Pelvic Inflammatory Disease
Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) is an infection that affects women, and can affect your womb, ovaries, and fallopian tubes. It can present without obvious symptoms, but it can become serious if undetected and can potentially cause long-term fertility issues, so it’s important to know the signs to look out for.
In this guide, we’ll look at the symptoms of pelvic inflammatory disease, as well as the causes of PID and the treatments that are available.
What is 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 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.
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 - so you're not alone.
Is pelvic inflammatory disease serious?
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.
How is PID diagnosed?
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.
Pelvic inflammatory disease treatments
If you’re suffering from PID, you’ll naturally want to know more about the treatment for pelvic inflammatory disease. If it's diagnosed easrly, then PID can be treated effectively with antibiotics.
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. Our pelvic abscess guide contains more information about how abscesses are diagnosed and treated.
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.
Complications from pelvic inflammatory disease
While PID can be treated with antibiotics in most cases, you should also be aware of the potential damage PID can cause. Most people will take antibiotics and have no further problems, but in some cases, PID can lead to long-term issues.
Recurrent pelvic inflammatory disease
If the infection isn’t fully cleared, sometimes the PID can come back repeatedly – this is known as ‘recurrent pelvic inflammatory disease’. It’s really important that you finish your course of prescribed antibiotics, and that your sexual partners are tested and treated. If PID damages your womb or fallopian tubes, then it can be easier for the infection to come back in these areas, and you may be at risk of developing PID again.
Infertility
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.
What antibiotics treat pelvic inflammatory disease?
Because PID can be caused by a variety of different bacteria, you might be given a mixture of antibiotics to treat PID. Your course of antibiotics will be prescribed by your doctor or health provider, but these are some of the antibiotics commonly used to treat PID:
- ceftriaxone
- doxycycline
- metronidazole
- ofloxacin / levofloxacin / moxifloxacin
Do not take antibiotics that haven’t been prescribed by your healthcare provider, even if they’re on this list – if in doubt, always see your doctor.
Looking for more information about pelvic pain and other treatments available? Visit our pelvic pain treatment page.
Sources
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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
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