

  • MULTI-VITAMIN & MINERAL - A good multivitamin and multimineral supplement is necessary for a well-balanced nutrient intake and good health.


  • Herbal Remedies: Maxi Multi Liquid Vitamin w/ Trace Minerals, 32 fl. oz.

    Herbal Remedies: Super Multi-Vitamin & Multi-Mineral, Pure Vital Earth, 98% Bio-Available For Absorption, 32 fl. oz.

    Herbal Remedies: Damage Control Master Formula, High Potency Multi-Vitamin, 60 Packets (30 Day Supply)

    Herbal Remedies: Women's Living Green Liquid Gel Multi-Vitamin, Irwin Naturals, 90 Softgels

    Herbal Remedies: Organic Life Vitamins, Peter Gillham's Natural Vitality, 30 Packets, 1 fl. oz. Each

    Herbal Remedies: Peter Gillham's Liquid Organic Life Vitamins, 32 fl. oz.

    Herbal Remedies: Enzymatic Therapy, Doctor's Choice MultiVitamin For Women Age 45 Plus, 180 Tabs

    Herbal Remedies: Electro-Vita-Min, Trace Minerals, 180 Tabs

    Herbal Remedies: Multi-Vitamin & Mineral Complete, Trace Minerals, 120 Tabs

    Herbal Remedies: Alive! Whole Food Energizer Multi-Vitamin & Mineral W/ Naturally Occurring Iron (No Iron Added), Nature's Way, 90 Tabs

    Herbal Remedies: Multi-Vitamin With Minerals, Hi-Tech, 90 Tabs

    Herbal Remedies: Multi-Vitamin & Mineral without Iron, Complete Vitamin Supplement, Nature's Way, 100 Caps

    Herbal Remedies: Multi-Vitamin & Mineral with Iron, Complete Vitamin Supplement, Nature's Way, 100 Caps

  • VITAMIN C - This vitamin is essential for the proper functioning of the immune system. It also helps with the formation of collagen, which is very important if you are suffering from a vaginal infection or PID. Collagen is a protein that is found in an abundant supply in the body. It maintains the integrity of skin, ligaments, tendons and bone. If the collagen matrix (which is the main component of connective tissue) is intact, infection is less likely to spread, and your organs are less likely to become scarred by the infection. The bacteria can spread through the connective tissue so having extra vitamin C at this time will help to strengthen the connective tissue, make it more resistant, and decrease the time it takes for your body to repair damaged tissue.


  • Vitamin C (1,000 mg three to four times per day).

    Herbal Remedies: Vitamin C 1000 w/Rosehips, 100% Natural, 1000 mg, 250 Caps

    Herbal Remedies: Vitamin C 500 W/ Bioflavonoids, 100% Natural, 500 mg, 250 Caps

    Herbal Remedies: Vitamin C Liquid W/ Rose Hips & Bioflavoids, Dynamic Health, Kosher, Natural Citrus Flavor, 1000 mg, 16 fl. oz.

    Herbal Remedies: Ester C With Bioflavonoids, Nature's Way, 1000 mg, 90 Tabs

    Herbal Remedies: Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps

    Herbal Remedies: The Right C, Nature's Way, 1000 mg, 120 Tabs

  • ZINC - Zinc is an important mineral for the immune system and needs to be taken when an infection is present. Not only does it help to boost immunity, which can encourage faster healing, but it can help to prevent a recurrence.


  • Zinc (30 mg per day).

    Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz.

    Colloidal Silver & Zinc Lozenges, Silva Solution, 90 Lozenges

    Zinc Lozenges W/ Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges

    Zinc (Chelated), 100% Natural, Nature's Way, 30 mg, 100 Caps

  • SELENIUM - Selenium is an essential trace element. It's main function is to inhibit the oxidation of fats (lipids) as a component of the enzyme glutathione peroxidase. When combined with vitamin E, Selenium is a vital antioxidant. This trace element is necessary for pancreatic function and tissue elasticity, and plays a vital role in regulating the effects of thyroid hormone on fat metabolism. Adding a Selenium supplement to your diet will aid in the production of antibodies and help maintain a healthy heart and liver, and when combined with vitamin E and zinc, can provide relief from an enlarged prostate in men. Studies have shown some positive results when this supplement is used in the treatment of arthritis, cardiovascular disease, male infertility, cataracts, AIDS, and high blood pressure. Other scientific studies have shown that Selenium inhibits grow of tumors, and there is some evidence that AIDS patients also have an increased survival rate when they take a Selenium supplement as it increases red and white blood cell counts.


  • Selenium (200 mcg per day).

    Herbal Remedies: Selenium, 100% Natural, Nature's Way, 200 mcg, 100 Caps

    Herbal Remedies: Selenium Supplement, Yeast Free, NOW Foods, 200 mcg, 180 Caps

    Herbal Remedies: Selenium Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.

  • VITAMIN E - We now know that vitamin E encourages an increased resistance to chlamydial infections. As well as taking a vitamin E orally, you can open up a capsule and apply the oil to the inflamed area -or insert a yeast-free capsule into the vagina to help soothe the tissues and encourage healing.


  • Vitamin E (400 IU per day).

    Herbal Remedies: Vitamin E, d-alpha tocopherol, 400 IU, 100 Softgels

    Herbal Remedies: Ester E Natural Vitamin E, California Natural, 400 IU, 60 Softgels

    Herbal Remedies: Vitamin E, 400 IU, 100% Natural, NOW Foods, 100 Gels

    Herbal Remedies: Vitamin E-1000, NOW Foods, 1000 IU, 100 Gels

  • B VITAMINS / B-COMPLEX - These water-soluble vitamins are often deficient in women with vaginal infections. They are needed for healthy cell replication, which is particularly important when cells (such as those in the vagina) are bombarded with infection.


  • B-complex (50 to 100 mg).

    Herbal Remedies: Vitamin B-100 Complex w/ Coenzyme B-2, Nature's Way, 631 mg, 100 Caps

    Herbal Remedies: Vitamin B-50 Complex w/ Coenzyme B-2, Nature's Way, 330 mg, 100 Caps

    Herbal Remedies: Liquid Yeast, B Complex, TwinLab, 16 fl. oz.

    Herbal Remedies: B-Stress Vitamin Complex With Siberian Eleuthero, Nature's Way, 100 Caps

    Herbal Remedies: Ultimate B (Vitamin B Complex Formula), Nature's Secret, 60 Tabs

    Vitamin B-12 Complex Liquid, NOW Foods, 2 fl. oz.

  • FOLIC ACID (VITAMIN B-9) - Folic acid is especially important for women (800 mcg per day).


  • Folic Acid, 100% Natural, Natures Way, 800 mcg, 100 Caps

  • VITAMIN A & BETA-CAROTENE - Vitamin A is an important nutrient in maintaining cell membrane integrity. Vitamin A also plays an important role in proper bone formation, reproduction and vision. Beta-carotene is a type of vitamin A that is known to help your body produce collagen, and it also helps to keep your cartilage strong. It is important that you have adequate levels in your body to help stop the spread of infection. Beta-carotene is also a powerful antioxidant and is found in high concentrations in the ovaries. However, if there is not enough in the body, levels in the ovaries will be inadequate, and the ovaries will be less likely to be able to fight off attacking infectious agents. Studies show that adequate levels of beta-carotene can help to prevent excess cell damage. Beta-carotene is also vital for immune function and for the normal growth of the type of tissue found in the vagina.


  • Vitamin A (25,000 IU one to two times per day) or beta carotene (50,000 IU one to two times per day).

    Herbal Remedies: Vitamin A, 10,000 IU, 100% Natural, Nature's Way, 100 Softgels

    Herbal Remedies: Dry Vitamin A & D Nature's Way, 15,000/400 IU, 100 Caps

    Multi-Carotene Antioxidant Supplement, Nature's Way, 60 Softgels

    Beta Carotene, 100% Natural, Natures Way, 25,000 IU, 100 Softgels

  • BROMELAIN - Bromelain been used for various types of swelling and inflammation. In Europe, Bromelain is used to aid in recovery from surgery and athletic injuries, but they also recommend it for the treatment of hemorrhoids, phlebitis, inflammation of the veins of the leg, osteoarthritis, rheumatoid arthritis, gout, and dysmenorrhea (menstrual pain). Bromelain is active both in the acid environment of the stomach and the alkaline environment of the small intestine, which makes it fairly effective as an oral digestive aid as well.


  • Bromelain (500 mg three times per day between meals).

    Bromelain 2000 GDU, Now Foods, 500 mg, 90 Tabs

  • ESSENTIAL FATTY ACIDS - Essential fatty acids are critical in the production of prostaglandins. In the body prostaglandins help regulate fat metabolism, inflammatory response, hormones, as well as the cardiovascular, immune and central nervous systems.


  • Anti-inflammatory essential fatty acid oils (for example, flax, borage, evening primrose) 1,500 mg two to three times per day.

    Herbal Remedies: Flax Seed Oil, 1000 mg, 250 Caps

    Herbal Remedies: Borage Oil, 1000 mg, Natures Way, 60 Softgels

    Herbal Remedies: Evening Primrose Oil, Cold-Pressed, Nature's Way, 500 mg, 250 Softgels

    Herbal Remedies: Evening Primrose Oil, Cold-Pressed, Nature's Way, 1300 mg, 120 Softgels

    Herbal Remedies: Evening Primrose Oil, NOW Foods, 100% Pure, 4 fl. oz.

  • FLAX SEED OIL - Flax seed oil is a rich, vegetarian source of omega 3 and omega 6 essential fatty acids. Worldwide studies have shown that using Flaxseed oil boosts the immune system, promotes anti-tumor activity, normalizes blood pressure levels and inhibits cancer cell growth. Flaxseed oil is beneficial for allergies, cardiovascular health, cholesterol levels, circulation, eczema, eyesight, immune function, learning ability, nerve problems, osteo-arthritis, rheumatoid arthritis, viral illness, weight management, diabetes, blood pressure, inflammation, psoriasis, multiple sclerosis, ulcerative colitis, acne, dry skin, energy levels, PMS, mood swings, and liver problems.

    Flax Seed oil (1000 mg per day).

    Herbal Remedies: Barlean's Flax Oil, 100% Highest Lignan Content, Organic, Pesticide & Herbicide Free, 16 fl. oz.

    Herbal Remedies: Barlean's Flax Oil, Highest Lignan, 1000 mg, 250 Caps

  • GARLIC - Often called 'nature's antibiotic', garlic is very important while you are trying to fight off an infection because it has strong antibacterial properties. So not only can it help to deal with the present infection, but it can help to prevent a recurrence by making the body an inhospitable place for invaders. Fresh cloves of garlic can be obtained at your supermarket. 2-3 cloves of garlic, 3 times daily is recommended.

    Garlic (2-3 capsules (4,000 mcg of allicin per day) or 2-3 fresh cloves 3 times per day).


  • Herbal Remedies: Garlic Oil Tincture, Alcohol Free, Nature's Way, 1 fl. oz.

    Herbal Remedies: Garlic Bulb Cloves, Garlic Supplement, Nature's Way, 580 mg, 100 Caps

    Herbal Remedies: Odorless Garlic Supplement, NOW Foods, 50 mg, 250 SoftGels

    Herbal Remedies: Garlic Supplement, Kwai, Triple Concentrated, 180 Tabs

    Herbal Remedies: Every Day Garlic Supplement, Kwai, 30 Tabs

    Herbal Remedies: Garlic Tincture, 100% Organic, 2 fl. oz.

    Herbal Remedies: Aged Garlic Extract, Cardiovascular Formula 100, Wakunaga Kyolic Supplements, 300 Caps

    Herbal Remedies: Kyolic Liquid Aged Garlic Extract, Cardiovascular, Vegetarian, Wakunaga Kyolic, 4 fl. oz.

    Herbal Remedies: Kyolic Aged Garlic Extract, One-A-Day, Vegetarian, 1000 mg, Wakunaga Kyolic, 30 Caps

    Aged Garlic Extract, Cholesterol Formula 104, Wakunaga Kyolic, 200 Caps

  • ACIDOPHILUS - Lactobacillus acidophilus, a 'healthy' bacteria known as flora, normally inhabits the vagina in good numbers. Infections such as bacterial vaginosis tend to 'get hold' when the balance between healthy and unhealthy bacteria in the body change. Therefore, it makes sense that if the bacteria in your body is largely healthy, it is less likely that opportunistic bacteria can take over. What's more, lactobacillus is toxic to Gardnerella vaginalis, which is the main cause of bacterial vaginosis. Acidophilus needs to be taken orally, but it is also suggested that you also use it internally by inserting an acidophilus capsule directly into the vagina.

    Acidophilus (one capsule, with meals).

    Herbal Remedies: Acidophilus Powder, Non-dairy, 4 oz, bulk

    Herbal Remedies: Acidophilus, 3 Billion, Now Foods, 90 Tabs





    HERBAL RECOMMENDATIONS

    Herbs are taken to help increase the effectiveness of your immune system. They can be useful while you taking medication, but they are also extremely effective when used following an attack in order to prevent a recurrence. Some herbs work on the infection directly.

    Herbal remedies may offer relief from symptoms. Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose for teas is 1 heaping tsp. per cup of water steeped for 10 minutes (roots need 20 minutes).

  • TEA TREE OIL (Melaleuca alternifolia) - Tea tree oil has been the subject of recent research into its beneficial effect on vaginal infection. It appears to have antimicrobial properties and was especially successful in treating trichomonas. This essential oil is not taken by mouth but used vaginally to combat trichomonas and bacterial vaginosis. It is possible to buy tea tree oil pessaries, which you insert into the vagina. Another trick is to add a few drops of the essential oil to your bath, together with 3 cups of pure apple cider vinegar, which can be very helpful when you have a vaginal infection.


  • Herbal Remedies: Tea Tree Essential Oil, 100% Pure Oil, NOW Foods, 1 fl. oz.

    Herbal Remedies: Tea Tree Oil Antiseptic Solution (15% Water Soluble), 2 fl. oz.

    Herbal Remedies: Tea Tree Oil (Melaleuca alternifolia), 100% Pure Oil, 2 fl. oz.

    Herbal Remedies: Tea Tree Oil Suppositories, 6 Count (For Vagina or Rectal Use)

    Herbal Remedies: Organic Apple Cider Vinegar (Mother), Organic, Dynamic Health, 16 fl. oz.

    Herbal Remedies: Apple Cider Vinegar, 285 mg, 90 Tabs

    Herbal Remedies: Apple Cider Vinegar, NOW Foods, 450 mg, 90 Tabs

    Herbal Remedies: Apple Cider Vinegar Supplements & Products

  • ECHINACEA - This is the herb of choice for boosting the immune system and strengthening its ability to fight off infection. Studies show that echinacea is more effective if taken with short breaks (the immune system benefits are less effective if it is taken continuously). It is suggested to use Echinacea ten days on and ten days off, ten days on etc. for maximum benefit


  • Mountain Rose Herbs: Echinacea, Bulk Organic Herbs

    Herbal Remedies: Echinacea Immune Support Tea, Certified Organic, Yogi Tea, 16 Tea Bags

    Herbal Remedies: Echinacea Tincture, Orange Flavor, Alcohol Free, 100% Organic (Great For Children), 1 fl. oz.

    Herbal Remedies: Echinacea Root Complex, Nature's Way, 180 Caps

    Herbal Remedies: 5 Echinacea Supplement, Vegetarian, Herbal Remedies USA, 1000 mg, 60 Liquid VCaps

    Herbal Remedies: Echinacea Extract, Standardized, Nature's Way, 340 mg, 60 Caps

    Herbal Remedies: Echinacea Herb, Nature's Way, 400 mg, 180 Caps

    Herbal Remedies: Echinacea & Olive Leaf Extract, Immune Defense, Standardized, Nature's Way, 60 Caps

    Herbal Remedies: Echinacea Tincture, Nature's Way, Alcohol Free, 1 fl. oz.

  • For acute infection, combine half parts of Yarrow (Achillea millefolium), Pasque Flower (Pulsatilla Pratensis), Marigold (Calendula officinalis), and Poke Root with one part of each Echinacea and Goldenseal. Take 30 to 60 drops tincture every two to four hours. Use caution with poke root. A tea can be made from Calendula Flowers and the tinctures added to the tea.


  • Mountain Rose Herbs: Yarrow, Organic Bulk Herbs

    Herbal Remedies: Yarrow Tincture, 2 fl. oz.

    Herbal Remedies: Yarrow Flower Herb, 325 mg, 100 Caps

    Shaman Shop: Pulsatilla Herb Powder, Herbal Extracts, 1/4 lb. Bulk Herbs

    Mountain Rose Herbs: Calendula (Pot Marigold), Organic Bulk Herbs

    Mountain Rose Herbs: Poke Root, Organic Bulk Herbs

    Herbal Remedies: Poke Root Extract Herb Tincture, Herbal Remedies USA, 2 fl. oz.

    Mountain Rose Herbs: Echinacea, Organic Bulk Herbs

    Herbal Remedies: Echinacea Tincture, Nature's Way, Alcohol Free, 1 fl. oz.

    Herbal Remedies: Goldenseal Root Tincture, 100% Organic, 2 fl. oz.

  • For chronic infection, combine equal parts of Echinacea, Goldenseal, Licorice Root, Myrrh Gum, Wild Indigo, and Red Root. Make a tea out of herbs and add 30 drops of tincture two to three times per day. Take Turmeric three times per day and Bromelain to enhance anti-inflammatory effects.


  • Herbal Remedies: Echinacea Tincture, Nature's Way, Alcohol Free, 1 fl. oz.

    Herbal Remedies: Goldenseal Root Tincture, 100% Organic, 2 fl. oz.

    Herbal Remedies: Licorice Extract Tincture, Herbal Remedies USA, 2 fl. oz.

    Herbal Remedies: Myrrh Gum Supplement Tincture, 2 fl. oz.

    Herbal Remedies: Wild Indigo Extract Tincture, Herbal Remedies USA, 2 fl. oz.

    Herbal Remedies: Red Root Tincture, 2 fl. oz.

    Herbal Remedies: Turmeric Tincture, 100% Organic, 2 fl. oz.

    Herbal Remedies: Turmeric Extract (Curcuma longa), Standardized to 95% Curcuminoids, Nature's Way, 500 mg, 120 Tabs


    Herbal Remedies: Bromelain 2000 GDU, Now Foods, 500 mg, 90 Tabs

  • Grapefruit Seed Oil or Extract has been used to fight a variety of infections including bacterial, viral, fungal, parasitic, and worm infections.

    Herbal Remedies: Grapefruit Essential Oil, 100% Pure, NOW Foods, 1 fl. oz.

    Herbal Remedies: Grapefruit Seed Extract, 125 mg, 100 Tabs

    Herbal Remedies: Grapefruit Seed Extract Liquid Concentrate, 2 fl. oz.

    Herbal Remedies: Grapefruit Seed Extract Liquid Concentrate, 4 fl. oz.

    Herbal Remedies: Grapefruit Seed Extract (GSE) Liquid Concentrate, 1 Gallon

  • Blue Cohosh (Caulophyllum Thalictroides) and False Unicorn Root (Chamaelirium Luteum) are recommended as tonics for the general well-being of the female genital tract. Do not use during pregnancy.


  • Mountain Rose Herbs: Blue Cohosh, Organic Bulk Herbs

    Herbal Remedies: Blue Cohosh Tincture, 100% Organic, 2 fl. oz.

    Herbal Remedies: Blue Cohosh Powder, 4 oz. Bulk

    Herbal Remedies: False Unicorn Root Extract Herb Tincture, 2 fl. oz.

  • Shatavari (Asparagus racemosa) is a cooling, calming, nourishing and purifying herb which has a special affinity with women though it is also excellent for men. It is rich in Vitamin A, nutritious starches, and hormone analogues. Shatavari tones, cleanses, nourishes, and strengthens the female reproductive organs and so is traditionally used for PMS, amenorrhea, dysmenorrhea, leucorrhea, menopause, and pelvic inflammatory disease like endometriosis. It also supports deeper tissue and build blood and so it helps to remove infertility, prepare the womb for conception, prevent miscarriage and acts as a post-partum tonic where it helps to increase lactation and normalize the uterus and the changing hormones. warning: Do not take during pregnancy.


  • Herbal Remedies: Shatavari Herb, Vegetarian, Banyan Botanicals, 500 mg, 90 Tabs

    Herbal Remedies: Shatavari Root Powder, Certified Organic, Banyan Botanicals, 1/2 lb.

    Herbal Remedies: Women's Support, Banyan Botanicals, 500 mg, 90 Tabs

    Note: If you are pregnant, do not take any herbal or dietary supplement until you have consulted with your midwife, naturopath, dietician, or health care provider. Some supplements should not be taken during pregnancy or doses may need to be adjusted for a pregnancy. You should not take any of the above herbs if you are taking, The Pill, Fertility drugs, HRT or any other hormonal treatment or other medication unless they are recommended by a registered, experienced practitioner.





    HOMEOPATHY

    A homeopathic practitioner may prescribe a patient-specific remedy to help reduce some of the symptoms associated with PID. Homeopathic remedies that are used in PID patients include Apis mellifica, Arsenicum album, Belladonna, Colocynthis, Magnesia phosphorica, and Mercurius vivus.







    PHYSICAL MEDICINE

    CASTOR OIL PACK

    Place a castor oil pack on the abdomen to reduce inflammation. Saturate a cloth with castor oil and apply directly to the skin, placing a heat source, such as a hot water bottle, on top. Leave in place for 30 minutes or more. Use for three to four consecutive days per week. Packs may be used daily.

    Herbal Remedies: Castor Oil, Expeller Pressed, Now Foods, 100% Pure, 16 fl oz - This oil can be used externally and internally, as a laxative. It is USP food grade.

    ACUPRESSURE

    Acupressure (applying pressure on specific pressure points) can increase blood flow to the pelvic region, reduce pain, and promote general health. See a qualified practitioner to teach you exact pressure points to use and proper technique. Acupressure is a similar to Acupuncture but is less invasive. Once learned, it can often be performed by the patient on themselves.

    ACUPUNCTURE

    Acupuncture may help enhance immune function and reduce pain and inflammation, especially with chronic PID. Acupuncture involves inserting needles at various points on the skin of the body. These needles are like antennae that direct qi (life force) to organs or functions of the body. This treatment may help with pain and also strengthen immunity. It is important that patients request disposable needles to prevent transmission of AIDS, hepatitis, and other infectious diseases.




    NOTIFY YOUR HEALTH CARE PROVIDER IF...

  • You or your family member has symptoms of pelvic inflammatory disease (PID).


  • Symptoms recur after treatment.


  • New, unexplained symptoms develop. Drugs used in treatment may produce side effects.

    MORE INFORMATION RESOURCES

    CDC-INFO
    1-800-CDC-INFO (800-232-4636)
    TTY: 1-888-232-6348
    CDC National Prevention Information Network (NPIN)
    P.O. Box 6003
    Rockville, MD 20849-6003
    1-800-458-5231
    1-888-282-7681 Fax
    1-800-243-7012 TTY
    E-mail: info@cdcnpin.org

    American Social Health Association (ASHA)
    P. O. Box 13827
    Research Triangle Park, NC 27709-3827
    1-800-783-9877

    National Library of Medicine
    MedlinePlus
    8600 Rockville Pike
    Bethesda, MD 20894
    1-888-FIND-NLM (1-888-346-3656) or 301-594-5983
    http://medlineplus.gov

    Centers for Disease Control and Prevention
    Division of Sexually Transmitted Diseases Prevention
    1-800-CDC-INFO (1-800-232-4636)
    www.cdc.gov/std

    Centers for Disease Control and Prevention
    National Prevention Information Network
    P.O. Box 6003
    Rockville, MD 20849-6003
    1-800-458-5231
    www.cdcnpin.org

    American Social Health Association
    P.O. Box 13827
    Research Triangle Park, NC 27709-3827
    919-361-8400
    www.ashastd.org

    MOONDRAGON'S LINKS TO RELATED SUBJECTS

    MoonDragon's ObGyn Information: Endometriosis

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