The leaflet is detailed below, or you can download the 'Pelvic Inflammatory Disease' leaflet in PDF.
What is Pelvic Inflammatory Disease
Pelvic Inflammatory disease (PID) is a condition that involves infection and inflammation of the upper female genital tract, including the womb (uterus), fallopian tubes, and ovaries. Any or all of these parts may be affected. PID is usually caused by an infection in the vagina and the neck of the womb (cervix) passing to the internal reproductive organs.
As the infection develops within the pelvis and becomes more widespread, PID may be diagnosed. If the infection remains untreated, the inflammation can eventually spread to the whole of the fallopian tubes. This can sometimes cause abscesses (pockets of infected fluid) to develop. The infection can then spread through the tubes and into the ovaries. The outer surfaces of the tubes may also start to stick to other organs such as the bladder and bowel.
About 1 in 50 women a year develop PID. It most commonly develops in sexually active women who are between 15-24 years of age. However, this figure may be an underestimate because many women with PID experience few or no symptoms.
When Diagnosed Early, PID Can Be Successfully Treated With Antibiotics and Rest.
If PID goes untreated in can lead to serious long-term complications; including chronic pelvic pain, ectopic pregnancy (a pregnancy that occurs outside the womb), or infertility. Unfortunately many women do not know that they have PID until permanent internal damage has been caused. If you have PID, further infection is common. After a first episode of PID, 20% of women have further episodes, mostly within two years.
The symptoms of pelvic inflammatory disease (PID) are not always very specific, meaning that the condition can be difficult to diagnose. Symptoms may appear suddenly, they may come and go or they may be constant:
- Thick or unusual vaginal discharge
- Bleeding between periods
- Fever and vomiting
- Pain in the rectum (back passage)
- Discomfort or pain during sexual intercourse
- Ache or pain in the lower abdomen
You may have PID without being aware of it. Sometime s, there are no symptoms at all or, if there are, they may not be obvious – for example, you may only experience mild discomfort.
PID can be caused by many types of bacterial infection, but the majority of cases occur as a result of a sexually transmitted infection (STI), most commonly Chlamydia or Gonorrhoea.
PID is often caused by more than one type of bacteria, and it can sometimes be difficult to pinpoint the bacterium responsible. A combination of antibiotics may therefore be prescribed to treat the condition so that a variety of bacteria can be treated.
Sometimes, the infection that leads to PID may start as a result of bacteria introduced into the vagina or upper genital tract during childbirth, an abortion or miscarriage, or a procedure to take a sample of tissue from the inside of the uterus for laboratory testing (endometrial biopsy).
In rare cases, PID can develop as a result of appendicitis, treatment following an abnormal cervical smear, or after the fitting of an IUD (intrauterine device).
In some cases, the cause of the infection that leads to PID is unknown. Such cases may be the result of normally harmless bacteria found in the vagina. These bacteria can sometimes get past the cervix and into the reproductive organs. Although harmless to the vagina, this type of bacteria can cause infection in other parts of the body. Infection in this way is most likely to happen when there has been damage to the cervix or if you have had PID before.
Having multiple sexual partners is one of the main risk factors for developing PID. The more partners you have penetrative sex with, the more likely you are to be exposed to bacteria that can cause PID, particularly if you are not using barrier contraception (condoms).
There is no single test available for diagnosing PID. PID is diagnosed by the symptoms and by a gynaecological examination. This will usually involve a specimen being taken from inside the vagina and cervix, using a cotton wool swab. Examining the specimen in the laboratory will reveal the type of bacteria that is causing the infection.
Because PID is difficult to diagnose by the symptoms alone, you may also have a blood test, or an ultrasound scan.
In some cases, a laparoscopy may be used to diagnose PID. A laparoscopy is a minor surgical procedure where two small cuts are made in the abdomen. A thin telescope is inserted so that the internal organs can be seen, and, if necessary, take tissue samples (request ‘Laparoscopy’ Leaflet for more information).
If diagnosed at an early stage, pelvic inflammatory disease (PID) can be treated quickly and efficiently. However, if left untreated, it can lead to more serious, long-term complications (See the ‘Complications’ section). Treatment involves:
A combination of at least two antibiotics is usually prescribed to treat PID. This is because PID often involves several different types of bacteria. Quick and efficient treatment of PID is essential for minimising the risk of infertility.
Antibiotics that are commonly prescribed to treat PID include Ofloxacin, Metronidazole and Doxycycline. You will usually have to take the antibiotics for 14 days. It is very important that you complete the entire course of antibiotics; otherwise the treatment may not be effective. You partner may also need to be tests and treated with antibiotics.
In particularly severe cases of PID, you may have to be admitted to hospital where you will receive antibiotics intravenously (through a drip in your arm),
The bacteria that cause PID can leave scar tissue and collections of infected fluid (abscesses) on the lining of the fallopian tubes. This makes it very hard for an egg to pass along it. The longer PID is left untreated, the more likely scarring will occur. Prompt treatment is essential for minimising the risk of damage to the fallopian tubes and other reproductive organs. Studies suggest that even delaying treatment by a few days can increase the risk of impaired fertility. Sometimes, blocked or damaged tubes can be repairs with surgery, such as a laparoscopy, which can help remove the lesions on the living of the tubes. However the results are mixed and it can sometimes cause further scarring.
A more radical form of surgery is a salpingectomy. This involves the removal of one or both of the fallopian tubes to help stop the spread of further infection. This is only to be considered as a last resort, as the rem0oval of both fallopian tubes will mean you will no longer be able to conceive naturally.
In the most serious cases of PID, it may be necessary to perform surgery through an abdominal incision (laparotomy) to drain abscesses. In this situation a large drain may be inserted into the abscess to allow it to drain. This would then be removed at a later date.
Avoid Sexual Intercourse
While you are receiving treatment for PID, you should avoid having sexual intercourse because it can interrupt the healing process. It is also important that any partners that you have had sexual contact with in the six months before your first symptoms are tested and treated to stop the infection recurring. If you have not had a sexual partner is the last six months, then you should contact your most recent partner.
Recurrent Pelvic Inflammatory Disease
Recurrent PID is where a woman develops PID on a recurring basis. The more often a woman gets PID, the more likely she is to get it in the future. The condition can recur if the initial infection is not entirely cured or because a sexual partner has not been tested and treated. If an initial case of PID damages the cervix, this can make it easier for bacteria to move into the reproductive organs in the future, making it more likely that the condition will develop again.
Sometimes PID can cause abscesses on the lips to the entrance of the vagina and on the lining of the fallopian tubes. An abscess is a collection of infected fluid. It can sometimes be treated with antibiotics. If an abscess does not respond to antibiotics, you may require surgery. It is important that abscesses are either treated or removed, as an abscess which bursts can be potentially life-threatening.
The word ectopic means in the wrong place. In a normal pregnancy, the fertilised egg implants in the womb lining. An ectopic pregnancy is one which occurs outside the womb. Over 95% of ectopic pregnancies occur in the fallopian tube. If PID develops in the fallopian tubes, it can scan the lining of the tubes making it more difficult for eggs to pass through. If a fertilised egg gets stuck and begins to grow inside the tube, it can cause the tube to burst, which can sometimes lead to severe internal bleeding. Ectopic pregnancy is a potentially fatal condition.
It is estimated that 20% of women become infertile as a result of PID. This means they are unable to conceive (get pregnant) naturally. PID can make a woman infertile by scarring the fallopian tubes so severely that it makes it virtually impossible for the egg to travel down into the uterus (womb). Delaying treatment for PID can dramatically increase your chances of becoming infertile.
The most effective way to prevent Pelvic Inflammatory Disease (PID) is to protect yourself from sexually transmitted infections (STIs). This means using a condom, femidom or cervical cap. It is also important to get regular sexual health check-ups.
You can get a check-up easily at your local sexual health clinic. You can find your nearest clinic by visiting the Family Planning Association website (www.fpa.org.uk) which allows you to search for your local clinic using your postcode.
You should also have a sexual health check if you have had sexual contact with someone who you think may have been infected with either an STI or PID.
Royal College of Obstetricians and Gynaecologists (2003) Green top Guidelines No 32: Management of acute PID.