Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infection of the female upper reproductive organs in the pelvis – the uterus (womb), fallopian tubes (the tube that connects the uterus to the ovaries) and the ovaries.

Key points about pelvic inflammatory disease

  1. The most common cause of pelvic inflammatory disease (PID) is from a sexually transmitted infection (STI). However, other bacteria from your vagina or nearby organs can also cause PID.
  2. Common symptoms of PID include lower abdominal (tummy) pain, abnormal vaginal bleeding or discharge, pain during sex, fever, nausea or vomiting.
  3. See your doctor if you have these symptoms – early diagnosis and treatment of PID reduces the risk of serious and long-term complications.
  4. If you have PID, your doctor will also recommend a sexual health check to check for STIs.
  5. PID is treated with a combination of antibiotics and it is important that you complete the course of treatment to prevent complications.

If you have any of the following symptoms, contact your GP or go to the nearest emergency department immediately:

  • severe tummy pain
  • fever and chills
  • repeated episodes of vomiting
  • you feel unwell generally
  • heavy vaginal bleeding.

What are the causes of pelvic inflammatory disease?

Most cases of PID are caused by bacteria that spread from your vagina and cervix (the neck of your womb) to your uterus (womb) and fallopian tubes.


Image: Female reproductive organs. Source: Wikimedia Commons

Many different types of bacteria can cause PID. The most common of these is an STI such as chlamydia and gonorrhoea.

Other less common causes include:

  • from a termination of pregnancy (abortion) procedure
  • after pelvic operations
  • after an intrauterine device (IUD) insertion
  • the first few weeks after delivery of a baby
  • from spread of infections from nearby organs, eg, appendicitis.

Who is at risk of pelvic inflammatory disease?

You are more likely to have PID if you have the following risk factors:

  • younger than 30 years of age
  • have unprotected sex without a condom
  • have a sexual partner with an STI
  • have had a new sexual partner in the past 3 months
  • have more than 1 sex partner or have a sex partner who has other sex partners
  • have had an STI in the past 12 months
  • have had PID before
  • have had a termination of pregnancy, miscarriage or childbirth
  • have had an IUD insertion – (the small increased risk is usually within the first 3 weeks after the insertion).

What are the symptoms of pelvic inflammatory disease?

The symptoms can vary from very mild to severe.

Some women may not have any symptoms. The most common symptoms are:

  • pain or tenderness in your lower abdomen (tummy)
  • abnormal vaginal discharge
  • heavy or painful periods
  • unusual vaginal bleeding such as after sex or between periods
  • pain during or after sex
  • fever
  • nausea or vomiting.

What are the complications of pelvic inflammatory disease?

Complications are more likely to arise if PID is not treated, or if treatment is delayed, or if there is a severe infection.

The complications of PID include:

  • chronic or long-term lower abdominal pain
  • scarring of the fallopian tube, which can cause infertility (difficulty getting pregnant) or ectopic pregnancy (pregnancy outside your womb)
  • an abscess (collection of pus) in or around the fallopian tube and/or ovary.

If you get PID more than once you are at greater risk of developing these complications. In many countries, it's the most common preventable cause of infertility.

How is pelvic inflammatory disease diagnosed?

There is no specific, single test for PID and the doctor will rely on your symptoms and examination findings to decide if you have PID.

Your doctor will ask you about your symptoms, including your period, any previous operations and whether you have any sexual partner who has an STI. Your doctor will also examine your abdomen (tummy) and, with your consent, do a vaginal (internal) examination. Read more about informed consent.

The doctor will also request blood tests, a urine (pee) test and vaginal swabs to check for the cause of your infection. However, your swab tests can be negative for STIs even if you have PID.

If you have PID, your doctor will also recommend a sexual health check to check for other STIs such as HIV.

Sometimes, if your symptoms are severe, or if you have any complications, your doctor will ask for an ultrasound scan on your abdomen or other investigations.

How is pelvic inflammatory disease treated?

If your doctor thinks it's very likely you have PID, you will be given a course of antibiotics, usually before test results are available. This is to lower the risk of any possible long-term complications.

A combination of antibiotics are used to treat PID  as it is usually caused by a number of different bacteria The treatment usually includes a single antibiotic injection and oral antibiotics tablets for 2 weeks.

Antibiotics that are usually used to treat PID include:

  • Make sure you finish the course of treatment, even if your tests are all clear and you are feeling better.
  • If your symptoms do not improve or get worse within 2–3 days of treatment see your doctor again.
  • Return to your doctor or clinic for a follow-up check after treatment.
  • If you have abdominal pain, you can take pain relief such paracetamol while being treated with antibiotics.
  • Don't have sex again (or use condoms if that’s not possible) for 2 weeks from the start of your treatment and until 1 week after any recent sexual partners have been treated. Read more about partner notification/contact tracing.
  • Advise all partners from the past 3 months to get a sexual health check.

In severe cases of PID, your doctor may refer you to the hospital for admission to have medicines through a drip in your arm (intravenously).

How can I prevent pelvic inflammatory disease?

The complications of PID get worse with repeat infections, so prevention is essential.

Most PID in young women is the result of infection with an STI.

  • You can prevent these infections by using a condom every time you have sex, especially when having sex with new partners.
  • Make sure sexual partners are tested and treated.
  • Have a STI check before any gynaecological procedure like an IUD insertion or termination of pregnancy.
  • Prompt treatment of STI may help prevent PID.
  • Have regular STI check-ups if you change your sexual partner.

Learn more

Pelvic inflammatory disease Health Promotion Agency and Ministry of Health, NZ
Pelvic inflammatory disease – patient information NZ Sexual Health Service
Pelvic inflammatory disease Family Planning, NZ
Pelvic inflammatory disease Just The Facts, NZ
A guide to pelvic inflammatory disease British Association for Sexual Health and HIV, UK

References

  1. Pelvic inflammatory disease Auckland Regional HealthPathways, NZ, 2020
  2. Pelvic inflammatory disease (PID): Management Summary New Zealand Sexual Health Society, 2017
Credits: Health Navigator Editorial Team. Reviewed By: Dr Poornima Nair, FRNZCGP, Hamilton Last reviewed: 04 Nov 2020