Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is a bacterial infection that affects the female upper genital tract; including the endometrium lining and tissue around the uterus (womb), ovaries and fallopian tubes. It can even reach the lining of the abdomen. Men cannot suffer from PID, but they can carry and transmit the bacteria to future sexual partners.

PID mainly affects sexually active women between the ages of 15-24 in the UK. In America, this equates to 4.4% of the sexually active female population.

If left untreated, PID can quickly result in pelvic tubo-ovarian abscesses in the ovaries and fallopian tubes. This can irreparably scar the tubes, making them too narrow for eggs to pass into the womb. This can lead to fertility issues, and makes you 6 times more likely to have an ectopic pregnancy (where the pregnancy is in the fallopian tubes rather than in the womb). Occasionally, abscesses can rupture, and therefore require immediate admission to hospital if found.

PID can be painful, with heightened pain during sex and urination. Even after PID is treated, and the infection has cleared, 18% of women will develop chronic pelvic pain that remains.

PID is caused by bacteria that reaches high up the female upper genital tract. It can be the result of an advanced sexually transmitted disease (STD), or damage to the cervix which allows otherwise healthy bacteria to travel up and grow into an infection. You can reduce your risk of developing PID by using protection during sex to avoid catching an STD, and treating any STD's you develop as early as possible.

There is no single comprehensive method to diagnose PID. It requires; a medical and sexual history check; a pelvic examination; cervical and vaginal swabs; and occasionally, samples taken through a laparoscopy (keyhole surgery) through the abdomen. Due to the speed PID can cause irreparable damage, the treatment for PID will occur as soon as PID is presumed to be the cause of your symptoms. Treatment is a course of antibiotics which treats all the different types of bacterium that may be causing the PID.


What are the Symptoms of Pelvic Inflammatory Disease (PID)?

The symptoms of PID are common with other conditions that result in pelvic pain. They increase in severity as the condition develops and irreparable damage is done.

  • Pelvic pain and discomfort in the lower abdomen and pelvis - This pain is not always present.
  • Pain felt deep inside the pelvis during sex (dyspareunia)
  • Increased vaginal discharge that may be yellow or green
  • A fever of over 38°C (100°F)
  • Pain during urination
  • Urge incontinence
  • Vaginal bleeding outside of the normal menstrual cycle, and often after sex
  • Very heavy periods (menorrhagia)
  • Very painful periods (dysmenorrhea)
  • Nausea and vomiting

Conditions with similar symptoms include appendicitis and ectopic pregnancy. Diagnostic tests for these conditions will be completed to rule them out before treatment for PID begins. If you are found to be pregnant as well as suffering with PID, you will be urgently admitted to hospital to protect the fetus during your treatment.


What Causes Pelvic Inflammatory Disease (PID)?

1 in every 4 cases of PID is caused by an STD. It can also be caused by directly catching the bacteria from a sexual partner, or receiving damage to the cervix which allows normal vaginal bacteria to reach higher up the genital tract.

  • Sexually transmitted diseases (STD's) - Most commonly chlamydia and gonorrhoea. These are bacterial infections that occur in the vagina and cervix in women, and penis and testicles in men. They are transmitted between sexual partners during unprotected sex. PID occurs in women, when the infection spreads and reaches the higher reproductive organs.
  • Unprotected sex with a carrier - As well as being a way to catch an STD, having unprotected sex with either a man or women that carry the bacteria that causes PID, will transfer the PID to you.
  • Vaginal bacteria - Bacteria that normally lives in the vagina can cause PID in the reproductive organs if it is able to get past the cervix. This can occur if you have:
    • a damaged cervix, which can occur from childbirth or a miscarriage.
    • had PID before.
    • had a procedure that opened the cervix; such as an abortion or had an intrauterine contraceptive device (coil) fitted.
    • used a vaginal douche.

To read about other causes of pelvic pain, visit the Causes and Diagnosis of Pelvic Pain page.


How to Treat Pelvic Inflammatory Disease (PID)

There is a 1 in 10 risk of becoming infertile as a result of PID, with your probability increasing the longer you go untreated. As diagnosing PID is not a straight forward task, your GP may recommend you begin treatment on the presumption that you are suffering from PID if your history suggests it is likely, and there is no other obvious cause for the pain.

Be aware that any damage that has already occurred to your reproductive organs, cannot be resolved through these treatments.

  • Antibiotics - A combination of antibiotics will be prescribed in a 2 week course. Used to treat all the different types of bacterium that may be causing the PID. Any recent sexual partners will also be treated with antibiotics, even if they have none of the symptoms and/or are male. If you have any pelvic abscesses, these will also be treated with broad-spectrum antibiotics and may require draining. See our page on pelvic abscesses for more information.
  • Pain relief - Over the counter pain medications, such as paracetamol and ibuprofen, will help relieve your symptoms whilst you recover. Always check the instructions if you are taking pain relief medications alongside antibiotics.
  • Abstinence from sex - Whilst you are being treated for PID, you should avoid sex and inform recent partners that they need to be tested to stop the infection being spread to others. Following the resolution of your PID, you should always use protection during sex and speak to your doctor before trying to conceive to test for any damage the PID caused.
  • Intrauterine contraception (coil) advice - If you have a intrauterine contraception fitted, it is currently recommended that it remains in place until the antibiotic treatment has begun. Speak to your doctor if you wish to have it removed.

To read about other treatments available for pelvic pain, visit our pelvic pain treatment page.


Sources

Centers for Disease Control and Prevention. (2015). 2015 Sexually Transmitted Diseases Treatment Guidelines: Pelvic Inflammatory Disease (PID). [online] Centers for Disease Control and Prevention, 2015. [viewed 10/05/18]. Available from: https://www.cdc.gov/std/tg2015/pid.htm

Centers for Disease Control and Prevention. (2017). Pelvic Inflammatory Disease (PID) - CDC Fact Sheet. [online] Centers for Disease Control and Prevention, 2017. [viewed 10/05/18]. Available from: https://www.cdc.gov/std/pid/stdfact-pid-detailed.htm

Das, B. B. Ronda, J. Trent, M. (2016). Infection and Drug Resistance.Pelvic inflammatory disease: improving awareness, prevention, and treatment. [online] 9, p191-197. [viewed 18/05/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998032/

Kairys, N. Roepke, C. (2017). Abscess, Tubo-Ovarian. [online] StatsPearls Publishing LLC, 2018. [viewed 23/05/18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448125/

Mitchell, C. Prabhu, M. (2013). Infectious disease clinics of North America. Pelvic Inflammatory Disease: Current concepts in pathogenesis, diagnosis and treatment. [online] 27(4), doi:10.1016/j.idc.2013.08.004. [viewed 18/05/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843151/

NHS Trust. (2015a). Pelvic inflammatory disease: Diagnosis. [online] National Health Service, 2015. [viewed 10/05/18]. Available from: https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/diagnosis/

NHS Trust. (2015b). Pelvic inflammatory disease: Overview. [online] National Health Service, 2015. [viewed 10/05/18]. Available from: https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/

NICE. (2015). Pelvic inflammatory disease: Scenario: Management. [online] National Institute for Health and Care Excellence, 2015. [viewed 10/05/18]. Available from: https://cks.nice.org.uk/pelvic-inflammatory-disease#!scenario

Soper, D. E. (2010). Obstetrics & Gynecology. Pelvic inflammatory disease. [online] 116(2), p419-428. [viewed 01/05/2018]. Available from: http://insights.ovid.com/pubmed?pmid=20664404

UChicago Medicine. (2018). Frequently Asked Questions About Pelvic Floor Disorders [online] UChicago Medicine, 2018 [viewed 01/05/2018]. Available from: http://www.uchospitals.edu/specialties/pelvic/faq/pelvic-floor-disorders.html