Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infection of the female reproductive system – the fallopian tubes, cervix, womb and ovaries.

Key points

  1. The most common cause of PID is from a sexually transmitted infection (STI)
  2. Occasionally, you can get PID after some gynaecological procedures, such as an abortion, pelvic operations, intrauterine device (IUD) insertion and after giving birth.
  3. PID is common in women under the age of 30 because chlamydia and gonorrhoea infections are common in this age group. However, tests for these are often negative in women with PID.
  4. Common symptoms of PID include lower abdmonal (tummy) pain, abnormal vaginal bleeding or discharge, pain during sex, fever, nausea or vomiting.
  5. If you have PID, your doctor will also recommend a sexual health check to check for STIs.
  6. PID is treated with a combination of antibiotics and it is important that you complete the course of treatment.

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 PID?

The most common cause of PID is an STI such as chlamydia and gonorrhoea. Other less common causes include:

  • from an abortion procedure
  • after pelvic operations
  • after an IUD insertion
  • the first few weeks after delivery of a baby.

You are at higher risk of getting PID if you:

  • are less than 30 years old
  • have had a new sexual partner in the past 3 months
  • have had an STI in the past 12 months
  • have a sexual partner with an STI
  • have symptoms such as abnormal vaginal bleeding, discharge or rash around your genitals
  • have had recent IUD insertion
  • are in the first few weeks after delivery of a baby.

What are the symptoms of PID?

The symptoms can vary from very mild to severe. The most noticeable symptoms are:

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

In some cases, you may notice no symptoms at all.

Sexual health check

If you have had recent unprotected sex (not using a condom) with a new partner, or have any of the symptoms mentioned above, it's time for a sexual health check. This involves having a vaginal examination and tests taken for STIs including chlamydia and gonorrhoea. This check can be done at your local sexual health service, doctor or Family Planning clinic.

What are the complications of PID?

The complications of PID include:

  • abscesses in or around your ovaries or fallopian tubes
  • chronic or long-term pelvic pain
  • infertility (difficulty getting pregnant) due to the infection damaging tissues, such as the fallopian tubes – this can be permanent
  • ectopic pregnancy (pregnancy that happens outside your womb).

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 PID 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 vagina, as well as doing blood tests, 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 perform an ultrasound scan on your abdomen (tummy) or other investigations.

How is PID treated?

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

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.
  • Don't have sex again (or use condoms if that’s not possible) until your treatment is finished and 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.
  • Return to your doctor or clinic for a follow-up check after treatment.

How can I prevent PID?

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

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.