Can Chronic Pelvic Inflammatory Disease Be Cured? Key Questions Answered

Q: Can Chronic Pelvic Inflammatory Disease Be Cured? Key Questions Answered

Hello, Miss： Widespread lower abdominal pain—could it truly be pelvic inflammatory disease? Based on the described examinations, it is actually difficult to determine. <br>If it is indeed pelvic inflammatory disease, the appropriate antibiotics should be taken for 14-21 days; how

Is it possible to completely cure chronic pelvic inflammatory disease and confirm that there is no bacterial infection? Is it necessary to perform a hysterosalpingography after recovery, and under what conditions would it be required?

In July and August 2020, I occasionally experienced mild pain in my left lower abdomen, but since it usually subsided after bowel movements, I didn't pay much attention to it.
It wasn't until early October, during a Pap smear and abdominal examination, that I discovered I had ovarian inflammation (with slight swelling of the ovaries and accompanying discharge).
I started treatment with antibiotics and anti-inflammatory medications.
During the three-day treatment, I experienced gastric discomfort, and on the third day, the pain became severe enough that I went to the emergency room for an endoscopy, which revealed a mild gastric ulcer.
I switched to a second antibiotic, but after five days, I began to feel pain on the right side as well.
The doctor explained that the bacteria were resistant to this antibiotic.
I then switched to a third medication, but after one day, it still caused gastric pain.
The second doctor determined there was no inflammation (possibly because I had taken antibiotics that day) and suggested the possibility of irritable bowel syndrome.
The next day, without taking antibiotics, the pain in both ovaries increased, and I also felt pelvic discomfort.
A third doctor diagnosed inflammation but indicated that bacterial cultures were needed.

I was informed that the bacteria (Klebsiella pneumoniae) were rarely found in the ovaries, which explained why the previous antibiotics were ineffective.
I started taking Cinalone, and it has been nearly two weeks.
Currently, my symptoms have eased, but occasionally I experience pain in both ovarian areas for an afternoon, which improves with medication.
The discharge typically appears only at night, not every day, and is white with a slight yellow tint, without any odor, but I still feel mild discomfort in my lower abdomen.
My current questions and concerns are:
1.
Typically, antibiotics are taken for 1-2 weeks.
In this case, should I return for a follow-up to continue the medication into the third week or longer? Will this help achieve a cure?
2.
How can I determine if there are no longer any bacteria present or if there is no inflammation? Can blood tests for inflammatory markers indicate this? How will I know if I have been cured, or is it possible to achieve a cure?
3.
The doctor mentioned that prolonged infections have a higher likelihood of causing hydrosalpinx or abdominal adhesions, which could lead to recurrent infections and infertility.
I am concerned about whether I need to undergo a hysterosalpingogram to check for hydrosalpinx, or under what circumstances further examination is necessary.
4.
How can I avoid recurrent infections, and what mindset should I adopt when facing and treating recurrent infections? I am beginning to feel that this issue may not be curable.
I am currently trying to adjust my routine, sleep, exercise, and manage stress in hopes of boosting my immune system.

Worried Miss, 20~29 year old female. Ask Date: 2020/10/31

Dr. Lin Manying reply Obstetrics and Gynecology

Hello, Miss: Widespread lower abdominal pain—could it truly be pelvic inflammatory disease? Based on the described examinations, it is actually difficult to determine.
If it is indeed pelvic inflammatory disease, the appropriate antibiotics should be taken for 14-21 days; however, there is still a possibility of recurrence.
If there are repeated episodes and issues with infertility (not conceiving after one year of unprotected intercourse), consideration will be given to examining the fallopian tubes.
The Hualien Hospital of the Ministry of Health and Welfare cares about your health.

Reply Date: 2020/10/31

More Info

Chronic Pelvic Inflammatory Disease (PID) can indeed be a challenging condition to manage, and your concerns are valid. Let's address your questions systematically.

1. Duration of Antibiotic Treatment: The typical course of antibiotics for PID is usually 14 days, but in cases of chronic or recurrent infections, a longer course may be necessary. Since you have been experiencing persistent symptoms and have had a change in your antibiotic regimen due to resistance, it is crucial to follow up with your healthcare provider. They may recommend continuing antibiotics for a longer duration or switching to a different class of antibiotics based on culture results. It is essential to adhere to your doctor's advice and not self-medicate, as improper use of antibiotics can lead to further resistance.

2. Determining Resolution of Infection: To assess whether the infection has resolved, doctors often look at clinical symptoms, laboratory tests, and imaging studies. Blood tests can measure inflammatory markers such as C-reactive protein (CRP) and white blood cell count, which can indicate ongoing inflammation or infection. Additionally, follow-up ultrasounds or pelvic exams may be necessary to evaluate the status of your ovaries and surrounding structures. If symptoms persist despite treatment, further evaluation may be warranted.

3. Concerns About Complications: Chronic PID can lead to complications such as hydrosalpinx (fluid in the fallopian tubes) or adhesions (scar tissue), which can affect fertility. If you have persistent symptoms or if your doctor suspects complications, they may recommend a hysterosalpingogram (HSG) or pelvic ultrasound to assess the condition of your fallopian tubes and ovaries. These tests can help identify any blockages or abnormalities that could impact fertility.

4. Preventing Recurrent Infections: To minimize the risk of recurrent PID, consider the following strategies:
- Safe Sex Practices: Use condoms to reduce the risk of sexually transmitted infections (STIs), which are a common cause of PID.

- Regular Check-ups: Regular gynecological exams can help catch infections early before they become chronic.

- Prompt Treatment: If you experience symptoms such as unusual discharge, pelvic pain, or fever, seek medical attention promptly.

- Healthy Lifestyle: Maintaining a healthy lifestyle, including a balanced diet, regular exercise, and adequate sleep, can help boost your immune system.

It's understandable to feel anxious about the potential for chronic issues related to PID. However, many women successfully manage their symptoms and lead healthy lives after treatment. Open communication with your healthcare provider is key; don't hesitate to express your concerns and ask for clarification on your treatment plan.

In summary, while chronic PID can be complex, with appropriate medical care, monitoring, and lifestyle adjustments, many women can achieve significant improvement in their symptoms and overall health. If you feel uncertain about your current treatment or diagnosis, seeking a second opinion from a specialist in reproductive health may provide additional reassurance and options for management.

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