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Pelvic inflammatory disease

Expert reviewer, Dr Madhavi Vellayan, Consultant Gynaecologist
Next review due May 2024

Pelvic inflammatory disease (PID) is an infection of your upper reproductive organs. They include your womb (uterus), ovaries and fallopian tubes.

An image showing the location of the womb and surrounding structures

About pelvic inflammatory disease

Pelvic inflammatory disease is often caused by a sexually transmitted infection (STI) such as chlamydia or gonorrhoea. It doesn’t always cause symptoms, so some people don’t realise they have it.

Pelvic inflammatory disease is usually treated with antibiotics. If the infection is very bad or isn’t being treated, you could get long-term pain in your pelvis or fertility problems.

Symptoms of PID

The symptoms of pelvic inflammatory disease (PID) can be very mild or you may not have any symptoms at all.

If you do get symptoms, these may include:

  • a dull, cramping or aching pain in your lower tummy – this might be on one or both sides, or just on the upper right side
  • an unusual vaginal discharge – this may be smelly
  • bleeding 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

These symptoms can be caused by other things, such as irritable bowel syndrome or cystitis. But you should get them checked out by your GP or your local sexual health clinic. If you have pelvic inflammatory disease, it’s important to start treatment as soon as possible, so you’re less likely to get complications.

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Diagnosis of PID

Your GP will ask about your symptoms and your medical and sexual history. They’ll also examine you. You’ll have a vaginal examination to check for signs of an 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 get tested so you can get the treatment you may need.

  • a blood test to check for infection
  • a urine test for chlamydia
  • a urine test to rule out a urine infection
  • a pregnancy test if you could be pregnant – the symptoms of PID are similar to those of an ectopic pregnancy

If your symptoms are very bad, your GP may 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 more tests. These tests may include:

  • a transvaginal ultrasound scan, which creates a picture of the inside of your pelvis
  • a laparoscopy, which is a keyhole procedure to look at your fallopian tubes, ovaries and womb
  • some more blood tests
  • an MRI or CT scan

Treatment of PID

Self-help

If you have pelvic inflammatory disease (PID), it’s important to see your GP, who will prescribe antibiotics (see below). You can’t treat yourself.

If your symptoms are very bad, you should get plenty of rest until you feel better. If you’re in pain, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Your GP may prescribe you some stronger painkillers. Always read the patient information that comes with your medicine. If you have any questions, ask your pharmacist or GP for advice.

Antibiotics

Pelvic inflammatory disease (PID) treatment involves taking two or more different types of antibiotics. You’ll usually need to start taking antibiotics straightaway, rather than wait for the results of the 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 might prescribe antibiotic tablets. You’ll usually need to take the antibiotic tablets for 14 days. It’s important to finish the whole course of antibiotics, even if you feel better, to make sure the infection clears up. Sometimes, your GP might also give you an antibiotic injection.

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 don’t get better or your symptoms get worse after you’ve been taking antibiotics for two to three days, speak to your GP. You may need to have antibiotics through a drip. You’ll usually need to go to hospital for this. If you have an intrauterine device (IUD) and antibiotics aren’t helping, your GP may suggest you have the IUD taken out.

If you’re pregnant, you’ll need to go to the hospital for antibiotics through a drip as well.

Surgery

If you have a very bad infection, or antibiotics through a drip aren’t working, you may need to have some fluid drained from the affected area. You may also need to have some damaged tissue taken away from inside your uterus. You may need:

  • a laparoscopy – this involves putting a tube with a camera into your tummy
  • the infected fluid drained with a needle – your surgeon will use an ultrasound scan to guide them to the right spot

Treating sexual partners

If you have pelvic inflammatory disease, your GP will test you for sexually transmitted infections (STIs), such as chlamydia and gonorrhoea. They’ll also ask you to tell any sexual partner that you have pelvic inflammatory disease. You’ll need to ask any sexual partner to get tested and treated for these infections 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 almost always caused by a sexually transmitted infection (STI). The most common infections causing it are chlamydia or gonorrhoea. When you have an infection, bacteria in your vagina or cervix can move up to your womb, fallopian tubes and ovaries. This can cause pelvic inflammatory disease.

You may be more likely to get pelvic inflammatory disease if you have:

  • had a STI or pelvic inflammatory disease before
  • had unprotected sex with several partners
  • had a new sexual partner (in the last three months)
  • had unprotected sex with a partner who may have had unprotected sex with several other partners
  • had an intrauterine device (IUD) or coil fitted in the last 20 days
  • recently had an abortion (termination of pregnancy)

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. To find out more, see our FAQ Why is an ectopic pregnancy more likely if I have PID?
  • Infertility. If PID damages your fallopian tubes, you may find it harder to get pregnant. PID is more likely to affect your fertility if it’s very bad or you’ve had it a number of times.
  • Long-term pain in your pelvis (chronic pelvic pain). This can be caused by PID that damages your fallopian tubes.

Prevention of PID

To prevent pelvic inflammatory disease (PID), you need to avoid getting a sexually transmitted infection (STI). You should practise safe sex, using barrier methods of contraception, such as a condom.

  • If your sexual partner is diagnosed with a STI or pelvic inflammatory disease, you should get tested (and treated, if necessary) too.
  • Avoid having sex with your partner until you’ve both finished your treatment for pelvic inflammatory disease or any STI.
  • Get tested for common STIs, such as chlamydia.
  • If you’re taking antibiotics for pelvic inflammatory disease, make sure you finish the full course.

Frequently asked questions

  • Pelvic inflammatory disease is mainly caused by a sexually transmitted infection (STI). Anyone can pass on the infection. So, it’s important to use barrier contraception (such as condoms) to prevent passing on STIs. Some people get symptoms of STIs, such as pain when peeing or discharge from their penis. But many don’t. So, if you think you could have caught an STI, get yourself tested.

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

    If you’ve had pelvic inflammatory disease (PID), your fallopian tubes can get damaged. 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, which may eventually bleed and burst.

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

    • bleeding from your vagina
    • pain in your tummy


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Related information

    • Pelvic inflammatory disease. BMJ Best Practice. bestpractice.bmj.com, last updated February 2021
    • Pelvic inflammatory disease. Patient. patient.info, last reviewed October 2014
    • United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease (2019 Interim Update). British Association for Sexual Health and HIV (BASHH). www.bashhguidelines.org, published 2019
    • Pelvic inflammatory disease. Medscape. emedicine.medscape.com, updated May 2019
    • Pelvic inflammatory disease. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2019
    • Gynaecological history and examination. Patient. patient.info, last reviewed June 2015
    • Acute pelvic inflammatory disease. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published November 2016
    • Gynecologic laparoscopy. Indications. Medscape. emedicine.medscape.com, updated September 2018
    • Ectopic pregnancy. Summary. BMJ Best Practice. bestpractice.bmj.com, last reviewed February 2021
    • Sexually transmitted infections. Patient. patient.info, last reviewed June 2016
  • Reviewed by Victoria Goldman, Freelance Health Editor and Abbey Stanford, Specialist Health Editor, Bupa Health Content Team
    Expert reviewer, Dr Madhavi Vellayan, Consultant Gynaecologist
    Next review due May 2024

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