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Pelvic inflammatory disease


Expert reviewer, Mr Robin Crawford, Consultant Gynaecologist
Next review due December 2021

Pelvic inflammatory disease (PID) is inflammation of the upper part of a woman’s reproductive organs. This includes your womb (uterus), ovaries and fallopian tubes.

Pelvic inflammatory disease is often caused by a sexually transmitted infection (STI) such as chlamydia or gonorrhoea. Around one in four cases of pelvic inflammatory disease in the UK are caused by STIs. Treatment (antibiotics) usually works well, but if you have a severe infection or if your pelvic inflammatory disease is left untreated, you could develop fertility problems.

An image showing the location of the womb and surrounding structures

Symptoms of PID

The symptoms of pelvic inflammatory disease (PID) can be mild and it’s possible that you won’t have any symptoms at all.

If you do get symptoms of pelvic inflammatory disease, they may include:

  • pain in your lower tummy (abdomen) – this might be on both sides or it can be in the upper right side of your tummy
  • an unusual discharge, which may be smelly, from your vagina
  • bleeding in between your periods or after you have sex
  • uncomfortable or painful sex
  • painful periods
  • heavy periods
  • a high temperature (over 38°C)
  • feeling sick or being sick
  • pain in your back

These symptoms aren't always caused by pelvic inflammatory disease, but if you have them, see your GP or visit your local sexual health clinic. If you do have pelvic inflammatory disease, it's important to start treatment early to reduce your risk of developing complications.

Diagnosis of PID

Your GP will ask about your symptoms and your medical and sexual history. They’ll also examine you, which will include doing a vaginal examination to check for signs of infection. Your GP may take some samples (swabs) from inside your vagina and cervix to test for bacteria and sexually transmitted infections. This is like having a cervical smear test and it may feel uncomfortable. But it’s important to be tested so you can get the treatment you may need.

Your GP may also do:

  • a blood test to check for infection
  • a urine test to rule out a urine infection
  • a pregnancy test if there’s a chance you may be pregnant – the symptoms of PID are similar to those of an ectopic pregnancy

If your symptoms are severe, your GP might advise you to go to hospital for more urgent treatment.

If your GP isn’t sure if you have pelvic inflammatory disease (PID), they may ask you to see a specialist for further tests to rule out other possible causes for your symptoms. These might include:

  • a transvaginal ultrasound scan, which produces an image of the inside of your pelvis
  • a laparoscopy, which is a keyhole procedure used to examine your fallopian tubes, ovaries and womb
  • some more blood tests
  • an MRI or CT scan

Treatment of PID

Medicines

Pelvic inflammatory disease (PID) treatment involves taking two different types of antibiotic. You’ll usually need to start taking them straightaway, rather than wait for the results of tests. This is because the long-term effects of pelvic inflammatory disease 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. It’s important to finish all of them as prescribed, to prevent any long-term problems. Make sure you finish the antibiotics before you have sex again (including oral sex) or use a barrier method of protection, such as a condom. Ideally, wait a week after you finish treatment before having sex, to be on the safe side.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Or your GP might prescribe you some painkillers. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist or GP for advice.

If you don’t get better or your symptoms get worse within three days of treatment, go back to see your GP.

If you have an intrauterine device (IUD), and your symptoms don’t improve within three days of starting antibiotics, your GP may suggest you have it removed.

If your symptoms are severe or don’t get better or if you're pregnant, you may need to have antibiotics through a drip. You’ll usually need to go to hospital for this treatment.

Surgery

If your condition is severe or antibiotics delivered through a drip don’t work for you, you may need to have fluid drained from the affected area. You may need to have surgery to do this during a laparoscopy. Alternatively, the fluid might be drained with a needle (your surgeon will use a scan, such as an ultrasound, to guide them to the right spot).

Treating sexual partners

If you have pelvic inflammatory disease, your GP will test you for sexually transmitted diseases. They’ll also ask you to tell any sexual partner that you have pelvic inflammatory disease, and ask them to be tested and treated too. This includes any sexual partners you may have had in the last six months. Staff at a sexual health clinic can contact your past partners for you.


What causes PID?

Pelvic inflammatory disease (PID) is caused by an infection. One in four cases of pelvic inflammatory disease in the UK, is due to a sexually transmitted infection (STI), usually either chlamydia or gonorrhoea. Bacteria that are usually found in your vagina or in your cervix can also move up to your womb, fallopian tubes and ovaries and cause pelvic inflammatory disease.

There are some things that increase your chances of developing pelvic inflammatory disease. These include if you have:

  • had an STI or pelvic inflammatory disease before
  • had unprotected sex with multiple partners
  • had unprotected sex with a partner who themselves may have had unprotected sex with multiple partners
  • an intrauterine device (IUD) or coil – but the risk is only for four to six weeks after this has been fitted
  • recently had a termination of pregnancy
  • recently had a miscarriage

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Complications of PID

If pelvic inflammatory disease (PID) isn’t treated or is not treated quickly, it can cause complications. These include the following.

  • An abscess (a collection of pus) can form on your ovary or fallopian tube.
  • Ectopic pregnancy – this is when a fertilised egg implants outside your womb, usually in one of your fallopian tubes. You can find out more about ectopic pregnancy in our FAQ below.
  • Infertility – this can happen because PID can damage your fallopian tubes, and that can make it more difficult to get pregnant. If the condition is severe or you’ve had it a number of times, it’s more likely to affect your fertility.
  • Long-term pain in your pelvis (chronic pelvic pain) can result from PID.

Prevention of PID

You can help to prevent pelvic inflammatory disease (PID) by using barrier methods of contraception, such as a condom. This helps to reduce your chances of getting a sexually transmitted infection (STI). You can also get yourself regularly tested for STIs.


Frequently asked questions

  • No, men don't get pelvic inflammatory disease (PID). But they can pass on a sexually transmitted infection (STI) that can cause the condition in women. Although some men have symptoms of STIs, such as pain when passing urine or discharge from their penis, many don’t. So, it’s important to use barrier contraception (condoms) and if you think you may have an STI, get tested.

  • Ectopic pregnancy is when a fertilised egg implants outside of the womb. This is most likely to happen in your fallopian tubes.

    If you’ve had pelvic inflammatory disease (PID), your fallopian tubes can become damaged and this can make them narrower or block them completely. The fertilised egg can get stuck inside the tube and begin to grow and develop there. This stretches the fallopian tube and eventually it may burst.

    If you could be pregnant and have the following symptoms, get medical help straightaway:

    • bleeding from your vagina
    • pain in your abdomen (tummy)

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Related information

    • Pelvic inflammatory disease. BMJ Best Practice. bestpractice.bmj.com, last reviewed 2 February 2018
    • Female reproductive organ anatomy. Medscape. emedicine.medscape.com, updated 24 September 2018
    • 2018 United Kingdom national guideline for the management of pelvic inflammatory disease. British Association for Sexual Health and HIV. www.bashhguidelines.org, published 2018
    • Pelvic inflammatory disease. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised October 2018
    • Acute pelvic inflammatory disease. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published November 2016
    • Pelvic inflammatory disease. PatientPlus. patient.info/patientplus, last checked 22 October 2014
    • Ectopic pregnancy. BMJ Best Practice. bestpractice.bmj.com, last reviewed October 2018
    • Sexually transmitted infections. PatientPlus. patient.info/patientplus, last checked 2 June 2016
    • Ectopic pregnancy. BMJ Best Practice. bestpractice.bmj.com, last reviewed October 2018
  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, December 2018
    Expert reviewer, Mr Robin Crawford, Consultant Gynaecologist
    Next review due December 2021



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