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 is not clear how many women are affected in the UK because it doesn’t always have any obvious symptoms.
PID mostly affects sexually active women from the age of 15 to 24.
When to seek medical advice
It’s important to visit your GP 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 GP or local emergency department. Delaying treatment for PID or having repeated episodes of PID can increase your risk of serious and long-term complications (see below).
There is 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 (the neck of the womb), but negative swabs do not exclude PID.
Causes of pelvic inflammatory disease
Most cases of PID are caused by a bacterial infection that has spread from the vagina or the cervix to the reproductive organs higher up.
Many different types of bacteria can cause PID. In about one in every four cases it is caused by a sexually transmitted infection (STI) such as chlamydia or gonorrhoea. In many other cases it is caused by bacteria that normally live in the vagina.
How pelvic inflammatory disease is treated
If diagnosed at an early stage, PID can be treated with a course of antibiotics, which usually lasts for 14 days. You will be given a mixture of antibiotics to cover the most likely infections, and often an injection as well as tablets.
It is important to complete the whole course and avoid having sexual intercourse during this time to help ensure the infection clears.
Your recent sexual partners will also need to be tested and treated to stop the infection recurring or being spread to others.
Complications of pelvic inflammatory disease
The fallopian tubes can become scarred and narrowed if they are affected by PID. This can make it difficult for eggs to pass from the ovaries into the womb, which 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 one in every 10 women with PID becomes infertile as a result of the condition, with the highest risk in women who have had delayed treatment or repeated episodes of PID. However, most women who are treated for PID will still be able to get pregnant without any problems.
PID can be difficult to recognise if the symptoms are mild, and some women don’t have any symptoms.
Most women have mild symptoms that may include one or more of the following:
*pain around the pelvis or lower abdomen (tummy)
*discomfort or pain during sex that is felt deep inside the pelvis
*pain during urination
*bleeding between periods and after sex
*heavy or painful periods
*unusual vaginal discharge, especially if it is yellow or green
A few women become very ill with:
*severe lower abdominal pain
*a high temperature (fever)
*nausea and vomiting
If it is diagnosed at an early stage, pelvic inflammatory disease (PID) can be treated easily and effectively with antibiotics prescribed by your GP or a doctor in a sexual health clinic.
However, if the condition is left untreated it can lead to more serious, long-term complications. See complications of pelvic inflammatory disease for more information about these and how they may be treated.
Treatment with antibiotics needs to be started quickly, before the results of the swabs are available.
As PID is usually due to a mixture of different bacteria, even in cases where chlamydia or gonorrhoea is identified, you will be given a mixture of antibiotics to cover the most likely infections.
Antibiotics commonly prescribed to treat PID include ofloxacin, metronidazole, ceftriaxone and doxycycline.
You should tell your doctor if you think you may be pregnant before starting antibiotic treatment because some antibiotics should be avoided during pregnancy.
You will usually have to take the antibiotic tablets for 14 days, sometimes beginning with a single antibiotic injection. It is very important to complete the entire course of antibiotics, even if you are feeling better, to help ensure the infection is properly cleared.
In particularly severe cases of PID you may have to be admitted to hospital where you will receive antibiotics intravenously (through a drip in your arm). 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.
In some cases, you may be advised to have a follow-up appointment three days after starting treatment so your doctor can check if the antibiotics are working.
If the antibiotics seem to be working, you may have another follow-up appointment at the end of the course of treatment to check if treatment has been successful.
If your symptoms haven’t started to improve within three 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 have been with in the six 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-standing relationships where neither partner has had sex with anyone else, and it is more likely to recur if both partners are not treated at the same time.
You should avoid having sex until both you and your partner have completed the course of treatment.
If you have not had a sexual partner in the previous six 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.
Practice safe sex.
Use condoms every time you have sex, limit your number of partners and ask about a potential partner’s sexual history. Talk to your doctor about contraception. Some forms of contraception may affect your risk of developing pelvic inflammatory disease. A contraceptive intrauterine device (IUD) may increase your risk of PID temporarily for the first few weeks after insertion, but a barrier method, such as a condom, reduces your risk.
Use of a birth control pill alone offers no protection against acquiring STIs. But the pill may offer some protection against the development of PID by causing your body to create thicker cervical mucus, making it more difficult for bacteria to reach your uterus, fallopian tubes or ovaries. It’s still important to use a condom every time you have sex, however.
If you’re at risk of an STI, such as chlamydia, make an appointment with your doctor for testing. Set up a regular screening schedule with your doctor, if you need to. Early treatment of an STI gives you the best chance of avoiding pelvic inflammatory disease.
Request that your partner be tested.
If you have pelvic inflammatory disease or an STI, advise your partner to be tested and, if necessary, treated. This can prevent the spread of STIs and possible recurrence of PID.
Douching (internal washing of the vagina) upsets the balance of bacteria in your vagina.
Pay attention to hygiene habits.
Wipe from front to back after urinating or having a bowel movement to avoid introducing bacteria from your colon into the vagina.