What is pelvic inflammatory disease?
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract, including the womb, fallopian tubes and ovaries.
PID is a common condition, although it's not clear how many women are affected. It mostly affects sexually active women aged 15 to 24.
Pelvic inflammatory disease symptoms
PID often doesn't cause any obvious symptoms.
Most women have mild symptoms that may include 1 or more of the following:
- pain around the pelvis or lower abdomen (tummy)
- discomfort or pain during sex that's felt deep inside the pelvis
- pain during urination
- bleeding between periods and after sex
- heavy periods
- painful periods
- unusual vaginal discharge, especially if it's yellow or green
A few women become very ill with:
- severe lower abdominal pain
- a high temperature (fever)
- nausea and vomiting
When to seek medical advice
It’s important to visit your doctor or a sexual health clinic if you experience any of the above symptoms.
If you have severe pain, you should seek urgent medical attention from your doctor or local emergency department. Delaying treatment for PID or having repeated episodes of PID can increase your risk of serious and long-term complications.
There's no simple test to diagnose PID. Diagnosis is based on your symptoms and the finding of tenderness on a vaginal (internal) examination. Swabs will be taken from your vagina and cervix (neck of the womb), but negative swabs don't rule out PID.
Read more about diagnosing PID.
Pelvic inflammatory disease causes
Most cases of PID are caused by a bacterial infection that's spread from the vagina or the cervix to the reproductive organs higher up.
Many different types of bacteria can cause PID. In about 1 in 4 cases, it's caused by a sexually transmitted infection (STI) such as chlamydia or gonorrhoea.
In many other cases, it's caused by bacteria that normally live in the vagina.
Read more about the causes of PID.
Pelvic inflammatory disease treatment
If diagnosed at an early stage, PID can be treated with a course of antibiotics, which usually lasts for 14 days. You'll be given a mixture of antibiotics to cover the most likely infections, and often an injection as well as tablets.
It's important to complete the whole course and avoid having sexual intercourse during this time to help ensure the infection clears.
Your recent sexual partners also need to be tested and treated to stop the infection recurring or being spread to others.
Read more about treating PID.
Complications of pelvic inflammatory disease
The fallopian tubes can become scarred and narrowed if they're affected by PID. This can make it difficult for eggs to pass from the ovaries into the womb.
This can increase your chances of having an ectopic pregnancy (a pregnancy in the fallopian tubes instead of the womb) in the future and can make some women infertile.
It's estimated that around 1 in 10 women with PID becomes infertile as a result of the condition. Women who have had delayed treatment or had repeated episodes of PID are most at risk. However, most women treated for PID are still able to get pregnant without any problems.
Read more about the complications of PID.
Prevention of pelvic inflammatory disease
You can reduce your risk of PID by always using condoms with a new sexual partner until they've had a sexual health check. Chlamydia is very common in young men, and most don't have any symptoms.
If you're worried you may have an STI, visit your local genitourinary medicine (GUM) or sexual health clinic for advice.
If you need an invasive gynaecological procedure, such as insertion of a coil or an abortion, have a check-up beforehand.
Causes of pelvic inflammatory disease
Pelvic inflammatory disease (PID) is caused by an infection developing in the female upper genital tract.
In most cases, the condition is caused by a bacterial infection spreading from the vagina or cervix (entrance to the womb) into the womb, fallopian tubes and ovaries.
PID is often caused by more than one type of bacterium and it can sometimes be difficult for doctors to pinpoint which are responsible. Therefore, a combination of antibiotics will be prescribed, so a variety of bacteria can be treated.
Sexually transmitted infections (STIs)
In about one in four cases, PID is caused by a sexually transmitted infection (STI) such as chlamydia or gonorrhoea .
These bacteria usually only infect the cervix, where they can be easily treated with a single dose of an antibiotic. However, if they're not treated there's a risk the bacteria could travel into the upper genital tract.
It's estimated that 1 in 10 women with untreated chlamydia may develop PID within a year.
Other causes
In many cases, the cause of the infection that leads to PID is unknown.
Sometimes, bacteria that's normally harmless and found in the vagina can get past the cervix and into the reproductive organs. Although harmless in the vagina, these types of bacteria can cause infection in other parts of the body.
This is most likely to happen if:
- you've had PID before
- there's been damage to the cervix following childbirth or a miscarriage
- you have a procedure that involves opening the cervix – such as an abortion, inspection of the womb, or insertion of an intrauterine contraceptive device (coil).
Which areas can become infected?
If an infection spreads upwards from the vagina and cervix, it can cause inflammation of the:
- womb lining (endometrium)
- fallopian tubes
- tissue around the womb
- ovaries
- lining of the inside of the abdomen (peritoneum)
Pockets of infected fluid, called abscesses, can also develop in the ovaries and fallopian tubes.
Diagnosing pelvic inflammatory disease
There's no single test for diagnosing pelvic inflammatory disease (PID) – it's diagnosed based on your symptoms and a gynaecological examination.
Your doctor will first ask about your medical and sexual history. The next step is to carry out a pelvic examination to check for any tenderness and abnormal vaginal discharge You may experience some discomfort during this examination, particularly if you do have PID.
Swabs are usually taken from the inside of your vagina and cervix. These are sent to a laboratory to look for signs of a bacterial infection and identify the bacteria responsible.
A positive test for chlamydia or gonorrhoea supports the diagnosis of PID. But most women have negative swabs and this doesn't rule out the diagnosis.
As PID can be difficult to diagnose, other tests may also be required to look for signs of infection or inflammation, or to rule out other possible causes of your symptoms. These tests may include:
- a urine or blood test
- a pregnancy test
- an ultrasound scan, which is usually carried out using a probe passed through the vagina (transvaginal ultrasound)
In some cases, laparoscopy (keyhole surgery) may be used to diagnose PID. A laparoscopy is a minor operation where 2 small cuts are made in the abdomen. A thin camera is inserted so that the doctor can look at your internal organs and, if necessary, take tissue samples.
This is usually only done in more severe cases where there may be other possible causes of the symptoms, such as appendicitis.
Admission to hospital
You may be urgently admitted to hospital if:
- you're pregnant – especially if there's a chance you may have an ectopic pregnancy
- your symptoms are severe – such as nausea, vomiting and a high fever
- you have signs of pelvic peritonitis
- an abscess is suspected
- you're unable to take oral antibiotics and need to be given them through a drip (intravenously)
- you may need emergency surgery, such as for appendicitis
Treating pelvic inflammatory disease
If it's diagnosed at an early stage, pelvic inflammatory disease (PID) can be treated easily and effectively with antibiotics. These can be prescribed by your doctor or a doctor in a sexual health clinic.
But if the condition is left untreated, it can lead to more serious, long-term complications. See complications of PID for more information about these and how they may be treated.
Antibiotics
Treatment with antibiotics needs to be started quickly, before the results of the swabs are available.
PID is usually caused by a variety of different bacteria, even in cases where chlamydia or gonorrhoea is identified. This means you'll be given a mixture of antibiotics to cover the most likely infections.
Antibiotics commonly prescribed to treat PID include:
- ofloxacin
- metronidazole
- ceftriaxone
- doxycycline
Tell your doctor if you think you may be pregnant before starting antibiotic treatment, because some antibiotics should be avoided during pregnancy.
You'll usually have to take the antibiotic tablets for 14 days, sometimes beginning with a single antibiotic injection. It's very important to complete the entire course of antibiotics, even if you're feeling better, to help ensure the infection is properly cleared.
In particularly severe cases of PID, you may have to be admitted to hospital to receive antibiotics through a drip in your arm (intravenously).
If you have pain around your pelvis or tummy, you can take painkillers such as paracetamol or ibuprofen while you're being treated with antibiotics.
Follow-up
In some cases, you may be advised to have a follow-up appointment 3 days after starting treatment. This is for your doctor to check if the antibiotics are working.
If they are, you may have another follow-up appointment at the end of the course to check if treatment has been successful.
If your symptoms haven't started to improve within 3 days, you may be advised to attend hospital for further tests and treatment. If you have an intrauterine device (IUD) fitted, you may be advised to have it removed if your symptoms haven't improved within a few days, as it may be the cause of the infection.
Treating sexual partners
Any sexual partners you've been with in the 6 months before your symptoms started should be tested and treated to stop the infection recurring or being spread to others, even if no specific cause is identified.
PID can occur in long-term relationships where neither partner has had sex with anyone else, and it's more likely to return if both partners aren't treated at the same time.
You should avoid having sex until both you and your partner have completed the course of treatment.
If you haven't had a sexual partner in the previous 6 months, your most recent partner should be tested and treated. Your doctor or sexual health clinic can help you contact your previous partners and this can usually be done anonymously, if you prefer.
Complications of pelvic inflammatory disease
Pelvic inflammatory disease (PID) can sometimes lead to serious and long-term problems, particularly if the condition isn't treated with antibiotics quickly.
But most women with PID who complete their course of antibiotics have no long-term problems.
Repeated episodes of PID
Some women experience repeated episodes of PID. This is known as "recurrent pelvic inflammatory disease".
The condition can return if the initial infection isn't entirely cleared. This is often because the course of antibiotics wasn't completed or because a sexual partner wasn't tested and treated.
If an episode of PID damages the womb or fallopian tubes, it can become easier for bacteria to infect these areas in the future, making it more likely that you'll develop the condition again.
Repeated episodes of PID are associated with an increased risk of infertility.
Abscesses
PID can sometimes cause collections of infected fluid called abscesses to develop, most commonly in the fallopian tubes and ovaries.
Abscesses may be treated with antibiotics, but sometimes laparoscopic surgery (keyhole surgery) may be needed to drain the fluid away. The fluid can also sometimes be drained using a needle that's guided into place using an ultrasound scan.
Long-term pelvic pain
Some women with PID develop long-term (chronic) pain around their pelvis and lower abdomen, which can be difficult to live with and can lead to further problems such as depression and difficulty sleeping (insomnia).
If you develop chronic pelvic pain, you may be given painkillers to help control your symptoms. Tests to determine the cause may be carried out. If painkillers don't control your pain, you may be referred to a pain management team or a specialist pelvic pain clinic.
Ectopic pregnancy
An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes.
If PID infects the fallopian tubes, it can scar the lining of the tubes, making it more difficult for eggs to pass through. If a fertilised egg gets stuck and begins to grow inside the tube, it can cause the tube to burst, which can sometimes lead to severe and life-threatening internal bleeding.
So medication is often used to stop the egg growing, or surgery could be recommended to remove it if you're diagnosed with an ectopic pregnancy.
Infertility
As well as increasing your risk of having an ectopic pregnancy, scarring or abscesses in the fallopian tubes can make it difficult for you to get pregnant if eggs can't pass easily into the womb.
It's estimated that about 1 in 10 women with PID becomes infertile as a result of the condition, with the highest risk for women who had delayed treatment or repeated episodes of PID. However, a long-term study in the US showed that women who had been successfully treated for PID had the same pregnancy rates as the rest of the population.
Blocked or damaged fallopian tubes can sometimes be treated with surgery. If this isn't possible and you want to have children, you may want to consider an assisted conception technique, such as in vitro fertilisation (IVF).
IVF involves surgically removing eggs from a woman's ovaries and fertilising them with sperm in a laboratory, before planting the fertilised eggs into the woman's womb. This technique can help you get pregnant if you can't have children naturally. However, the success rate is often low, depending on your age and other factors.
