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Pelvic inflammatory disease


Expert reviewer, Mr Raj Mathur, Consultant Gynaecologist
Next review due September 2019

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.

PID is usually caused by a sexually transmitted infection (STI), such as chlamydia or gonorrhoea. The treatment for PID usually works well, but if it’s a severe infection, or if it’s not treated, you could develop fertility problems.

An image showing the location of the womb and surrounding structures

Symptoms of PID

The symptoms of PID can be mild and some women don’t have any symptoms at all. This means you might not realise you have the condition, and therefore you may not get the right treatment.

Symptoms include:

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

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

Diagnosis of PID

Your GP will ask about any symptoms and your medical and sexual history. They will also examine you, including doing a vaginal examination to check for signs of infection. Your GP will 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.

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 is a chance you may be pregnant – the symptoms of PID are similar to those of an ectopic pregnancy (when a fertilised egg implants outside of the womb)

If your symptoms are severe, or your GP isn’t sure if you have PID, he or she may ask you to go to hospital for more urgent treatment. They may also ask you to see a specialist for further tests including:

  • 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

Treatment of PID

Medicines

If your GP thinks you have PID, you’ll be asked to take two different types of antibiotics. You will usually be asked to start taking them straightaway, rather than waiting for the results of tests. 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 and it’s important to finish all of them as prescribed, to prevent any long-term problems. You should finish the antibiotics before you have sex again, or use a barrier method of protection, such as a condom. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or GP for advice.

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

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 don’t get better, or if you're pregnant, you may need to have antibiotics through a drip. If this is the case, you will usually need to go to hospital.

Surgery

If your condition is severe or the antibiotics delivered through a drip do not work, you may need to have surgery. The aim of this is to drain fluids from the affected area.

Treating sexual partners

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


Causes of PID

PID is caused by a bacterial infection. This can be a sexually transmitted infection (STI), usually either chlamydia or gonorrhoea. Bacteria that are usually found in your vagina or on your cervix can also move up to your womb, fallopian tubes and ovaries.

There are some things that increase your chances of developing PID. These include:

  • have had an STI or PID before
  • have had unprotected sex with multiple partners
  • have had unprotected sex with a partner who themselves may have had unprotected sex with multiple partners
  • have an intrauterine device (IUD) fitted
  • have recently had a termination of pregnancy

Complications of PID

If it’s not treated, or not treated quickly, PID can cause complications. These include the following.

  • Infertility. PID can damage your fallopian tubes, and that can make it more difficult to get pregnant. If you have severe PID, or have had it a number of times, you’re more likely to become infertile.
  • Ectopic pregnancy. This is when a fertilised egg implants outside your womb, usually in one of the fallopian tubes. Sometimes an ectopic pregnancy can cause the fallopian tube to burst, which can be life-threatening. You can find out more about ectopic pregnancy in the Question and Answer below.
  • Long-term pain in your pelvis.
  • An abscess (a collection of pus) on your ovary or fallopian tube.

Prevention of PID

You can help to prevent PID by using barrier methods of contraception, such as a condom. This helps to reduce your chances of getting a sexually transmitted infection. You can also get yourself regularly tested for sexually transmitted diseases and have fewer sexual partners.


Frequently asked questions

  • No, men don't get PID. However, they can pass on a sexually transmitted infection (STI) that can cause PID in women. Although some men have symptoms of STIs, such as pain when passing urine or discharge from the penis, many don’t. So, it’s important to use barrier contraception (condoms) and if you think you may have an STI, to 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 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 you have the symptoms below, you should 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 updated April 2015
    • Pelvic inflammatory disease. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2015
    • Pelvic inflammatory disease. PatientPlus. patient.info/patientplus, last checked October 2014
    • Acute pelvic inflammatory disease: tests and treatment. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published August 2010
    • Pelvic inflammatory disease. Medscape. emedicine.medscape.com, September 2015
    • Ectopic pregnancy. BMJ Best Practice. bestpractice.bmj.com, last updated August 2015
    • Sexually transmitted infections. World Health Organisation. www.who.int, updated December 2015
    • Ectopic pregnancy. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised July 2013
    • Ectopic pregnancy. PatientPlus. patient.info/patientplus, last checked December 2015
    • Ectopic pregnancy. BMJ Best Practice. bestpractice.bmj.com, last updated August 2015
    • Map of Medicine. Pelvic inflammatory disease. International View. London: Map of Medicine; 2014 (Issue 2)
  • Reviewed by Sarah Smith, Freelance Health Editor, September 2016
    Expert reviewer, Mr Raj Mathur, Consultant Gynaecologist
    Next review due September 2019



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