Overview
Definition
Pelvic inflammatory disease (PID) is an infection of a woman’s reproductive organs, including the uterus (womb), fallopian tubes, ovaries, and the tissue surrounding these organs. It usually starts with a bacterial infection and inflammation of the cervix (cervicitis) that is generally caused by gonorrhea or chlamydia. PID is also linked to an imbalance of the organisms normally found in the vagina (bacterial vaginosis).
Symptoms
At first, PID may not cause any symptoms or may cause only mild symptoms, such as abnormal bleeding or discharge from the vagina. Some women don't even know they have it. They only find out later, when they can't get pregnant or they have pelvic pain.
As the infection spreads, the most common symptom is pain in the lower belly. The pain has been described as crampy or as a dull and constant ache. It may be worse during sex, bowel movements, or when you urinate. Some women also experience fever and/or chills, nausea and/or vomiting, lower back pain, a feeling of fullness or bloating in the abdomen, and a general feeling of illness or tiredness.
Causes
There are 3 main ways to get PID: through sexually transmitted diseases, from infections in the vagina, or through medical procedures. Bacteria enter the reproductive organs through the cervix; when the cervix is infected, bacteria from the vagina can more easily get into and infect the uterus and fallopian tubes.
Some STIs are caused by bacteria that infect the cervix (the opening to the uterus). If these bacteria pass through the cervix into the uterus or fallopian tubes, PID can occur. Chlamydia and gonorrhea are 2 common STDs that cause PID. Other bacteria normally found in the vagina that cause bacterial vaginosis can also cause PID this way.
Any medical procedure that opens a woman's cervix can allow bacteria to pass through the cervix into the uterus and fallopian tubes. These procedures can include: abortion, D&C (dilatation and curettage), and IUD (intrauterine device) insertion.
You may be more likely to get PID if you:
- Have a sexually transmitted infection (STI). The most common causes of PID are gonorrhea and chlamydia.
- Are at risk for STIs. You are at higher risk for STIs if you are young and you don't use condoms when you have sex. Having more than one sex partner also increases your risk for STIs.
- Have bacterial vaginosis (which is not an STI).
- Douche.
- Have recently had an IUD inserted or had an abortion.
- Had PID before.
Complications
If untreated, PID can cause scar tissue in the pelvic organs and lead to infertility. It can also lead to other problems, such as pelvic pain and tubal (ectopic) pregnancy.
Recurring infection is common and increases the risk of long-term health problems. It can be caused by:
- Inadequate treatment of the first infection.
- Failure to treat sexual partner(s).
- Increased vulnerability to infection.
Tests and Diagnosis
Unfortunately, there is no simple test for PID, which makes it difficult to diagnose. Your doctor will do a vaginal exam and take swabs to test for chlamydia and gonorrhea. During this exam, your doctor will also feel for any abnormalities and check for pain or tenderness in the internal organs. The test results may take some time, and so your doctor may treat you for the disease before the test results are ready. Treating PID early is important to prevent problems later on.
Your doctor may test you for the most common causes of PID and may also do blood tests to look for signs of infection. Your doctor may also order an ultrasound to see if there are other possible causes of your symptoms. An ultrasound may also show if there is damage to the fallopian tubes, uterus, or ovaries from PID.
Treatment and Drugs
PID is treated with 2 or more types of antibiotics to make sure that all the bacteria are killed. Take them as directed; if you don't take all of the medicine, the infection may come back. If you are taking oral antibiotics, it is extremely important to follow up with your health care provider within 3 days of starting treatment as well as after the medication is finished.
If your infection was caused by an STI, all sexual partners that you have been with in the 2 months before your symptoms started need to be treated with antibiotics to cure chlamydia and gonorrhea (even if they haven't noticed any symptoms). You should also avoid sex until 7 days after you and your partner(s) have been treated.
If you have a very bad case of PID or are pregnant, you may need to stay in the hospital and get antibiotics through a vein (IV). Sometimes surgery is needed to drain a pocket of infection, called an abscess. If you have an IUD for birth control, it may be removed.
Prevention
Since chlamydia and gonorrhea are common causes for PID, the ways to help reduce the chances of PID are similar to the ways to prevent chlamydia or gonorrhea. If you are sexually active, having regular check-ups for STDs and PID is important.
Your risk of infertility increases each time you have PID, so it is very important to prevent future infections. If you are experiencing any of the symptoms mentioned in the Symptoms section, you should seek medical attention as soon as possible.
Last Updated: July 12, 2010
