Pelvic inflammatory disease (PID) is an infection of the female reproductive organs, the uterus (womb) and fallopian tubes. PID may also spread along the tubes towards the ovaries and into the abdominal cavity. PID nearly always starts with a sexually transmitted infection. The most common types of sexually transmitted infection causing PID are bacteria called gonorrhea and chlamydia. PID may develop when these infections are not treated adequately.
This can happen if a woman is not aware that she has gonorrhea or chlamydia because she does not have any symptoms. It may also happen if an infection is not properly treated because she does not take all the prescribed medication. PID can develop straight after the initial infection, when it is called acute PID. If acute PID is left untreated or a woman has several attacks, chronic PID can develop after several months or even years.
As PID usually starts with sexually transmitted infections, the biggest risk factor is having sex without using a condom. A woman who has had a large number of sexual partners, or who has sex with a man who has had a large number of partners will be at greater risk of getting PID.
Much less often, PID can begin when the cervix is open, such as after childbirth, during a miscarriage or an abortion, or when an IUD is inserted. There will be a greater risk of PID during these events if there is an existing vaginal infection.
Acute PID is a sudden severe illness that makes you very unwell. Chronic PID causes ill health over a long period of time. An infection can localize on the tubes and cause abscesses that need to be removed surgically. Long-term pain is a problem for some women, possibly caused by adhesions (scars in the pelvic cavity).
Your doctor will perform a vaginal examination to find out if the womb and tubes are tender and whether there are any swellings. Swabs will be taken from inside the vagina and the cervix to test for bacteria. You may have an ultrasound scan using an internal probe in the vagina to look for an abscess. You may be referred to hospital for a laparoscopy.
The most effective way to protect yourself from PID is always to use a condom during sex. If you think you have been at risk of an infection or if you already have symptoms, contact your doctor. The sooner you are treated the lower the risk of infertility.
A woman who has PID should make sure that her partner is tested and treated immediately. If a man has any sexually transmitted infection, he should also tell his partner immediately. The partner may not know they have an infection as they may have no symptoms. It is vital that both partners have treatment to make sure they do not continue to carry the infection and give it back to each other, resulting in chronic PID. You should not have sex, even with a condom, until you have both finished your treatment and have been examined a second time.
PID is treated conventionally with a course of antibiotic tablets, usually for two weeks. Severe acute PID may be treated with antibiotic injections. It is very important to finish all the tablets to prevent the infection from coming back. You will be given two or three different types of antibiotics to cover all the possible bacteria that cause PID. Amoxycillin, metronidazole and doxycycline are three of the commonly used kinds. If you are allergic to an antibiotic or have any side effects, tell your doctor.
Your docotr will suggest a follow-up test after treatment is complete, usually another internal examination and a further set of swabs to check that the infection has cleared. If it is treated quickly and completely, PID need not cause infertility. The risk of permanent damage to the female organs will be increased if you develop PID again. It is important to avoid future risk.