Pelvic Inflammatory Disease (PID)

What is PID?

Pelvic inflammatory disease (PID) stems from a bacterial infection that spreads from the vagina through the cervix to the uterus, fallopian tubes or ovaries. PID is most often caused by the sexually transmitted diseases (STD) chlamydia or gonorrhea, but it can sometimes stem from the disruption of the normal state of bacteria in the vagina.

More than 1 million women in this country are diagnosed with PID each year, according to the American College of Obstetricians and Gynecologists (ACOG). Left untreated, PID leads to scarring of the fallopian tubes, a condition known as tubal factor infertility, which causes 25% to 35% of female infertility.

PID at a glance
  • PID is an infection of the female reproductive organs transmitted through sexual contact, which if left untreated can cause problems such as scarring, lifelong pain and infertility.
  • The infection can often go undetected because symptoms are vague or don’t appear at all.
  • Pelvic inflammatory disease affects 1 in 10 women with infertility.
  • Signs of PID include severe pain in the lower abdomen, fever or chills, vaginal discharge with odor, abnormal bleeding, or pain during urination or intercourse.
  • The first treatment course is antibiotics to attack the infection, with surgery as an option for more serious cases.
  • The surest ways to prevent PID are to use protection during sex, get tested, limit the number of sexual partners, and avoid douching.

PID Causes

Unprotected sex can lead to the transmission of an STD, which is the precursor to PID. The two main STDs that cause pelvic inflammatory disease are chlamydia and gonorrhea.

Other possible causes of PID include bacterial vaginosis (a change in the normal balance of bacteria present in the vagina), douching, childbirth, miscarriage or abortion.

Who can get PID?

All women are at risk for pelvic inflammatory disease, but it is most commonly diagnosed among those under the age of 25. ACOG reports that risk increases for any woman who has multiple sex partners, a sexually transmitted disease, a sex partner who has multiple sex partners, or previous history of PID.

PID symptoms

Symptoms are often vague, or they may not show up at all. Seek medical help any time there are questions or concerns, especially if these PID symptoms are present:

  • A slight ache in the lower abdomen
  • Pain in the upper right stomach area
  • Fever, possibly with chills
  • Vaginal discharge with an offensive odor
  • Pain or bleeding with sex
  • Bleeding between periods
  • Pain or burning sensation when urinating

Call your gynecologist immediately if more severe PID symptoms occur as noted below.

  • Serious pain in the lower abdomen or pelvic area
  • Fever with a temperature higher than 101 degrees Fahrenheit
  • Vomiting
  • Fainting, dizziness, moist or clammy skin, or other signs of shock

Testing for PID

No single test exists to detect pelvic inflammatory disease. To diagnose it, a provider will perform a physical examination, and discuss medical and sexual history. During a pelvic exam, the provider will look for signs of PID that include abnormal discharge from the cervix or vagina, pus near the fallopian tubes or ovaries (known as an abscess), and pain or tenderness in the reproductive organs. Sometimes an ultrasound or other imaging test may be ordered to further examine the internal organs.

The provider will most likely order blood tests to check for sexually transmitted infections (STIs) and a urinalysis to check for a urinary tract infection (UTI).

A Pap smear is not used to diagnose pelvic inflammatory disease.

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PID treatment

Because pelvic inflammatory disease stems from a bacterial infection, the first course of treatment is antibiotics. Sometimes, two or more antibiotics are prescribed together to tackle multiple strains of bacteria. More serious complications, such as an abscess in the fallopian tube or ovary, may require surgery.

It is extremely important to finish the entire course of prescribed treatment, even if symptoms subside before the medication is completed. A risk of re-infection exists until the course of treatment is complete, so patients should not participate in sexual activity until then.

Any recent sex partners should get tested and treated for any PID symptoms and STIs. They, too, should finish the prescribed treatment before engaging in further sexual activity.

Pelvic inflammatory disease can occur more than once, especially if sexually transmitted diseases are present. According to the Centers for Disease Control and Prevention (CDC), those who have been diagnosed with PID have a higher chance of getting it again.

What happens if it goes untreated?

Women who think they might have the condition should not wait to get medical help for any signs of PID. The longer the disease lives in the body, the likelihood for lifetime complications increases. Long-term issues can include:

While antibiotics will treat a single episode of PID, this treatment will not cure damage already done to reproductive organs.

PID and infertility

How does PID cause infertility?

Infertility affects 1 in 10 women with PID. Scarring inside or outside of the fallopian tubes, which can be a result of PID going untreated, can block an egg from traveling down the tubes to getting fertilized and can also block an embryo from moving to the uterus. These complications are called tubal factor infertility.

Scar tissue may cause a fertilized egg to implant in the fallopian tube instead of the uterus, a condition known as ectopic pregnancy. Improper implantation can cause the fallopian tube to burst, leading to dangerous bleeding in the abdomen that requires emergency surgery.

How to reduce the risk

Pelvic inflammatory disease can be prevented in the following manner.

  • Even if other birth control methods are in place, always use a condom to prevent sexually transmitted diseases.
  • Limit the number of sexual partners.
  • Check that sexual partners are limiting their number of sexual partners.
  • Get tested and suggest that sexual partners do the same.

Women should remember that at the first sign of PID symptoms, they should get medical help. The sooner treatment is administered, the better the chance for no long-term complications, especially infertility.