Pelvic inflammatory disease is a condition which affects the female reproductive system: which includes the ovaries, fallopian tubes, womb and the genital tract.

It is caused by a bacterial infection, and usually more than one type of bacteria is responsible; but it can often come about as a result of an untreated sexually transmitted infection, such as gonorrhoea or chlamydia.

The condition can cause symptoms such as pelvic pain, urinary pain and a change in periods. However, these may only be mild and go largely unnoticed in many cases.

If it is not treated, pelvic inflammatory disease can lead to the development of abscesses, chronic pelvic pain, and even infertility.

Doctors will typically need to perform a pelvic examination and conduct a laboratory analysis, using swab samples, to make a diagnosis. In some cases further testing, such as blood or urine sample tests or an ultrasound scan, may be required too.

In its early stages, PID is treatable with antibiotic medicine, but more complicated or severe cases may require admission to hospital.

On this page, we’ll discuss:

  1. The causes of PID
  2. Who gets PID
  3. Possible symptoms
  4. Complications
  5. How it is diagnosed
  6. How it is treated
  7. And what you can do to lower your risk

What causes pelvic inflammatory disease?

PID is caused by a bacterial infection.

There are several different types of bacterium which have the potential to cause it, and in many cases more than one of these is identified in patients who have PID.

However C. trachomatis (the bacteria responsible for genital chlamydia) and Neisseria gonorrhoeae (which causes gonorrhoea) are most commonly implicated.

According to the NHS, around a quarter of cases are thought to develop as a result of untreated chlamydia or gonorrhoea; whereas the CDC states that the prevalence of these infections in PID is even higher, being implicated in 33-50 percent of cases.

Pelvic inflammatory disease can also be caused by other types of bacteria in the vagina spreading past the cervix into the upper genital tract. This bacteria may be harmless when in the vagina, but cause problems when it comes into contact with other environments.

Infection can occur if the cervix becomes damaged after giving birth, or after a miscarriage; and certain procedures which require the cervix to be opened, such as having a contraceptive coil fitted, can also increase the chances of infection.

Douching (a process which uses water to flush bacteria out of the vagina) is also a possible cause, as it can upset the bacterial balance in the vagina.

Who gets PID?

Women who are sexually active are more at risk, and someone who has had PID in the past may be more likely to get it than someone who has not.

Public Health England released a report in 2015, which stated that the highest diagnosis rate in GP settings was among 20-24 year olds; whereas in hospital settings it was highest among 35-44 year olds.

In women aged 15-44, PHE reports that in 2011 there were 176 diagnoses made per ‘100,000 person-years’ in primary care settings; while in hospitals there were 241 cases per 100,000 of the population.

What are the symptoms of PID?

There are several symptoms associated with pelvic inflammatory disease, but they can be subtle and someone with the infection may not always notice them.

Possible symptoms include:

  • lower abdominal pain
  • fever
  • vaginal discharge
  • periods that are heavier or more painful than usual
  • intermenstrual bleeding or bleeding after sex
  • urinary pain or burning
  • vaginal discharge

In severe cases, someone may also develop nausea and vomiting.

Can PID have complications?

Yes.

Possible complications include:

  • Recurrent PID. This may be because during the initial infection, the reproductive organs sustain injury which leaves them more susceptible to becoming infected again.
  • Long-term pelvic pain.
  • Abscesses in the fallopian tubes or the ovaries.
  • Infertility. If the infection causes lasting damage in the fallopian tubes, this can have a direct effect on a woman’s capacity to conceive. Sperm may not be able to reach an egg as easily, or an egg may not be as able to travel to the womb. Roughly 1 in 10 women with PID, according to the NHS, will become infertile as a consequence of the infection. They state that those most at risk are those who delay seeking treatment or have recurrent episodes.
  • Ectopic pregnancy. This is where an egg, after becoming fertilised by sperm, attaches to tissue external to the womb. Most typically, it attaches to the fallopian tubes, and can occur if the lining of the fallopian tubes become scarred by the infection.

The earlier someone with PID is diagnosed and treated, the less likely they are to develop complications.

How is PID diagnosed?

A doctor may need to undertake several tests in order to determine the presence of pelvic inflammatory disease, and rule out other possible conditions.

  • Gynaecological exam. This is typically the first stage in this process, during which the doctor will assess potential symptoms (such as whether the pelvic area is tender or if the vagina is expelling any discharge).
  • Cervical swab. This will be then be taken and sent for analysis, to check for the presence of chlamydia or gonorrhoea. A positive result may indicate PID; however, a negative result does not necessarily rule out the condition.
  • Urine test, blood test, ultrasound scan or pregnancy test. These may also be used to confirm a diagnosis or to make sure that symptoms are not being caused by other factors.
  • Laparoscopy. This is a procedure where small incisions are made in the abdomen, and a tiny camera is inserted to view inside the affected area to check for inflammation. It is only used in a small number of cases.

How is PID treated?

A combination of antibiotic medicine is typically used to treat PID. These may be given as tablets or as an injection.

The type given may depend on the type of bacteria causing the infection, and whether or not the patient is pregnant.

For the treatment of PID, NICE guidelines advise a combination of either:

  • ofloxacin and metronidazole;
  • ceftriaxone (or cefixime), doxycycline and metronidazole;
  • or ceftriaxone (or cefixime), and azithromycin;

in cases where the risk of gonococcal infection is low, or:

  • ceftriaxone (or cefixime), doxycycline and metronidazole;

where the risk of gonococcal infection is high.

In some cases, one antibiotic may be given as an injection, followed by a two-week course of one or more other antibiotics orally.

If symptoms are severe, then admission to hospital may be necessary. In such cases antibiotic medicine may need to be administered via an intravenous drip.

PID patients who are also pregnant will also need to be admitted to hospital.

Can I lower my risk of pelvic inflammatory disease?

Yes.

  • Prior to having a procedure such as a contraceptive coil fitted, it’s advisable to have an examination with a doctor to rule out the presence of infection.
  • Not douching can help to preserve helpful bacteria in the vagina and lower the risk of PID.
  • Lowering your chances of getting an STI, by practising safe sex and using barrier contraception, is another way to reduce your risk of developing pelvic inflammatory disease.

If you’re sexually active, it’s advisable to get tested for STIs at least once a year; but if you think you may have come into contact with an STI, then you should speak to your doctor and get tested as soon as possible. The earlier STIs such as chlamydia are detected and treated, the less likely it is that complications such as PID will develop.

Page last reviewed:  Tuesday, Apr 25 2017