Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is infection of the uterus, fallopian tubes, ovaries and surrounding tissue. It usually develops when organisms move upwards from the vagina or cervix. Lower abdominal pain, discharge and fever may occur, but symptoms may be mild or absent. Early diagnosis and appropriate treatment help reduce permanent tubal damage risk. This information is general and does not replace individual diagnosis or treatment decisions.

What is pelvic inflammatory disease (PID)?

PID is an infection of the upper genital tract. The infection can spread from inside the uterus to the tubes and ovaries, and sometimes to the abdominal cavity. Serious outcomes such as a pus-filled collection in the tube and ovary (tubo-ovarian abscess) can occur. For this reason, the combination of pain, fever and discharge requires medical assessment.

What causes PID, and who is at greater risk?

Sexually transmitted organisms such as chlamydia and gonorrhoea are often responsible, but other vaginal organisms may contribute. Treatment therefore usually targets more than one organism.

Having had a sexually transmitted infection before, contact with a new partner, having had PID before, and the period shortly after an intrauterine device (IUD) is inserted are among the situations that increase risk. This information consists of history elements that guide the diagnosis; it carries no judgement of the person.

What symptoms can PID cause?

PID often presents with mild or non-specific symptoms, and in some people it causes no symptoms at all. Symptoms that can occur include:

• Lower abdominal or groin pain
• Unusual or unpleasant-smelling vaginal discharge
• Bleeding outside of a period or after sex
• Painful sex
• Fever and chills
• Nausea, vomiting

Mild symptoms do not mean the infection is unimportant; even mild PID can leave damage to the tubes.

How is PID diagnosed?

The diagnosis of PID is mostly based on clinical findings. Lower abdominal pain with no other cause found, together with tenderness of the cervix, uterus or ovarian area on examination, is generally considered sufficient to start treatment. Fever, abnormal discharge, raised inflammatory markers on blood tests, and chlamydia or gonorrhoea detected on a sample taken from the cervix support the diagnosis. An HIV test is also recommended once the diagnosis is made.

Ultrasound is requested when the diagnosis is not certain or a complication such as an abscess is suspected. Fluid collection or thickening in the tubes can be seen on imaging. Further methods such as laparoscopy may be considered if needed.

How is PID treated?

Mild to moderate PID is usually treated as an outpatient with a combination of oral antibiotics, sometimes together with an injection. Treatment is expected to respond within a few days; if there is no improvement, the person returns for reassessment and may be switched to intravenous treatment. Even if symptoms resolve, the course of antibiotics must be completed for the duration set by the doctor; antibiotics should not be used on your own initiative. The choice and duration of medicine are determined by the doctor according to the individual.

When is hospital admission needed?

Hospital admission and intravenous treatment may be needed when a surgical emergency cannot be excluded, in a tubo-ovarian abscess, in pregnancy, in a severe clinical picture, when medicine cannot be taken because of vomiting, or when there is no response to oral treatment. In suspected PID during pregnancy, hospital assessment is recommended because the risks to the mother and the pregnancy are increased.

Does my partner need assessment too?

Because a sexually transmitted organism may be involved, assessment and, if needed, treatment of the partner or partners who had sexual contact in the period before symptoms began is recommended. To prevent re-infection, sexual activity should be avoided until treatment is complete, symptoms have resolved and the partner or partners have also been treated. After treatment, repeat testing for chlamydia and gonorrhoea is recommended in the following months.

What changes if I have an IUD?

If an intrauterine device (IUD) is in place, the risk of PID relates mainly to the first period after it is inserted. The IUD does not necessarily need to be removed; it can be managed with medicine and close monitoring. If there is no improvement within a few days, removal may be considered. This decision is made by the doctor according to the individual.

What happens if PID is untreated?

If treatment is delayed or never given, the infection can leave permanent damage to the tubes. This can result in tubal infertility and ectopic pregnancy; a collection of pus (abscess) and more serious spread can also develop. Even mild or symptomless PID can carry a risk of infertility. This risk is not the same for everyone; many people can conceive afterwards. The relationship between tubal disorders and pregnancy is a separate topic and requires detailed assessment.

What can help prevent PID and recurrence?

Barrier methods such as condoms and testing when needed are important for protection against sexually transmitted infections. When an infection is detected, early treatment helps reduce the risk of progression to PID. Because people who have had PID before are at risk of recurrence, completing treatment and having the partner assessed are important. Seeing a doctor without delay for a new symptom such as discharge, pain or bleeding allows a new infection to be caught early.