Most women with PID have mild symptoms but sometimes they can be severe. Symptoms may include:
- abnormal vaginal discharge that may smell unpleasant
- irregular periods, bleeding between periods or periods that are heavier than usual
- pain in the lower part of your abdomen (tummy), which may spread to your legs
- uncomfortable or painful sex
- a high temperature (over 38°C)
- feeling sick or vomiting
These symptoms aren't always caused by PID but if you have them, see your GP or local sexual health clinic. It's very important to seek help early to reduce your risk of developing complications. However, because PID may have symptoms that can be confused with those of other conditions, it can sometimes take a while to diagnose.
Your GP will ask about your symptoms and your medical and sexual history. He or she will also examine you.
Your GP may take some samples (swabs) from inside your vagina and cervix to test for bacteria. He or she will insert a speculum into your vagina to hold it open, similar to when you have a smear test, and then use a cotton wool swab to take one or more samples. The swabs will be sent to a laboratory to be tested for chlamydia and gonorrhoea as well as other bacteria. You may also be offered routine tests for other STIs – for example a blood test can show if you have certain infections.
If there is a possibility you could be pregnant, your GP may recommend that you have a pregnancy test because the symptoms of PID can be very similar to those of ectopic pregnancy. He or she may also test a sample of your urine to check for a urinary tract infection.
If you have ongoing pain, irregular or heavy bleeding and your GP isn’t sure if you have PID, he or she may refer you to a specialist for further tests including:
- a pelvic ultrasound or transvaginal ultrasound scan, which uses sound waves to produce an image of the inside of your body
- a biopsy, which involves taking a small sample of tissue from the lining of your womb – this is then sent to a laboratory for testing
- a laparoscopy, which is a keyhole procedure used to examine your fallopian tubes, ovaries and womb
If your GP thinks that you have PID, he or she will prescribe a combination of antibiotics for you to start taking straight away, even though the test results probably won't be ready for a few days. This is because the long-term effects of PID can be serious, so it's best to start treatment as soon as possible.
Your GP will usually prescribe a two-week course of antibiotics to treat the infection. Always ask your GP for advice and read the patient information leaflet that comes with your medicine. It’s important to finish your treatment before you have sex again. If you have an IUD fitted, your GP may recommend that you have it removed if your symptoms don’t improve with antibiotic treatment.
If it’s found that your PID was caused by an STI, it’s essential that your partner is also tested and treated.
Your GP will probably ask you to come back a few days later to check that your symptoms are getting better and to talk through your test results. He or she may then want to see you four to six weeks later to see if your treatment has been successful.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
If your symptoms are severe or you're pregnant, you may be admitted to hospital for further treatment. You’re likely to be given antibiotics through a drip for the first 24 hours, followed by tablets. See our FAQs for more information.
The bacteria that cause PID can leave scar tissue and cause abscesses (collections of infected fluid) in your fallopian tubes. Occasionally you may need surgery to drain an abscess in or around your fallopian tubes or ovaries. You may also be offered keyhole surgery to remove fibrous scar tissue (adhesions) that can develop after PID.
If you have a regular sexual partner, it’s important for him or her to make an appointment to see a GP or at a sexual health clinic for tests and treatment. Wait until you have both completed your treatment before you have sex so that there is no risk of you infecting each other again.
The doctor or nurse that you see may ask for details of your sexual history over the past six months or more. This will be in confidence. Staff at the sexual health clinic can contact your past partners for you.
PID is most commonly caused by an STI, usually chlamydia or gonorrhoea. You can catch an STI by having sex with an infected partner – your partner may not know that he or she has an infection. Young women who have a new sexual partner, numerous sexual partners or unprotected sex are more at risk of STIs. Although women in same sex relationships are at a lower risk of STIs, it's still possible for these conditions to be passed on through oral sex or by sharing sex toys.
It’s possible for infections other than STIs to cause PID. Bacteria that are usually found in your vagina and on your cervix can sometimes get into your womb and spread to your fallopian tubes, ovaries and surrounding tissues. Although the bacteria are harmless to your vagina, they can cause an infection in other parts of your body.
You're also more at risk of developing PID:
- in the first six weeks after having an intrauterine device (IUD) or coil inserted
- after having an operation to terminate a pregnancy
- after a miscarriage
- if you douche (rinse out) your vagina
It’s possible for PID to lead on to a number of complications, including the following.
- PID can cause infertility. The risk of you becoming infertile after having PID is related to the number of times you get the condition and how severe it is.
- If you do go on to get pregnant, you’re more likely to have an ectopic pregnancy than a woman who has never had PID. An ectopic pregnancy is when a fertilised egg implants outside your womb, most often in one of the fallopian tubes. It's not possible for pregnancy to continue outside the womb. Sometimes an ectopic pregnancy can cause the fallopian tube to rupture (burst) leading to life-threatening bleeding. See our FAQs for more information.
- You may develop chronic pelvic pain after having PID.
The best ways to reduce your risk of STIs that often cause PID are to use condoms and limit the number of sexual partners you have. It’s important to remember that although condoms will reduce your risk of getting an STI, they can't completely prevent all infections.
Can men get PID?
No, men don't get PID. However, they can catch or pass on a sexually transmitted infection (STI) that can cause PID in women.
Women can get PID if infections pass from the vagina and cervix (neck of the womb) to the womb (uterus), ovaries and fallopian tubes. You may have been infected by a male sexual partner who has an STI, such as gonorrhoea or chlamydia. Although some men will have symptoms of STIs, such as pain when passing urine or inflammation of the urethra leading to discharge from the penis, often there aren’t any symptoms.
Therefore, it's very important for any sexual partners you have had in the past six months to be tested and treated for the infection so that they don't pass it on to anyone else. If you visit a sexual health clinic, staff there can contact your past partners for you. Using condoms when you have sex can reduce your risk of getting or passing on STIs.
If I have PID, does it mean I have an STI?
If you have PID, it doesn’t definitely mean that you have a sexually transmitted infection (STI), but it’s likely because they are the most common cause of the condition.
PID is most commonly caused by chlamydia or gonorrhoea but it can be caused by other infections too. For example, other bacteria that are usually found in your vagina and on your cervix can sometimes get into your womb and spread to your fallopian tubes, ovaries and surrounding tissues. Although the bacteria are harmless to your vagina, they can cause an infection in other parts of your body.
You're at an increased risk of developing PID in the first few weeks after having an intrauterine device (IUD) or coil inserted or after having an operation to terminate a pregnancy.
Why is an ectopic pregnancy more likely if I have had PID?
Ectopic pregnancy is more likely if you have had PID because it can lead to a blockage in your fallopian tubes. This means the egg can’t pass through to your womb as it would usually after it has been fertilised.
When an infection spreads from your cervix and along your fallopian tubes, it causes inflammation (salpingitis). This causes the lining of your fallopian tubes to become red and swollen, and the tubes can become very narrow as they produce extra secretions that can make the walls stick together. This means that any fertilised eggs can’t move along the fallopian tubes properly to reach your womb. This leads to an ectopic pregnancy, which is when pregnancy occurs outside your womb.
The longer you delay treatment for PID, the greater your risk of having an ectopic pregnancy. Therefore, it's important to visit your GP or local sexual health clinic if you think you may have PID. The earlier your treatment starts, the better.
Will PID go once I finish my course of antibiotics?
This depends on how severe your PID is and if the antibiotics are effective for you.
Different women respond to treatment for PID in different ways. Your GP will usually prescribe a course of a combination of antibiotics to take for at least two weeks to treat the infection. You're likely to be given two types of antibiotics in tablet form, but if your symptoms don't start to improve within three days, you may need more treatment and some women may need to go into hospital.
You may need to go to hospital for further tests and treatment if it's not possible to rule out other conditions, such as appendicitis or ectopic pregnancy, or if you:
- have an abscess in your pelvis caused by the infection
- have very severe symptoms
- can't keep down any medicine because of vomiting
- are pregnant
- have symptoms that aren't getting any better after three days of antibiotic treatment
If you go into hospital for treatment, you may be given antibiotics through a drip for the first 24 hours, followed by tablets.
If you have an abscess in your pelvis caused by the infection, you may need an operation to have this drained to ease your PID symptoms.
There is also the possibility that your symptoms are caused by another condition. You may need to have other tests to rule these out. Ask your GP for more information.
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- Pelvic inflammatory disease. Medscape. www.emedicine.medscape.com, published April 2013
- Pelvic inflammatory disease. BMJ Best Practice. www.bestpractice.bmj.com, published October 2012
- Ectopic pregnancy. Medscape. www.emedicine.medscape.com, published May 2013
- Pelvic inflammatory disease. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published March 2013
- Sexually transmitted infections (STIs) help. Family Planning Association. www.fpa.org.uk, published November 2012
- Lesbians, bisexual women and safe sex. Avert. www.avert.org, accessed 2 September 2013
- Pelvic inflammatory disease (PID). British Association for Sexual Health and HIV. www.bashh.org, published January 2012
- Pelvic inflammatory disease (PID) – CDC fact sheet. Centers for Disease Control and Prevention. www.cdc.gov, published September 2011
- Oats J, Abraham S. Fundamentals of obstetrics and gynaecology. 8th ed. London: Mosby; 2005: 20
- Fallopian tube disorders. Salpingitis. Medscape. www.emedicine.medscape.com, published March 2012
- Ectopic pregnancy. Patient Plus. www.patient.co.uk, published January 2013
- General information. Public Health England. www.hpa.org.uk, accessed 7 October 2013
- Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press; 2010: 738
- Urethritis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published September 2009
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