Pelvic inflammatory disease (PID) is an infection of a woman’s reproductive organs. See a picture of the organs inside the pelvis.
Treating PID right away is important, because PID can cause scar tissue in the pelvic organs and lead to infertility. It can also lead to other problems, such as pelvic pain and tubal (ectopic) pregnancy.
PID is caused by bacteria entering the reproductive organs through the cervix. When the cervix is infected, bacteria from the vagina can more easily get into and infect the uterus and fallopian tubes.
You may be more likely to get PID if you:
At first, PID may not cause any symptoms or may cause only mild symptoms, such as bleeding or discharge from the vagina. Some women don't even know they have it. They only find out later, when they can't get pregnant or they have pelvic pain.
As the infection spreads, the most common symptom is pain in the lower belly. The pain has been described as crampy or as a dull and constant ache. It may be worse during sex, bowel movements, or when you urinate. Some women also have a fever.
Even though PID causes mild or no symptoms, it can still cause serious problems. So you need to understand what puts you at risk for PID or STIs and see your doctor if you have any unusual symptoms.
Your doctor will ask about your lifestyle and symptoms. He or she will examine you and do tests to see if you have PID. The test results may take some time. For this reason, your doctor will treat you for the disease before the test results are ready. Treating PID early is important to prevent problems later on.
Your doctor may test you for the most common causes of PID and may also do blood tests to look for signs of infection. Your doctor may also order an ultrasound to see if there are other possible causes of your symptoms. An ultrasound may also show if there is damage to the fallopian tubes, uterus, or ovaries from PID.
To treat PID, you will need to take antibiotics. Take them as directed. If you don't take all of the medicine, the infection may come back.
If your infection was caused by an STI, your sex partner(s) will also need to be treated so you don't get infected again. Do not have sex until both of you have finished your medicine, and be sure to follow up with your doctor to make certain that the treatment is working.
If you have a very bad case of PID or are pregnant and infected, you may need to stay in the hospital and get antibiotics through a vein (intravenous). Sometimes surgery is needed to drain a pocket of infection, called an abscess.
Your risk of infertility increases each time you have PID, so it is very important to prevent future infections. Using a condom each time you have sex can reduce your chance of getting an STI that could lead to PID.
Frequently Asked Questions
Learning about pelvic inflammatory disease (PID):
Pelvic inflammatory disease (PID) is usually caused by a sexually transmitted infection (STI) that infects the cervix, which connects the upper vagina to the uterus. When the cervix is infected with an STI, it becomes easier for other bacteria present in the vagina to get into and infect the uterus and fallopian tubes. PID can also develop as a result of bacterial vaginosis (BV), which is a drop in the vagina's "good" organisms and an increase in its potentially "bad" organisms. When this happens and the problem organisms spread into the uterus and fallopian tubes, PID can result. (BV is not sexually transmitted.) See a picture of the female pelvic organs.
The most common causes of PID are:
PID caused by chlamydia may have milder symptoms or no symptoms (compared with PID caused by gonorrhea), which can delay diagnosis.
Practicing safe sex by using condoms prevents STIs. This greatly lowers PID risk. For more information, see the Prevention section of this topic.
Women who have an intrauterine device (IUD) inserted for birth control have a higher risk of getting PID in the first month after insertion, especially if bacterial vaginosis or an STI is present at the cervix at the time of insertion. The insertion procedure may transfer bacteria from the vagina or cervix to the uterus. Your risk of infection can be reduced if:
Symptoms of pelvic inflammatory disease (PID) range from none at all to severe.
It's common to think that PID symptoms are a sign of something less serious. Many women who have pelvic organ damage caused by PID report that they've never been diagnosed with PID. This is particularly true of PID that is caused by chlamydia, which may cause no symptoms.
PID symptoms often do not appear until infection and inflammation have spread to the fallopian tubes or the lining of the abdomen (peritoneum). Symptoms of PID tend to be more noticeable during menstrual bleeding and sometimes in the week following.
The main symptom of PID is lower abdominal pain, usually described as crampy or as constant and dull. This pain may get worse during bowel movements, sexual intercourse, or urination. You may also have one or more other symptoms, including:
Be sure to see your doctor when you have any of the above symptoms, because PID and several other conditions with similar symptoms require prompt treatment.
Pelvic inflammatory disease (PID) usually starts with a bacterial infection and inflammation of the cervix (cervicitis). This is usually caused by gonorrhea or chlamydia. PID is also linked to an imbalance of the organisms normally found in the vagina (bacterial vaginosis). The bacteria then spread to other female reproductive organs.
Sometimes PID starts after bacteria are carried beyond the cervix by an invasive procedure. This could be the insertion of an intrauterine device (IUD), a dilation and curettage (D&C), an induced abortion, or a hysterosalpingogram test (which uses a tube to inject dye through the cervix into the uterus and fallopian tubes for X-ray imaging).
In some cases, infection moves into a fallopian tube and ovary. This can form a pocket of pus called a tubo-ovarian abscess. After having this problem, as many as 93% of women cannot become pregnant.1
PID causes inflammation in the uterus and fallopian tubes. In turn, the inflammation can form scar tissue (adhesions) in the abdominal cavity and the reproductive organs. This does not always cause symptoms. The scar tissue can lead to:
PID may also occur inside the abdomen as:
The longer PID treatment is delayed, the more likely you are to have permanent damage. Similarly, each recurrent pelvic infection increases your risks of tubal infertility, chronic pelvic pain, and ectopic pregnancy.
You have an increased risk for developing pelvic inflammatory disease (PID) if you:
Use condoms to avoid exposure to sexually transmitted infections (STIs).
Some gynecological procedures can increase your risk of PID by introducing bacteria into the reproductive tract. Such medical procedures include:
PID is rare in women who are not sexually active, don't have menstrual periods, are pregnant, or have had their uterus or ovaries removed during a hysterectomy.
Pelvic inflammatory disease (PID) symptoms often don't develop until inflammation or scar tissue (adhesions) develop. Scar tissue can cause ongoing (chronic) pelvic pain, infertility, and ectopic pregnancy. For this reason, immediate medical attention is necessary to treat possible PID symptoms or complications.
Call your doctor immediately if you have abdominal pain and any of the following:
Call your doctor to find out when an evaluation is needed if you:
If you have not been diagnosed with PID but you have symptoms that concern you, see the following topics:
Any symptoms or other changes that suggest PID or a sexually transmitted infection (STI) should be evaluated by a doctor as soon as possible. Watchful waiting is not appropriate.
To prevent reinfection from an STI, be sure that anyone you have had sexual contact with has been tested, treated if necessary, and uses condoms when you resume sexual relations.
The following health professionals can diagnose and treat pelvic inflammatory disease (PID):
Complications of PID are usually treated by a gynecologist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Pelvic inflammatory disease (PID) is often difficult to diagnose because:
Guidelines for PID care urge prompt treatment, even when only the minimal clinical criteria for the diagnosis of PID are met and even before laboratory test results are available.3 This means that you may be given antibiotic treatment right away, based on your risk factors, medical history, and physical exam. Delaying treatment for several days could increase your risks of fallopian tube damage and infertility.
To learn about your medical history, your doctor may ask you the following questions.
After your medical history is taken, the initial exam for PID will include a pelvic exam.
Other tests may be done to confirm the diagnosis of PID, to rule out other problems (such as appendicitis), or to find out whether the infection has spread. These tests include:
Laparoscopy and ultrasound are considered the best procedures for diagnosing PID. But these tests are not done unless the diagnosis is in doubt or the results from the procedure will change the method used for treatment.
There is no standard screening for pelvic inflammatory disease (PID) at this time. But routine annual screening of young, sexually active women for chlamydia is thought to reduce the number of cases of PID and is recommended by experts.
Be sure to have a gynecologic exam promptly whenever you notice pelvic infection symptoms or pelvic pain. If you have been exposed to an STI, see your doctor for testing right away. If you are diagnosed with an STI, especially gonorrhea or chlamydia, you will be treated and evaluated for PID. Your partner(s) must also have treatment for the STI.
Women who have recently been infected with the human immunodeficiency virus (HIV) also should be checked for other STIs.
Untreated pelvic inflammatory disease (PID) can produce scar tissue (adhesions) that can cause ongoing (chronic) pelvic pain, ectopic pregnancy, and infertility. This is why PID must be treated right away, even if you have only one or two signs of PID.3 This means that you may be given antibiotic treatment before lab results have come back, based on your medical history and a physical exam. This is because waiting several days to treat you could raise your risks of fallopian tube damage and infertility.4
Antibiotic treatment for pelvic inflammatory disease (PID) usually takes 14 days. But the number of days you continue to take antibiotics depends on your infection and the type of antibiotic medicine. Your partner will also need treatment. Although you may feel better before the 2 weeks are up, be sure to finish taking the medicine. If you don't, the infection may return. You may also be able to use a nonsteroidal anti-inflammatory drug (NSAID) to relieve PID pain or discomfort.
Follow-up evaluations are important for making sure that treatment is working. Close monitoring may be able to prevent complications, such as chronic pelvic pain and infertility. Your doctor will want to check you 2 to 3 days after you've started treatment, then 7 to 10 days later. You will also have a checkup 4 to 6 weeks after treatment has ended, to monitor your recovery.
If you have an intrauterine device (IUD) for birth control in place and you develop PID, your doctor will give you antibiotics to treat the infection. You may not need to have the IUD removed, depending on how severe the infection is.3
Your doctor will recommend hospitalization if you are pregnant, are very ill, are vomiting, may need surgery for a tubo-ovarian abscess or ectopic pregnancy (which can result from PID), or aren't able to treat yourself at home.
Anyone with whom you have had sexual contact in the last 60 days should be evaluated and treated for sexually transmitted infections (STIs) to prevent reinfection and passing infection on to someone else. Treatment for gonorrhea or chlamydia is not the same as treatment for PID. Different antibiotics are sometimes prescribed for PID, and they are taken for a longer period of time. Your partner will probably also need to take antibiotics.
To prevent reinfection, do not have sex until both you and your sex partner(s) have completed antibiotic treatment.
If initial antibiotic treatment cures the infection that caused pelvic inflammatory disease (PID), you will not need ongoing treatment. But it is important to make sure the infection is cured by following up with your doctor.
Avoiding a recurrent pelvic infection, particularly involving a sexually transmitted infection (STI), is the key to preventing another episode of PID. Regular condom use reduces the risk of recurrent PID. (Having repeat episodes of PID increases your risks of tubal infertility, chronic pelvic pain, and ectopic pregnancy. For more information, see the Prevention section of this topic.)
Most cases of PID are cured with antibiotic therapy. Surgery is not usually necessary to treat PID. But surgery may be needed to:
Exploratory surgery is sometimes used when a diagnosis is still unclear after other tests are done or when antibiotic treatment is not working. Diagnostic laparoscopy (which involves using a small lighted viewing instrument) is usually used.
To avoid reinfection, it is critically important that you and your sex partner(s) be treated.
After having PID, it's important that you have any further pelvic symptoms checked promptly. Your doctor will want to examine you for signs of another infection, possible pelvic organ damage (adhesions), and other possible causes of your symptoms.
If you have had chlamydia (a common cause of PID) one time in the past, you might now be more sensitive to this bacteria. A second chlamydia infection can cause more irritation and pelvic organ damage that is worse than before. For this reason, it's very important that you use condoms to avoid being exposed to STIs. After having had PID, using a condom every time you have sex lowers your risk of recurrent PID and ongoing (chronic) pelvic pain.
Preventing an STI is easier than treating an infection after it occurs. Abstaining from sexual contact is the only certain way to avoid exposure to STIs. Consistent condom use will greatly reduce your risk of an STI infection that can lead to PID. Even if you are using another birth control method to prevent pregnancy, use condoms to reduce infection risk.
Use a condom every time you have sex. This lowers your risk of getting an STI or PID. You must put on a condom before beginning any sexual contact. Use condoms with a new partner until you are certain he or she does not have an STI.
You can use a male or female condom. A female condom is a good option for a woman whose partner does not have or will not use a male condom. For information about male and female condoms, see how to use a condom.
Avoid douching, which increases your risk for vaginal and pelvic infections.
Pelvic inflammatory disease (PID) and sexually transmitted infections (STIs) require prompt medical treatment. If you have any unusual pelvic symptoms or pain, see your doctor without delay, even if your symptoms don't seem serious.
After you have started medical treatment for PID, your doctor will give you specific instructions for home care. Be sure to follow those instructions and keep all follow-up appointments.
Use the following home treatment measures to support your recovery.
The treatment of choice for pelvic inflammatory disease (PID) is usually 2 weeks of a broad-spectrum antibiotic, which kills more than one type of bacteria. But the number of days you continue to take antibiotics depends on your infection and the type of antibiotic medicine. If taken properly, antibiotics will destroy the bacteria causing PID. Prompt antibiotic treatment may prevent complications from PID or reduce their severity.
Treatment is started even when you meet only the minimum criteria for PID with or without other symptoms. Treatment for gonorrhea or chlamydia is not the same as treatment for PID. Different antibiotics are sometimes used for PID, and they are taken for a longer period of time.
To prevent reinfection, sex partners with or without symptoms must also be tested for sexually transmitted infections (STIs) (particularly gonorrhea and chlamydia). Any infection must be immediately treated.
It sometimes takes more than one course of medicine to cure PID. Sometimes bacteria can become resistant to an antibiotic, meaning that the antibiotic is no longer effective against the bacteria. This makes it necessary to try another type of antibiotic.
Reinfection from an untreated sex partner also requires another round of antibiotic treatment.
The treatment for PID usually takes 2 weeks. But the number of days you continue to take antibiotics depends on your infection and the type of antibiotic medicine. It is very important that you take all the medicine, or the infection can come back.
Surgery is not usually done to treat pelvic inflammatory disease (PID) unless it is needed to:
Surgery is sometimes used when a diagnosis is still unclear after other tests are done or when antibiotic treatment is not working. Diagnostic laparoscopy is usually used.
Procedures that may be used to diagnose and treat the complications of pelvic inflammatory disease (PID) include:
The need for surgical treatment of PID has decreased over the past several years because of earlier diagnosis and better antibiotic treatment.
Laparoscopy or laparotomy may be done for diagnosis of pelvic symptoms, and treatment can be done at the same time. Laparoscopy is used more often. Laparotomy typically requires a longer recovery period.
There is no other treatment available for pelvic inflammatory disease at this time.
|American Congress of Obstetricians and Gynecologists (ACOG)|
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American Congress of Obstetricians and Gynecologists (ACOG) is a nonprofit organization of professionals who provide health care for women, including teens. The ACOG Resource Center publishes manuals and patient education materials. The Web publications section of the site has patient education pamphlets on many women's health topics, including reproductive health, breast-feeding, violence, and quitting smoking.
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The mission of the American Social Health Association is to improve the health of individuals, families, and communities, with a focus on preventing sexually transmitted diseases and their harmful consequences.
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The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention is a branch of the Centers for Disease Control and Prevention (CDC). Their Web site provides information and updates on sexually transmitted diseases (STDs), human immunodeficiency virus (HIV), and tuberculosis (TB). You can also find fact sheets on these health topics.
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The National Institute of Allergy and Infectious Diseases conducts research and provides consumer information on infectious and immune-system-related diseases.
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The hotline is available Monday through Friday, 8 a.m. to 11 p.m., Eastern standard time. It provides education, research, and public policy information on sexually transmitted diseases (STDs), including minor and major STD infections. Referrals, information on prevention, and free pamphlets are available.
- Soper DE (2010). Infections of the female pelvis. In Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases, 7th ed., vol. 1, pp. 1511–1519. Philadelphia: Churchill Livingstone Elsevier.
- Paavonen J, et al. (2008). Pelvic inflammatory disease. In KK Holmes et al., eds., Sexually Transmitted Diseases, 4th ed., pp. 1017–1050. New York: McGraw-Hill.
- American Academy of Pediatrics (2009). Pelvic inflammatory disease. In LK Pickering et al., eds., Red Book: 2009 Report of the Committee on Infectious Diseases, 28th ed., pp. 499–504. Elk Grove Village, IL: American Academy of Pediatrics.
- Centers for Disease Control and Prevention (2006, updated 2007). Pelvic inflammatory disease section of Sexually transmitted diseases treatment guidelines, 2006. MMWR, 55(RR-11): 56–61.
- American College of Obstetricians and Gynecologists (2004, reaffirmed 2008). Chronic pelvic pain. ACOG Practice Bulletin No. 51. Obstetrics and Gynecology, 103(3): 589–605.
Other Works Consulted
- Ross J (2007). PID, search date May 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||Kirtly Jones, MD - Obstetrics and Gynecology|
|Last Revised||November 23, 2010|
Last Revised: November 23, 2010
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