WHAT IS IT?
Pelvic inflammatory disease (PID) is a bacterial infection of the pelvic organs in women that can involve the uterus (in which case the infection is called endometritis), the Fallopian tubes [salpingitis), the ovaries [ovarian abscess), or the peritoneum (the lining of tissue around the pelvic organs,- pelvic peritonitis). One, several, or all of these organs can be affected. PID is usually caused by sexually transmitted bacteria such as gonorrhea and chlamydia, but it can be caused by other bacteria as well. It is the most serious infection of the genital area in women.
HOW COMMON IS IT?
It is estimated that about one million women develop PID each year, but this is likely to be an underestimate since in many parts of the country PID is not reportable to the local health department. Three-quarters of the women infected are younger than twenty-five, but women of any age can be infected.
About 85 percent of cases of PID are caused by sexually transmitted bacteria; a woman who has unprotected genital intercourse with a male partner infected with PID-causing bacteria is at high risk for becoming infected. The sexually transmitted bacteria break down the defenses in the cervix that normally prevent vaginal bacteria from moving up into the pelvic organs; thus they allow these bacteria to contribute to the infection.
The other 15 percent of cases of PID are caused by gynecological procedures that mechanically open the cervix and allow the vaginal bacteria to rise into the pelvic organs and cause infection. Women who have an invasive gynecological procedure—such as an abortion, the insertion of an intrauterine device IUD , or hysterosalpmgography (an X-ray study to examine the Fallopian tubes and uterus by means of the injection of dye into these structures)—are at increased risk for developing PID. In addition, women who use IUDs as a birth control method run a higher risk for developing PID if exposed to sexually transmitted infections. Women who douche are also in the high-risk category, possibly because douching pushes vaginal bacteria higher up into the genital tract. Women who have had PID in the past are at increased risk of having it again, because scarring from the infection makes them more vulnerable.
Men, obviously, do not get PID, but they can be infected with the bacteria that cause it.
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Because the virus can be transmitted during an outbreak and it is likely that the virus can be transmitted during asymptomatic shedding (described earlier), it’s important to know when outbreaks are occurring. Some people with herpes infections believe that they can tell when they are having an outbreak, that they always have some warning sign that lets them know ahead of time. However, this is not always true. In the case of asymptomatic shedding, unfortunately, no one knows for sure when shedding days occur. Some people shed as infrequently as a few days out of the year, whereas others may be shedding as often as several days per month. People seem to shed the virus more frequently around the time of symptomatic outbreaks, such as during the week before and after an outbreak, but it’s possible to shed at any time. However, it is important to keep in mind that people with herpes are not always shedding virus.
When genital or oral symptoms are present, genital and oral sex or kissing should be avoided with an uninfected partner, because this is a very risky time for transmission. People should consider themselves as “having an outbreak” from the appearance of the first symptom until the lesion is replaced by normal-appearing skin. Even if you are not sure whether the symptoms are from an outbreak, play it safe. Using a condom for genital sex at this time does not necessarily offer full protection, because a person may be shedding virus outside the area that a condom protects.
Symptoms that may indicate that the virus is active are tingling; itching; a red area or bump that may or may not be painful; a slit in the skin; an ulcer, blister, or pustule; or leg pain. These are warning signs that the virus may be on the surface of the skin and that one may therefore transmit the virus to others.
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Epididymitis is usually treatable with antibiotics. Treatment should be started as soon as possible, even before the results of the tests are known, to decrease the risk of scarring to the epididymis and future infertility. If a sexually transmitted cause of epididymitis (such as gonorrhea or chlamydia) is suspected, the antibiotics generally used are a combination of ceftriaxone and doxycycline. However, if the infection is thought to have resulted from performing anal intercourse, then ofloxacin is the best antibiotic. If the cause is not thought to be a sexually transmitted bacterium, ofloxacin is again the best choice. If the swelling and pain are significant, bed rest and scrotal elevation are helpful in draining the infection from the testicle. Bed rest should be continued until the scrotum is no longer tender.
If the symptoms are not improved after about three days of treatment, a referral to a urologist is indicated. Rarely hospitalization is necessary to administer intravenous antibiotics. If swelling and tenderness persist after treatment, an evaluation may be performed for other possible causes of testicular pain and swelling, such as testicular cancer, tuberculosis, or fungal causes of epididymitis. These unusual infectious causes may be more common among men with compromised immune systems, such as men with human immunodeficiency virus (HIV) infection. Partners of men treated for epididymitis must also be evaluated and treated if the cause of infection is known or suspected to be from a sexually transmitted bacterium.
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Robert decided that he wanted to “be responsible” and be tested for infections before having sex with his new partner, Lauren. He didn’t want to risk infecting her with an STD. He had just read in a magazine article that most of the sexually transmitted infections can be symptom free, and because he had been sexually involved in the past without using condoms, he decided to be tested for all infections. He went to a local family planning clinic, where he was diagnosed with chlamydia by a urethral swab test. He had never had any symptoms of infection in the urethral area, such as discharge or burning with urination, but he found out that about half the men with this infection don’t have any symptoms.
Robert was given an antibiotic to treat the infection and was told it was important he contact his last sexual partner to inform her of the diagnosis. He had broken up with his partner of two years, Linda, about two months ago. Although it was difficult for him, he realized that this infection could cause infertility if not treated, and he called Linda to inform her. She was initially surprised but was very grateful to hear from him. She realized that although it must have been difficult for him to call, it meant he cared enough about her and her future to do so.
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A flurry of publicity recently scared millions of men and caused the government to organize major studies to investigate whether or not a link exists between vasectomy and prostate cancer. Good news: There is no evidence that a vasectomy increases a man’s risk of prostate cancer. So why, then, does it seem that so many men who have had a vasectomy are diagnosed with prostate cancer? For one thing, a vasectomy is common, and a lot of men out there have had one. For another, as an editorial in the Journal of the American Medical Association pointed out, “most vasectomies are performed by urologists and most prostate cancers are diagnosed by urologists, often during procedures to evaluate genitourinary tract symptoms. Therefore, men who have undergone vasectomy may be more likely to have their prostate cancers diagnosed.” In other words, because these men have a prior relationship with a urologist, they’re more likely to return to a urologist for urinary symptoms and have their cancer diagnosed.
The official word on this, from the National Institutes of Health’s panel on vasectomy and the risk of prostate cancer, is: If you’ve had a vasectomy, don’t be alarmed; you’re not at cancer’s doorstep. “At the present time, providers shall continue to offer vasectomy vasectomy reversal is not warranted to prevent prostate cancer, and screening for prostate cancer should not be any different for men who have had a vasectomy than for men who have not.” The doctors on this panel felt the results of research on this subject were “inconsistent,” and that the associations drawn from it were weak. They, too, cited “a strong potential for detection bias,” because of “possible differences in the use of health care services by men who have had vasectomies that resulted in a different rate of detection.”
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