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Pelvic Inflammatory Disease

Topic Overview

What is pelvic inflammatory disease?

Pelvic inflammatory disease, or PID, is an infection of a woman's reproductive organs.

Treating PID right away is important, because PID can cause scar tissue in the pelvic organs and lead to infertility. It can also cause other problems, such as pelvic pain and tubal (ectopic) pregnancy.

What causes PID?

PID is caused by bacteria entering the reproductive organs through the cervix. When the cervix is infected, bacteria from the vagina can more easily get into and infect the uterus and fallopian tubes.

You're more likely to get PID if you:

  • Have a sexually transmitted infection (STI). The most common causes of PID are gonorrhea and chlamydia.
  • Are at risk for STIs. If you are young and you don't use condoms when you have sex, you're more likely to get STIs. Having more than one sex partner also increases your risk for STIs.
  • Have bacterial vaginosis.
  • Douche.
  • Have recently had an IUD inserted or had an abortion.
  • Have had PID before.

What are the symptoms?

At first, PID may not cause any symptoms. Or it may cause only mild symptoms, such as bleeding or discharge from the vagina. Some women don't even know they have it. They only find out later, when they can't get pregnant or they have pelvic pain.

As the infection spreads, the most common symptom is pain in the lower belly. The pain has been described as crampy or as a dull and constant ache. It may be worse during sex, during bowel movements, or when you urinate. Some women also have a fever.

How is PID diagnosed?

Even when PID causes mild or no symptoms, it can still cause serious problems. So you need to see your doctor if you have any unusual symptoms.

Your doctor will ask about your lifestyle and symptoms. He or she will examine you and do tests to see if you have PID. The test results may take some time. For this reason, your doctor will treat you for the disease before the test results are ready. Treating PID early is important to prevent problems later on.

Your doctor may test you for the most common causes of PID and may also do blood tests to look for signs of infection. Your doctor may also order an ultrasound to see if there are other possible causes of your symptoms. An ultrasound may also show if there is damage to the fallopian tubes, uterus, or ovaries from PID.

How is it treated?

To treat PID, you will take antibiotics. Take them as directed. If you don't take all of the medicine, the infection may come back.

If your infection was caused by a sexually transmitted infection, your sex partner(s) will also need to be treated so you don't get infected again. Do not have sex until both of you have finished your medicine. And be sure to follow up with your doctor to make sure that the treatment is working.

If you have a very bad case of PID or are also pregnant, you may need to stay in the hospital and get antibiotics through a vein (intravenous). Sometimes surgery is needed to drain a pocket of infection, called an abscess.

Can you prevent PID?

Your risk of infertility increases each time you have PID, so it is very important to prevent future infections. Using a condom each time you have sex can reduce your chance of getting a sexually transmitted infection that could lead to PID.

Cause

Pelvic inflammatory disease (PID) is caused by bacteria entering the reproductive organs through the cervix. When the cervix is infected, bacteria from the vagina can more easily get into and infect the uterus and fallopian tubes.

Sexually transmitted infections

Pelvic inflammatory disease (PID) is usually caused by a sexually transmitted infection (STI) that infects the cervix.

When the cervix, which connects the upper vagina to the uterus, is infected with an STI, other bacteria in the vagina can more easily get into and infect the uterus and fallopian tubes.

The most common STIs that cause PID are gonorrhea and chlamydia.

PID caused by chlamydia may have milder symptoms or no symptoms (compared with PID caused by gonorrhea), which can delay diagnosis. PID caused by chlamydia is most common among teenagers and young adult women.

Bacterial vaginosis

Bacterial vaginosis (BV) is a drop in the vagina's "good" organisms and an increase in its potentially "bad" organisms.

When this happens and the problem organisms spread into the uterus and fallopian tubes, PID can result. BV is not sexually transmitted.

PID and intrauterine devices (IUDs)

Inserting an IUD while there is infection in the vagina or the cervix can cause PID. This is especially likely if bacterial vaginosis or an STI is present at the time of insertion.

Symptoms

Symptoms of pelvic inflammatory disease (PID) range from none at all to severe. They often don't appear until infection has spread.

Symptoms tend to be more noticeable during menstrual bleeding and sometimes in the week following.

You may have one or more of these symptoms:

  • Pain in the lower belly, usually described as crampy or as constant and dull. This is the main symptom. It may get worse during bowel movements, sexual intercourse, or urination.
  • A sense of pressure in the pelvis.
  • Low back pain. Sometimes this pain spreads down one or both legs.
  • More discharge from the vagina than usual, or discharge that is yellow, brown, or green.
  • Fever.
  • Pain during sex.
  • Irregular menstrual bleeding.
  • Urinary symptoms, such as burning or pain when you urinate.

What Happens

Pelvic inflammatory disease (PID) causes inflammation in the uterus and fallopian tubes. In turn, the inflammation can form scar tissue in the abdominal cavity and the reproductive organs. This doesn't always cause symptoms. But the scar tissue can cause:

  • Infertility. Scarring inside the fallopian tubes is permanent and can twist or block the tubes. When the tubes are blocked, a woman's eggs can't get to the uterus.
  • Tubal (ectopic) pregnancy. Sometimes the scarring traps a fertilized egg in the fallopian tube, where it begins to grow. This requires emergency treatment.
  • Chronic (ongoing) pelvic pain. For more information, see the topic Chronic Female Pelvic Pain.

PID may also occur inside the belly as:

The longer treatment is delayed, the more likely you are to have permanent damage. And the more often you have repeat infections, the higher your chances of having problems.

What Increases Your Risk

You are more likely to get pelvic inflammatory disease (PID) if you:

  • Are at risk for sexually transmitted infection (STI). Sexually active teens and young women have the highest rate of STIs. Having sex without using a condom increases your risk for STIs.
  • Have had PID before. If you have had PID once, your reproductive tract may be less able to fight a new infection because of scar tissue from past PID.
  • Have had chlamydia before. A second infection can cause more irritation and pelvic organ damage that is worse than the first time.
  • Douche. Doctors advise against douching, because it can cause vaginal and pelvic infections.

Some medical procedures can increase your risk of PID by introducing bacteria into the reproductive tract. These include:

  • Scraping the lining of the uterus (D&C) or taking a tissue sample (biopsy).
  • Inserting an IUD. Your risk of infection can be reduced if:
    • You are tested and treated for STIs and bacterial vaginosis (if detected) before IUD insertion.
    • The insertion is done carefully to minimize the chance of infection (clean technique).
  • Examining the uterus or fallopian tubes with a lighted viewing tube (hysteroscopy) or with an X-ray using dye injected into the uterus and fallopian tubes (hysterosalpingogram).
  • Inducing abortion.

In some cases, PID can spread from tuberculosis bacteria that have spread to the pelvic area.

PID is rare in women who aren't sexually active, don't have menstrual periods, are pregnant, or have had their uterus or ovaries removed.

When should you call your doctor?

Pelvic inflammatory disease and several other conditions with similar symptoms require prompt treatment.

Call your doctor right away if you have belly pain and any of the following:

  • A positive home pregnancy test
  • Fever of 38.3°C (101°F) or higher
  • Pain or difficulty urinating

Call your doctor soon if you:

  • Have a dull pain, unusual cramping, or a feeling of pressure in the lower belly.
  • Have pain during sex, especially in the belly.
  • Have abnormal vaginal bleeding, bleeding between menstrual periods, or bleeding after sex or douching.
  • Have a vaginal discharge that is yellow or green or smells bad.
  • Need to urinate often or have pain, burning, or itching with urination for longer than 24 hours.
  • Think you may have been exposed to a sexually transmitted infection, or you have a sex partner who has symptoms, such as discharge, genital sores, or pain in the genital area.

Who to see

Your family doctor, general practitioner, or gynecologist can diagnose and treat pelvic inflammatory disease (PID).

Complications are usually treated by a gynecologist.

Examinations and Tests

Pelvic inflammatory disease (PID) is diagnosed by the combination of your medical history, your symptoms, a physical examination, and lab test results.

Medical history

Your doctor may ask you a number of questions, such as what your symptoms are, what method of birth control you use, and whether you or your partner engage in high-risk sexual behaviours.

Physical examination

Your examination for PID will include a pelvic examination.

You will also be tested for gonorrhea, chlamydia, and bacterial vaginosis.

Lab tests

Imaging tests


  • Pelvic or transvaginal ultrasound
    . It can show internal organs on a computer screen to see if there are any other causes of pain.

  • Laparoscopy
    . The doctor inserts a lighted viewing instrument into the belly to look for signs of infection and scar tissue.

  • MRI

    or

    CT scan
    . These tests are used in rare cases if symptoms aren't improving with treatment or an ultrasound has shown a possible growth or abscess that needs to be further evaluated.

Early detection

Yearly chlamydia testing for young, sexually active women is thought to reduce the number of cases of PID. This screening is recommended by experts.

Treatment Overview

Antibiotics are the main treatment for pelvic inflammatory disease (PID). And it's important to treat PID right away, even if you have only one or two symptoms. This is because waiting several days to treat you could raise your risks of fallopian tube damage and infertility.footnote 1

You may be given medicine even before lab results have come back, based on your medical history and a physical examination.

Most cases of PID are cured with antibiotics. But sometimes surgery is needed to drain an abscess or cut scar tissue.

Your doctor will recommend hospitalization if you are pregnant, are very ill, are vomiting, may need surgery for a tubo-ovarian abscess or ectopic pregnancy, or aren't able to treat yourself at home.

If you have an IUD and you get PID, you may not need to have the IUD removed, depending on how severe the infection is.footnote 1

Treatment for your sex partner(s)

If your PID was caused by a sexually transmitted infection (STI), anyone with whom you have had sex in the last 60 days should be checked and treated.

Having sex too soon after treatment could cause your infection to come back, so it's important to wait. The amount of time you must wait depends on what type of treatment you have. Talk to your doctor to be sure.

Follow-up treatment

Follow-up visits to your doctor are important for making sure that treatment is working and to prevent complications, such as chronic pelvic pain and infertility.

Your doctor will want to check you 2 to 3 days after you've started treatment to see if you are improving or if you need a different antibiotic.

After you've had PID, you will need to have any further pelvic symptoms checked promptly. Your doctor will want to examine you for signs of another infection, possible pelvic organ damage (adhesions), and other possible causes of your symptoms.

Prevention

You can prevent pelvic inflammatory disease (PID) by using condoms. This helps protect you from sexually transmitted infections that cause PID. To learn more, see the topic Safer Sex.

Avoid douching, which increases your risk for vaginal and pelvic infections.

Home Treatment

Use the following home treatment measures to support your recovery.

  • Rest. Rest as much as possible until your symptoms start to get better (usually a couple of days). Then return to your usual activities slowly.
  • Pain medicine. Take regular doses of a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, for pain. If pain doesn't improve within 48 to 72 hours, tell your doctor.

Resuming sex

It's very important that you don't have sexual relations until your treatment is completed. Otherwise, there is a risk that the infection will come back. Talk to your doctor about when it is safe for you to start having sex again.

Medications

Pelvic inflammatory disease (PID) is usually treated with a broad-spectrum antibiotic, which kills more than one type of bacteria.

How long you need to take antibiotics depends on your infection and the type of antibiotic used. Although you may feel better before you have taken all of your pills, don't stop taking them. If you stop too soon, your infection may return.

Treatment usually takes 14 days. But the number of days you continue to take antibiotics depends on your infection and the type of antibiotic medicine. You may also be able to use a non-steroidal anti-inflammatory drug (NSAID) to relieve PID pain or discomfort.

It sometimes takes more than one course of medicine to cure PID. Sometimes bacteria can become resistant to an antibiotic. This means that the antibiotic is no longer effective against the bacteria. In this case, you'll need to try another type of antibiotic.

Medication choices

Surgery

Surgery isn't usually done to treat pelvic inflammatory disease (PID) unless it is needed to:

  • Drain or remove a pocket of pus, such as a tubo-ovarian abscess.
  • Cut scar tissue that is causing pain. This hasn't been shown to relieve pain when the scarring is severe.footnote 2

Surgery—usually laparoscopy— is sometimes used when a diagnosis is still unclear after other tests are done or when antibiotic treatment is not working.

Surgery choices

Procedures that may be used to diagnose and treat the complications of PID include:

  • Laparoscopy. The surgeon inserts a lighted viewing instrument through a very small cut (incision). He or she can look for signs of ectopic pregnancy or infection and scar tissue and can make repairs if needed.
  • Laparotomy. The surgeon makes a small cut to look inside the belly and make repairs if needed.
  • Drainage of an abscess using a needle and syringe. The doctor usually uses ultrasound to clearly see where the needle is going. This makes an incision unnecessary.

References

Citations

  1. Centers for Disease Control and Prevention (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR, 64(RR-03): 1–137. http://www.cdc.gov/std/tg2015. Accessed July 2, 2015. [Erratum in MMWR, 64(33): 924. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6433a9.htm?s_cid=mm6433a9_w. Accessed January 25, 2016.]
  2. American College of Obstetricians and Gynecologists (2004, reaffirmed 2010). Chronic pelvic pain. ACOG Practice Bulletin No. 51. Obstetrics and Gynecology, 103(3): 589–605.

Other Works Consulted

  • Wiesenfeld H, Paavonen J (2010). Pelvic inflammatory disease. In SA Morse et al., eds., Atlas of Sexually Transmitted Diseases and AIDS, 4th ed., pp. 94–110. Philadelphia: Saunders.

Credits

Current as of:
July 17, 2020

Author: Healthwise Staff
Medical Review:
Kathleen Romito MD - Family Medicine
Thomas M. Bailey MD - Family Medicine
Adam Husney MD - Family Medicine
Martin J. Gabica MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
Sarah Marshall MD - Family Medicine
Kevin C. Kiley MD - Obstetrics and Gynecology