Pelvic inflammatory disease (PID) is a syndrome that primarily affects women of reproductive age. It occurs when bacteria spread to the organs of the female reproductive system, and is commonly a result of sexually transmitted infections.

Infections such as chlamydia and gonorrhoea can lead to PID. Infections that are not sexually transmitted, however, can also cause PID.

What is pelvic inflammatory disease?

Pelvic inflammatory disease (PID) is a common complication involving bacteria from the vagina, which travel upwards through the cervix to the upper genital tract and reproductive organs. The condition can affect the female reproductive tract, involving the vagina, the cervix, the lining of the uterus (endometrium) or tissues around the womb, the fallopian tubes and/or the ovaries.

If left untreated, the condition can lead to significant complications, including infertility and chronic pain. Prompt treatment is key to minimising risks.

Learn more about investigating infertility by reading Investigating Infertility | 7 Critical Preliminary Blood Tests.

What is pelvic inflammatory disease also known as?

Pelvic inflammatory disease is also known as pelvic inflammatory disorder, but is commonly abbreviated to PID.

What causes pelvic inflammatory disease?

The most common cause of pelvic inflammatory disease are bacteria from a sexually transmitted infection (STI), which travel upwards from the vagina, causing infection in any of the female reproductive organs.

Can you have PID without an STD?

The bacteria that cause pelvic inflammatory disease are spread via sexual contact. It’s possible for it to occur in long term relationships, where neither partner has had sexual intercourse with another person.

PID can be caused by bacteria normally present in the vagina, which can spread to other pelvic organs, causing infections that can lead to PID. These bacteria might be harmless in the vagina but can cause infection elsewhere in the body.

Who is at risk of PID?

You have an increased risk of developing PID if you have any of the following risk factors:

Under 25 years old
Sexually active from an early age
Multiple sexual partners
New sex partner
Previous PID diagnosed
History of sexually transmitted infection, including bacterial vaginosis (BV)
Intrauterine device (IUD) as a method of birth control.

What are the symptoms of pelvic inflammatory disease?

Symptoms are often mild or silent, meaning some women might not be aware they have the condition until it becomes severe.

Symptoms usually include one of more of the following:

Pelvic pain/lower abdominal pain
Heavy or painful periods
Bleeding in between periods or after sex
Pain during sex
Problems weeing
Abnormal vaginal discharge (green, yellow or smelly).

When to seek help

Speak to your doctor if you’re concerned about any symptoms you think could be linked to a sexually transmitted infection or pelvic inflammatory disease.

You might require urgent care or medical attention, if you’re experiencing any of the following:

Fainting
Vomiting
High fever (above 101F)
Severe pelvic pain/severe pain.

Any of the above signs or feeling acutely unwell can indicate a serious complication. In some cases, surgery might be necessary to treat the cause.

Pelvic inflammatory disease in men

Although men cannot develop PID, they can still be silent carriers of the bacteria that cause PID to develop in women. Therefore, it’s important a man to be tested and treated for SDIs, if his partner develops PID.

How do you test for pelvic inflammatory disease?

Diagnosis of pelvic inflammatory disease is usually based on symptoms and a physical exam.

To diagnose PID, your doctor will most likely run a serious of tests, including any or all of the following:

Urine test
Blood tests
Genital swabs
Pregnancy test.

If symptoms are ongoing, without an obvious cause, an ultrasound or laparoscopy might be suggested. A laparoscopy is a procedure involving keyhole surgery, using special cameras to take a closer look at the internal organs.

How common is pelvic inflammatory disease?

PID is a common condition affecting women globally but the exact figures are unclear. There’s limited contemporary data from low to middle income countries. Difficulties in diagnosing PID might mean many more people than we know of are living with the condition.

Data from the U.S predicts that approximately 2 million American women of reproductive age are living with the PID.

Data from the UK shows a decline in the rate of PID in the decade between 2009-2019 – probably due to widespread chlamydia screening.

Is pelvic inflammatory disease a serious condition?

Pelvic inflammatory disease can be serious and, in some cases, life threatening, although this is rare.

Following treatment, PID can still result in further complications, which might make getting pregnant challenging. Some women are left with long lasting, chronic pelvic pain.

According to the Centers for Disease Control & Prevention (CDC), 1 in 8 women with a history of PID have difficulties getting pregnant.

How long does pelvic inflammatory disease last?

The infection that causes pelvic inflammatory disease will last until it’s treated. However, the damage caused by the infection can lead to long term complications that last for months or a number of years. In some severe cases, PID can cause permanent damage.

What happens if pelvic inflammatory disease is left untreated?

If left untreated, pelvic inflammatory disease can cause serious complications; it can also increase the chances of infertility.

Complications of pelvic inflammatory disease

The longer the condition is left untreated, the more serious its effects can be.

Complications associated with PID include:

Scarring of the fallopian tubes. Severe scarring can lead to blockage or narrowing of the fallopian tubes. This can make it difficult for an egg to pass through. Most women who receive treatment, however, are able to get pregnant naturally
Ectopic pregnancy. Scarring in the fallopian tube increases the chance of ectopic pregnancy, where a fertilized egg implants itself in the tube rather than in the womb
Recurrent PID. Delays in treatment increase the chance of repeat episodes. If you’ve had PID once, you’re at increased risk of developing it again in the future. Recurrent episodes can occur if the original infection wasn’t treated effectively. Repeat episodes increase the risk of infertility
Tubo-ovarian abscess. A pocket of infected fluid can develop into an abscess. Antibiotics will be needed to clear the infection. In some cases, abscesses need to be drained surgically
Infertility. PID lowers your chances of getting pregnant naturally. Scarring of the fallopian tubes or lining of the womb and abscesses can make it difficult to get pregnant. This might mean you’ll need IVF treatment or artificial reproductive techniques (ART) in order to achieve pregnancy
Chronic pelvic pain. Some women are left with long term pelvic or abdominal pain, which can be difficult to live with.

Learn more about ectopic pregnancies by reading our article What Is An Ectopic Pregnancy? | Discover The 6 Risk Factors.

How do you treat pelvic inflammatory disease?

PID is most easily treated if caught early. Early treatment will involve a course of oral antibiotics to treat the infection. Treatment is likely to involve a mixture of antibiotics to cover all likely infections. Your doctor might also suggest a one off injection of antibiotics to start your treatment.

After starting the antibiotics, you should start to feel an improvement in your symptoms. It’s important to complete the course, even if you’re feeling better, to make sure the infection clears completely. If your symptoms haven’t improved during this time, further tests might be needed.

Avoid being sexually active during your treatment. This will ensure healing and prevent re-infection.

Recent sexual partners (within the last 6 months) will need to be tested and treated to stop re-occurrence and spread. This can be done anonymously, and your care provider can make contact with your partners, if you prefer. PID will probably return unless both partners are treated.

If you have an IUD in place, it might need to be removed, and replaced after treatment is completed.

Can pelvic inflammatory disease be cured?

Yes, PID can be cured if caught early, but treatment cannot undo any damage that has already been caused by the infection.

In most cases, PID is treated effectively with a course of antibiotics. If it’s caught later, or if you’re feeling very unwell, you might need to be admitted to hospital for a course of IV antibiotics given to you through a drip.

Are PID and HPV the same thing?

PID is not the same as Human Papilloma Virus (HPV). Many women who have pelvic inflammatory disease, however, also have HPV, which causes genital warts. HPV is a risk factor for cervical cancer; therefore, if you’re known to have HPV, you’ll be advised to have more frequent pap smears.

How do you prevent PID?

The good news is that PID can often be prevented and the risks minimized, if you know what to look for.

To keep yourself safe, consider the following:

Practise safe sex. Even if you take birth control pills, use a barrier method, such as condoms, every time you have sex with a new partner, to protect against STIs
Book a sexual health check. A regular check up can catch things early, even if you don’t have symptoms
Visit a GUM or sexual health clinic, or speak to your GP for advice, if you have concerns
Avoid douching. Certain products can wash away the healthy bacteria needed to support overall health. This can make it easier for infection to take hold.

These things can feel embarrassing at the time, but don’t let that put you off getting help. Health professionals are used to supporting and advising people in similar situations; they do it all the time as part of their everyday job.

Earlier is always better than later when it comes to this type of thing. Remember that delaying treatment can lead to serious complications which could have been prevented.