How is Pelvic Inflammatory Disease (PID) Tested & Diagnosed?

Pelvic Inflammatory Disease (PID) Testing

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When it comes to the field of sexual health, the context of disease underreporting is even more accurate as the topic itself seems to be a highly stigmatized concept that many people avoid talking about lest that it might shed them under a bad light. However, when we are talking about issues concerning a person’s sexual health, an imperative diagnosis and treatment regimen is even more critical due to how delicate and sensitive the genitalia is. While there might be efforts being done by international health organizations to educate the public regarding sexual health issues, it might be more important to focus on the provision of information regarding diagnosis options and procedures to simultaneously reassure the patient that the procedure is safe and easy to do, and inform them regarding the choices that they have available for them.

As a starting point, it might be more efficient to look at a complication that seems to be a standalone condition but has its subsequent health consequences if the disease is not correctly diagnosed and addressed at the soonest time possible.

To begin, let us look at how pelvic inflammatory disease (PID) is diagnosed within the medical community.

The Basics of Pelvic Inflammatory Disease

Pelvic inflammatory disease or PID is a syndrome that usually results from the cascading ascension of microorganisms from the genitalia to the upper urinary tract regions of your body – resulting in an invasion of these sections that then further results in the development of symptoms that mainly manifests around the pelvic area of a woman. It is commonly preceded by an infection within the genitalia, primarily by a sexually transmitted disease such as chlamydia and gonorrhea. Both conditions do not necessarily cause PID upon contracting the condition, but it does put the person at risk for developing PID, especially when the infection is allowed to proliferate within the genitalia.

The Manifestations and Presentations

The manifestations of PID is known to be non-specific, meaning that its symptoms are not distinct and would often overlap with the presentations of other conditions – making it common for many people to mistake it for other conditions when there are no tests performed to solidify further and confirm the diagnosis of the disease. The symptoms themselves must not be used as a diagnostic measure due to how inconsistent and inaccurate the diagnosis would be if it would be solely based on this criterion, but it might still be more efficient to be informed regarding the symptoms that could signal a prompt consultation with your doctor.

In most cases, symptomatic patients would often present with the following symptoms upon contracting a potential PID case:

  • A painful sensation in the lower abdominal area or around the pelvic area
  • A low-grade fever of around 38C
  • An unusual discharge from your vagina with an unpleasant odor
  • A painful sensation during sexual intercourse that may or may not be accompanied by bleeding
  • A burning sensation when you urinate
  • Bleeding instances between periods

It is highly recommended that you get yourself tested when you notice some of these symptoms, when you or your partner has been exposed to an STD, or if you are noticing some unusual observations primarily within your pelvic region.

Recommended Preventive Measures

Essentially, since PID is primarily caused by pathogens that cause sexually transmitted infections, it is important to be wary about your sexual practices as this would be the primary source of infection for sexually active individuals. If you are sexually active, it is highly recommended that you remain monogamous and only interact with a partner whose sexual health you are aware of to ensure that you are not unknowingly exposing yourself to someone with an STD, diagnosed or undiagnosed. In addition to that, it is also recommended that you use contraception such as a condom during your sexual activities to ensure that you have an additional layer of protection from the potential transmission of an STD during your interaction.

On another note, it is also recommended that you avoid the excessive washing of your genitalia as the vagina naturally contains a stable balance between good and bad bacteria. The harmful bacteria are usually pathogenic, and the good bacteria maintain the environment of the vagina to ensure that the pathogens are not able to increase and infect your urinary tract. During excessive washing or douching, this balance is skewed, and the good bacteria are now unable to prevent the proliferation of the pathogenic microorganisms – resulting in the invasion of genitalia and the production of a full-blown infection. Once left untreated and undiagnosed, this infection could result in the ascension of microorganisms to the upper urinary tract structure, leading to PID development.

The Common Treatment Regimen

In most cases where the patient has a diagnosed case of PID, the treatment plan would often involve the use of broad-spectrum antibiotics to eliminate as many pathogenic species as possible that may have caused the infection within your upper urinary tract. The antibiotics may either be administered orally or through an IV infusion, and the treatment would depend on your physician's recommendation as to what regimen would suit your condition best. Do note that the use of antibiotics would require a prescription and a conclusive consultation from your physician to ensure that the medication would not be misused. Once again, do not self-medicate to prevent the development of antimicrobial resistance.

On the one hand, it is also important to note that the antibiotics administered during this treatment process would only eliminate pathogens within your urinary tract. No medication would be able to reverse the damages caused by the disease within your system – implying that a proper treatment regimen should be immediately administered to avoid the development of irreversible complications and injuries to the structures of your urinary tract.

Complications of a Complication

PID is classified as a complication because it results in the development of further health sequelae that are sometimes life-threatening if not managed correctly. For instance, PID may result in the development of ectopic pregnancy wherein the fertilized egg cell grows within the fallopian tube due to when the embryo was blocked in the tube by the PID-caused scarring. When this happens, the patient is put at risk for developing a severe case of bleeding when the fallopian tubes rupture, making it life-threatening if the patient's pregnancy is not monitored effectively.

Furthermore, due to how PID causes scarring within the patient's fallopian tubes and the ovaries, an affected patient can become infertile in the long run. Essentially, it becomes challenging for affected patients to become pregnant, but it is still possible in some cases with the help of the proper remedies that could aid the patient’s fertility.

Lastly, true to its namesake, PID causes chronic pelvic pain in the long run due to the scars and damages that the condition produces within the internal structures of the organs within the pelvic area. Without proper treatment, these manifestations could often disrupt a patient’s quality of life – resulting in further complications that may likewise involve the patient’s mental health and fortitude.

Understanding Pelvic Inflammatory Disease Testing

The Why of Testing

For any condition that requires a diagnostic procedure, there is always a reason as to why the diagnostic procedure is needed, and the reason for nearly all conditions would often be the same, at least in its baseline rationale: it is to correctly identify the disease and provide the proper treatment regimen to address the condition at the soonest time possible. While some conditions could easily be diagnosed with the help of a physical exam and a review of the patient’s manifestations due to their distinct presentations, there are those particular ones, such as PID, that are non-specific and would overlap with other conditions when it comes to their symptoms. Furthermore, in the case of PID, where the disease results in irreversible damages, in the long run, it is even more critical for an affected patient to be diagnosed correctly with the help of multiple tests that go hand in hand in confirming the presence of microorganisms in the upper urinary tract.

The When of Testing

As to when a patient should get tested for PID, it is not necessarily a condition that you could routinely test for due to the absence of dedicated tests that could be administered for the disease. Essentially, what you could routinely test for instead is STIs and STDs that you may contract, mainly when you are sexually active, and your sexual habits are sometimes questionable at best. Regarding when you should get tested for a case of PID, it is highly recommended that you get examined as soon as you present specific symptoms of the condition as delaying the treatment process may increase your risk of developing severe complications that you certainly would want to avoid.

The Who of Testing

Similar to how other conditions behave, there are also risk factors that you would want to be wary of, as this will sometimes be the signal that you have to get tested for PID once you develop symptoms that may be classified under the condition. For instance, if you have an untreated STD, if you have more than one sex partner and you are not aware of their sexual health status, if your sex partner has multiple sex partners, if you had PID before, if you are sexually active in general, if you use an intrauterine device or IUD, or if you employ excessive douching of your vagina, then you might consider having yourself routinely tested for a PID, or tested for PID itself once you observe some of the symptoms that PID commonly manifests.

The How of Testing

There is no one way to relay the expectations you should put forward, as the diagnostic procedure for PID is widely varied depending on your consulting physician's discretion and clinical judgment. However, you should expect that apart from the painless, non-invasive diagnostic procedures that are more common among the public, some may require a sample from you that would involve a minor surgical procedure such as a biopsy or a laparoscopy. Of course, this would entail pain as the procedure would essentially collect tissue samples from your urinary tract structure, but fret not, as these processes would use anesthetics that would desensitize you from the pain of the sample collection process. Make sure, though, that you communicate with your doctor before they perform the procedure to ensure that you know what to expect from your diagnostic process.

The What of Testing

In the diagnosis of PID, there are a total of five tests that are used either individually or hand in hand to provide a comprehensive outlook on the presence of any pathogenic microorganisms within your upper urinary tract structure. Do note that these tests are not dedicated procedures for diagnosing PID, and they are only used to determine specific diagnostic parameters that could point towards the presence of microbial ascension in a patient’s system.

The table below shows the different features of each diagnostic process, including the sample required from the patient, the waiting time for the results to be delivered, the tool or equipment used to perform the test, and the indication of each test.

Clinical Diagnosis

Laparoscopy

Endometrial Biopsy

Transvaginal Ultrasound

Magnetic Resonance Imaging

Sample Required

None

None

Tissue sample

None

None

Waiting Time

Immediately

Depending on laboratory

Depending on laboratory; 1 week on average

Instantaneous

Instantaneous

Tool Used

None

Several; Surgical procedure

Several; Surgical Procedure

Ultrasound equipment

MRI equipment

Indication

Baseline assessment and history taking

Standard for diagnosis of all cases

Histopathologic diagnosis

Cases with non-diagnostic clinical findings

Cases with non-diagnostic clinical findings

The Tests Administered for PID Diagnosis

To know more about the procedures that are often indicated for the diagnosis of PID, the following section highlights the tests used to determine the presence of microorganisms in the patient’s upper urinary tract, as well as the specifics of each test, including the mechanism of the procedure, the timeline of testing, the sample necessary for the operation, the expenses and insurance involvement in each test, and the reliability of the process with regards to how it can determine a PID case with accuracy.

Clinical Diagnosis

The Process

Although the symptoms of PID are non-specific and do not necessarily point towards a precise PID diagnosis, some professionals prefer to use a clinical diagnosis using history assessment, a simple laboratory workup, and a physical examination to determine whether the patient is showing sure signs and symptoms that may point towards the need for a more comprehensive laboratory test for PID.

In cases where the physician is suspecting a possible PID case, they would often look for the following symptoms during the assessment:

  • Low-grade fever of around 38C
  • Abnormal cervical or vaginal mucopurulent discharge
  • Presence or abundance of WBCs during saline microscopy of vaginal secretions
  • Elevated erythrocyte sedimentation rate (ESR) value
  • Elevated c-reactive protein value

If any of the following symptoms are observed, the physician would usually recommend using other laboratory techniques that sometimes involve imaging methods to determine whether there is a structural indicator for a potential PID case.

The Timeline

In most cases, since the assessment is done inside the clinic itself and the physician performs the test, the results would be available instantaneously. However, in cases where the physician initially requests a simple laboratory workup to obtain specific blood parameters, it might take a few hours to get the results. You would still have to wait for the laboratory to process your sample.

The Sample

Essentially, there is no sample required for a simple physical workup.

The Cost and Average Pricing

The price would ultimately vary in this aspect since your physician themselves performs the procedure. It would depend on the consultation fee that you would have to ask for during your consultation.

The Insurance Coverage

Physical exams are essentially part of a consultation, and their price would ultimately be covered under your physician's professional fee. The clinical diagnosis will likewise be included if your insurance covers your consultation.

The Accuracy and Reliability

Although a clinical diagnosis arguably is one of the most straightforward procedures to perform, it is by far the most unreliable for diagnosing PID due to its non-specific symptoms.

Laparoscopy

The Process

The process of laparoscopy essentially employs a small incision of around 1 to 1.5 cm in length in the lower abdominal area, usually below the belly button of the patient. Following that, a tube will then be inserted through the incision – pumping carbon dioxide into the abdominal cavity to inflate the abdominal area. This pumping of carbon dioxide allows the physician to visualize the organs better and gives them more space to manipulate the apparatus during the visualization process.

Following the insertion of the tube, the laparoscope or a tiny camera will then be inserted into the tube, allowing the device to provide images of the patient’s internal structures within the abdominal area or wherever the incision was made for the procedure.

During this process, the physician will look for signs of PID such as edema within the walls of the fallopian tube, presence of multiple abnormal blood vessels near the upper urinary tract structure, and the presence of exudates that may indicate an infection within these areas. Once these images are confirmed and analyzed, the carbon dioxide that was previously pumped will then be let out of the abdominal cavity, and the wound will then be stitched using clips along with a proper surgical dressing to prevent any wound infection later on.

The Timeline

When using laparoscopy to diagnose PID, the procedure would usually take 30 minutes to 1 hour, depending on the physician's technique performing the test. The results would often be provided instantaneously as the process is a real-time visualization of the internal structures, but analysis of the images may take some time depending on how evident the signs of PID are within your system.

The Sample

No sample is collected for this procedure as the urinary tract structures are visualized in real-time.

The Cost and Average Pricing

The major downside of a laparoscopic procedure is its overwhelming price which might deter some users from availing themselves of this highly sensitive diagnostic tool. On average and without any contribution from insurance companies, the price for a laparoscopic procedure could range between $1700 to $5000.

The Insurance Coverage

In some cases, and depending on the extent of the laparoscopic procedure, your insurance policy may cover the cost of your test. However, this would rely heavily on the scope of your policy and whether the indication for the procedure falls under the terms of your contract with the insurance company.

The Accuracy and Reliability

A laparoscopic procedure for a PID diagnosis has an 81% sensitivity rate and a 100% specificity rate.

Endometrial Biopsy

The Process

An endometrial biopsy procedure for diagnosing PID and many other conditions that involve the genitourinary tract of female patients is usually performed inside the doctor’s office as a minor surgical procedure. The process itself can be a painful procedure due to the lack of anesthesia in some instances, but the painful sensation may sometimes only be brief as it is only evident during the sample collection part of the process.

For the test, your doctor will first insert a speculum into your vagina to better visualize the cervix. Once done, the cervix will then be cleaned by a solution that will help prevent the entrance of other harmful substances inside your uterus. Following that, a small suction tube will then be inserted inside your cervix and will be manipulated towards the lining of your uterus wherein the tube, currently carrying the apparatus necessary to collect a tissue sample, will then nick a small portion of tissue sample within the lining of the uterus for analysis. Once collected, the tube will then be pulled out, and the sample obtained will be sent to a pathologist to examine the presence of damages or any indicators of a potential PID case.

When it returns positive for an infection, the process itself will often confirm the presence of PID in a patient, but do note that it is still unable to determine the type of infection or causative microorganism that is currently within the patient’s system.

The Timeline

The procedure might take a few minutes only as it is only meant to collect a tissue sample from your endometrial lining, but the processing of the results might take around a week on average, depending on the processing speed of the laboratory that performed the analysis.

The Sample

The sample collected for this diagnostic procedure is a small tissue sample collected from the patient’s endometrial lining.

The Cost and Average Pricing

Depending on the facility, the price for an endometrial biopsy ranges from $346 to $746.

The Insurance Coverage

In most cases, yes, the procedure is covered by insurance policies, but it would still depend on your premium coverage.

The Accuracy and Reliability

Based on certain studies, the specificity and sensitivity rate of endometrial biopsy for diagnosing PID is 90%.

Transvaginal Ultrasound

The Process

For a transvaginal ultrasound procedure, the test would often begin with your doctor asking you to lie down on an examination bed, often with a stirrup to hold the legs open throughout the procedure. This would then be followed by inserting an ultrasound wand covered by a condom and lubricating gel into the vagina – taking note, of course, of any allergies that you might have to latex or to the lubricating gel that has been administered.

Once the transducer or the wand is inside of you, the machine will then be turned on by the physician wherein the equipment will now send out sound waves that will bounce off the structures of your internal organs – providing an image of the structures within as the wand is turned and adjusted to target better the organs that need analysis. Do note, though, that you may experience some pressure throughout the test as the wand will inevitably need to be adjusted to provide a better picture of your body’s internal structures.

The Timeline

The procedure itself may take anywhere between 30 minutes to 1 hour, and the results may either be released immediately or after 1 day, depending on the discretion of the laboratory or physician that performed the test.

The Sample

No sample is required for this type of test.

The Cost and Average Pricing

The average price for a transvaginal ultrasound test would range between $245 to $402, depending on the facility where you performed the test.

The Insurance Coverage

The procedure may be covered in some private insurance policies, but do note that its inclusion will still depend on the premium that you have availed.

The Accuracy and Reliability

Due to the relatively poor visibility of a transvaginal ultrasound when it comes to the detailed features of the upper urinary tract of the patient, the test only has a 30% sensitivity rate and a 67% specificity rate for PID.

Magnetic Resonance Imaging

The Process

Magnetic resonance imaging or MRI is a non-invasive procedure that employs a strong magnetic field that forces protons to align with the field. Once this happens, the MRI machine sends out a radiofrequency current which would then stimulate the protons while simultaneously causing them to spin out of equilibrium – resulting in a strain against the pull of the magnetic field. Once the current is stopped, the sensors within the MRI machine will be able to detect the energy released by the protons as they attempt to realign with the magnetic field – being reflected as an image through the machine with the help of a contrast dye that primarily serves as the substance that interacts with the currents itself.

The Timeline

A complete MRI scan might take a few minutes depending on the scope of the area being visualized, but the results are readily available in real-time as the images appear.

The Sample

No sample is necessary for this type of test.

The Cost and Average Pricing

Depending on the facility, an MRI scan of the pelvic area would range between $500 to $7900.

The Insurance Coverage

In most cases, yes, an MRI scan is covered by most insurance policies, mainly if the test is medically necessary as required by a physician.

The Accuracy and Reliability

An MRI scan has a specificity and sensitivity rate of 95%, but its high costs and rare indication in acute cases of PID are why it is not often used as the standard for diagnosis.

The Total Cost and Expenses of PID Diagnosis

The following table summarizes the total expenses that a patient might incur when availing of specific diagnostic procedures for PID.

Clinical Diagnosis

Laparoscopy

Endometrial Biopsy

Transvaginal Ultrasound

Magnetic Resonance Imaging

Average Cost

Depends on consultation fee

$1700 to $5000

$346 to $746

$245 to $402

$500 to $7900

Covered by Insurance?

Yes

In some cases, yes, depending on scope of premium

In some cases, yes, depending on scope of premium

Yes, in certain private policies

Yes, if medically necessary

Frequently Asked Questions (FAQs)

Is PID a sexually transmitted disease in itself?

No, but PID is often preceded by an STI such as chlamydia and gonorrhea.

Does PID increase the risk of developing cancer in patients?

Yes. Some studies have shown that patients with PID had an increased risk of developing ovarian and cervical cancers due to the chronic damage caused by the infection.

Is it possible to completely cure PID?

Yes and no. Yes, you can completely remove the cause of PID from your system, but no, you cannot necessarily cure structural damages caused by the condition.

How soon can you get pregnant again after being treated for PID?

In most cases, affected women may safely get pregnant 12 to 14 months after their treatment, assuming that there are no irreversible complications previously caused by their condition.

Is it possible to get PID without having an STD?

Yes, and this might often be due to the proliferation of the vagina’s normal flora when excessive douching is employed.

Additional Resources

American Family Physician

BMC Infectious Diseases

Centers for Disease Control and Prevention

References

Mark Riegel, MD

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