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.
Signs, symptoms & indicators of Pelvic Inflammatory Disease (PID)
High ESR or elevated ESR
Severe right/severe/severe left lower abdominal pain or absence of severe abdominal pain
Unexplained nausea
Chronic/acute/recent abdominal pain
Chronic abdominal pain can be experienced when PID becomes chronic. There will usually be a history of acute onset pain when the infection first begins. The pain may become low grade in chronic PID.
Having a slight/having a high/having a moderate fever
Having chills from an illness or frequent 'chills'
Counter Indicators
Not having a fever
Painful deep penetration during sex
Conditions that suggest Pelvic Inflammatory Disease (PID)
Female Infertility
The most worrying complication of PID is infertility. Scars that damage the fallopian tubes make it difficult for a fertilised egg to pass along the tube to the womb. After one infection, more than 10% of women will suffer from infertility. PID also increases the risk of ectopic pregnancy, when the fertilised egg implants in the fallopian tube because it cannot reach the womb. This is a dangerous condition and the tube will probably need to be removed during an operation.
Vaginitis/Vaginal Infection
If a vaginal infection is caused by gonorrhea and it spreads to the uterus, it is probable that the woman will contract pelvic inflammatory disease (PID).
Risk factors for Pelvic Inflammatory Disease (PID)
Pelvic Inflammatory Disease (PID) can lead to
Vaginitis/Vaginal Infection
If a vaginal infection is caused by gonorrhea and it spreads to the uterus, it is probable that the woman will contract pelvic inflammatory disease (PID).
Recommendations for Pelvic Inflammatory Disease (PID)
Vaginal Depletion Pack
The use of the vaginal depletion pack is recommended as an integral part of PID treatment, as it promotes the drainage of exudate from the involved tissues.
Antibiotics
The main treatment of PID is antibiotics. Most often these antibiotics cure the infection, but no single antibiotic kills the bacteria that cause PID, so two or more antibiotics may be needed.
Hydrotherapy
Sitz baths can powerfully affect the organs of the lower abdomen and pelvis.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Weakly counter-indicative |
| May do some good |
| Highly recommended |
Glossary
Pelvic Inflammatory Disease
(PID) A Purulent (pus-like) vaginal discharge with fever and lower abdominal pain.
Bacteria
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Gonorrhea
A sexually-transmitted disease that is often without symptoms. If there are symptoms in the female, they include frequent and painful urination, cloudy vaginal discharge, vaginal itching, inflammation of the pelvic area, and abnormal uterine bleeding. If the male has a purulent (pus-like) urethral discharge, he should assume he has gonorrhea until proven otherwise.
Chlamydia
A sexually-transmitted disease that is often without symptoms. Some females experience a white vaginal discharge that resembles cottage cheese, a burning sensation when urinating, itching, and painful intercourse. A clear watery urethral discharge in the male probably is a chlamydia infection.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Cervix
The lower part of the uterus that opens into the vagina.
Laparoscope
An instrument inserted into the body that relays pictures back to a computer screen.
Ectopic
Located outside normal position, e.g., location of fetus in pregnancy.