Pelvic inflammatory disease (PID) is a serious infection of the upper genital tract/reproductive organs (uterus, fallopian tubes, and ovaries) in women. PID can be sexually transmitted or occur naturally. It can lead to infertility in women (being unable to have children) or life-threatening complications.
Women between the ages of 15 and 25 have the highest incidence of PID. In the United States, PID is the leading cause of infertility in women.
How does one get a PID?
The most common causes of PID are two sexually transmitted infections (STDs)—chlamydia and gonorrhea—that go untreated. Other non-sexually transmitted bacteria or germs can also be a cause.
PID occurs when an infection in the cervix and vagina is not treated immediately. The infection spreads from the cervix up to the uterus, fallopian tubes and ovaries, which can be damaged if not treated early. PID can develop anywhere from several days to several months after infection with an STD.
What can cause an upper genital tract infection to spread?
- Untreated infection. Without treatment, about 10-15% of women with chlamydia will develop PID.
- There is a small risk associated with using an intrauterine device (IUD). There is a slightly increased risk of PID in the first 3 weeks after admission, but overall the risk is low.
- Douching. Women who shower once or twice a month are more likely to have PID than those who shower less than once a month.
What are the symptoms of PID?
- Dull pain or tenderness in the lower abdomen
- Burning or pain when urinating (urine)
- Nausea and vomiting
- Bleeding between menstrual periods
- Increased or changed vaginal discharge
- Pain during sex
- Fever and chills
It is possible for a woman to have PID and have no symptoms, or have symptoms too mild to notice, for an unknown amount of time. PID can also be misdiagnosed as appendicitis, ectopic pregnancy, ruptured ovarian cysts, or other problems.
How is PID diagnosed?
A healthcare provider may diagnose PID if all three of the following symptoms are found during a pelvic exam:
There may be other explanations for these symptoms, so your healthcare provider may also order additional tests—such as tests for chlamydia or gonorrhea.
Pelvic ultrasound is a useful procedure for diagnosing PID. An ultrasound can look at the pelvic area to see if the fallopian tubes are enlarged or if there is an abscess (pus-filled area).
In some cases, a laparoscopy may be needed to confirm the diagnosis. Laparoscopy is a surgical procedure in which a thin, flexible tube with a lighted end (laparoscope) is inserted through a small incision in the lower abdomen. This procedure allows the doctor to see the internal organs of the pelvis and take samples for laboratory studies, if necessary.
How is PID treated?
Broad-spectrum antibiotics are the recommended treatment. Sexual partners of patients who have PID should be screened and treated if they have had recent intercourse to prevent re-infection.
If you are being treated for PID:
- Take all medications as directed.
- You may need a follow-up test 48 to 72 hours after starting treatment to make sure the medicine is working.
- Return for another checkup after treatment is complete to make sure the infection is completely gone.
- Tell your partner to get tested and treated.
I remember: Do not have sex until you are treated and you and your partner are healed.
Hospitalization to treat PID may be recommended if a woman:
- is seriously ill (nausea, vomiting and high fever).
- she is pregnant;
- unresponsive to or unable to take oral medications and requires intravenous antibiotics.
- has an abscess (an infected area with pus) in the fallopian tube or ovary.
If symptoms persist or if an abscess does not go away, surgery may be needed. Complications of PID, such as chronic pelvic pain and scarring, are difficult to treat but sometimes improve with surgery.
Untreated PID infections can lead to:
- Infertility. Because of PID, each year more than 100,000 women will be unable to have children as a result of scarring or damage to the cells lining the fallopian tubes.
- Cystitis (inflammation of the bladder)
- Ectopic (tubal) pregnancy
- Recurrent episodes of PID
- Chronic pelvic pain
Talking to your partners
Telling a partner can be difficult, but keep in mind that most people with an STD don’t know they have it. It’s important to talk to your partner as soon as possible so they can get treatment. Men are more likely than women to develop symptoms of chlamydia or gonorrhea (two STDs that cause PID). It’s possible to pass PID back and forth, so if you get treated and your partner doesn’t, you can get infected again.
