Pelvic Inflammatory Disease

Symptoms

PID often does not cause any obvious symptoms.

Most symptoms are mild and may include 1 or more of the following:

• pain around the pelvis or lower tummy
• discomfort or pain during sex that's felt deep inside the pelvis
• pain when peeing
• bleeding between periods and after sex
• heavy periods
• painful periods
• unusual vaginal discharge, especially if it's yellow, green or smelly

A few people become very ill with:

• severe pain in the tummy
• a high temperature (fever)
• feeling and being sick

Causes

Pelvic inflammatory disease (PID) is caused by an infection developing in the female reproductive system.

In most cases, the condition is caused by a bacterial infection spreading from the vagina or cervix (entrance to the womb) into the womb, fallopian tubes and ovaries.

PID is often caused by more than one type of bacterium and it can sometimes be difficult for doctors to pinpoint which are responsible.

This means a combination of antibiotics will be prescribed so a variety of bacteria can be treated.

Sexually transmitted infections (STIs)

The main cause of PID is through a sexually transmitted infection (STI) such as chlamydia, gonorrhoea or mycoplasma genitalium.

These bacteria usually only infect the cervix, where they can be easily treated with antibiotics. 

But if they're not treated there's a risk the bacteria could travel into the female reproductive organs.

If you have chlamydia and it's left untreated, it may develop into PID within a year.

Other causes of PID

In many cases, the cause of the infection that leads to PID is unknown.

Sometimes, the usually harmless bacteria found in the vagina can get past the cervix and into the reproductive organs.

Although harmless in the vagina, these types of bacteria can cause infection in other parts of the body.

This is most likely to happen if:

• you have had PID before
• there's been damage to the cervix following childbirth or a miscarriage
• you have a procedure that involves opening the cervix (such as an abortion, inspection of the womb, or insertion of an intrauterine device (IUD)

Risk Factors

Anyone with female reproductive organs can get PID, but you're more likely to get it if you:

• have more than 1 sexual partner
• have a new sexual partner
• have a history of STIs
• have had PID in the past
• are under 25
• started having sex at a young age

Diagnosis

There's no single test for diagnosing pelvic inflammatory disease (PID). It's diagnosed based on your symptoms and a gynaecological examination.

Your doctor will first ask about your medical and sexual history.

The next step is to carry out a pelvic examination to check for any tenderness and abnormal vaginal discharge.

You may experience some discomfort during this examination, particularly if you do have PID.

Swabs are usually taken from the inside of your vagina and cervix. These are sent to a laboratory to look for signs of a bacterial infection and identify the bacteria responsible.

A positive test for chlamydia, gonorrhoea or mycoplasma genitalium supports the diagnosis of PID.

But most people have negative swabs and this doesn't rule out the diagnosis.

As PID can be difficult to diagnose, other tests may also be required to look for signs of infection or inflammation or rule out other possible causes of your symptoms.

These tests may include:

• a urine or blood test
• a pregnancy test
• an ultrasound scan, which is usually carried out using a probe passed into the vagina (transvaginal ultrasound)

In some cases, a laparoscopy (keyhole surgery) may be used to diagnose PID.

• A laparoscopy is a minor operation where 2 small cuts are made in the abdomen.
• A thin camera is inserted so the doctor can look at your internal organs and, if necessary, take tissue samples.

This is usually only done in more severe cases where there may be other possible causes of the symptoms, such as appendicitis.

Treatment Options

If diagnosed at an early stage, PID can be treated with a course of antibiotics, which usually lasts for 14 days.

You'll be given a mixture of antibiotics to cover the most likely infections, and often an injection as well as tablets.

It's important to complete the whole course and avoid having sexual intercourse during this time to help ensure the infection clears.

Your recent sexual partners should also be treated for any sexually transmitted infections that may have caused your PID. This will help stop it coming back or spreading to other people.

Prevention Tips

You can reduce your risk of PID by always using barrier contraception, such as condoms, with a new sexual partner until they have had a sexual health check.

Chlamydia is very common and most people do not have any symptoms.

If you're worried you may have an STI, visit your local genitourinary medicine (GUM) or sexual health clinic for advice.

If you need an invasive gynaecological procedure, such as insertion of an intrauterine device (IUD) or an abortion, have a check-up beforehand.

Complications

The fallopian tubes can become scarred and narrowed if they're affected by PID. This can make it difficult for eggs to pass from the ovaries into the womb.

This can increase your chances of a pregnancy that grows outside the womb, usually in the fallopian tubes (ectopic pregnancy). This type of pregnancy cannot be saved and can cause life-threatening problems.

If you keep getting PID or treatment is delayed, it can increase your risk of infertility.

When To See A Doctor

It's important to visit a GP or a sexual health clinic if you experience any symptoms of PID.

If you have severe pain, you should seek urgent medical attention from your GP . 

Delaying treatment for PID or having repeated episodes of PID can increase your risk of serious and long-term complications.

There's no simple test to diagnose PID. Diagnosis is based on your symptoms and the finding of tenderness during a vaginal (internal) examination.

Swabs will be taken from your vagina and the neck of the womb (cervix), but negative swabs do not rule out PID.