Pelvic inflammatory disease (PID) is a bacterial infection of a woman’s reproductive organs. Left untreated or treated too late, PID can damage the reproductive organs, which may make it difficult or impossible for a woman to conceive.  PID can also increase the risk of pregnancy complications.

PID can occur in any of the organs in the pelvis. These include the uterus and its linings and walls, the fallopian tubes and the ovaries. Infectious bacteria travel into the body from the vagina and scar the reproductive tissue. Most cases of PID are the result of infection by two sexually transmitted diseases (STDs) – gonorrhea and chlamydia. In some cases, PID may be caused by medical procedures performed on the reproductive organs. It can also develop when bacteria that occurs naturally in the vagina migrates farther inside the body.

Sexually active women under 25 years old are at greatest risk for developing PID because they have an increased chance of developing sexually transmitted diseases. In addition, their stage of physical development makes them more susceptible to infection.

PID is often a “silent” disease, with most women experiencing mild symptoms or no symptoms at all. Even when no symptoms are present, PID infections can cause serious organ damage. When symptoms do occur, they may include abdominal pain, unusual vaginal discharge and fever. Since the same symptoms may occur with other conditions, PID can be difficult to diagnose.

Diagnosis of PID usually begins with a medical history and gynecological examination. Other tests may be performed, including blood tests and vaginal cultures to test for infections (e.g., STDs). In some patients, an ultrasound or laparoscopy may be advised.

Women who seek treatment for PID usually receive antibiotics immediately, even before a diagnosis is confirmed. This is because the importance of avoiding damage to reproductive organs outweighs any risk of waiting to confirm the diagnosis. Antibiotics can cure the infection, but cannot reverse any organ damage caused by PID.

Many cases of PID may be prevented by practicing safe sex and promptly treating any sexually transmitted diseases.

The combination of no symptoms and potential for organ damage make PID a serious health threat, especially for young, sexually active women. Women can use their regular gynecological examinations to ask their physician about their risk factors for PID. Any symptoms or concerns should be immediately reported to a physician, preferably a gynecologist.

Pelvic inflammatory disease (PID) affects the upper reproductive organs of women, including the uterus, ovaries and, most commonly, the fallopian tubes. These organs can become inflamed when bacteria spreads through the cervix (opening that separates the uterus from the vagina) and into the uterus. The bacteria may occur naturally in the vagina or are introduced during sexual intercourse. Unlike infections in other body parts, which are usually caused by one organism, PID infections frequently include multiple bacterial organisms.

Normally, the mucous membrane of the cervix prevents bacteria or other organisms from moving into the uterus. When the cervix is infected or when its mucous membrane is diminished, it can allow bacteria to infect the uterus, fallopian tubes, ovaries or surrounding tissues. The infection may scar or inflame tissues or create a collection of pus called an abscess. PID can take days or months to develop after the initial bacterial infection.

PID is the most common cause of female infertility. During a woman’s monthly cycle, an egg is released by one ovary and travels through the fallopian tube to the uterus. For pregnancy to occur, the egg must be fertilized by sperm, usually in the fallopian tube, and become implanted in the uterus. When PID scars the tissues of any of these organs, the egg may be blocked and cannot be fertilized.

PID is also the most common cause of ectopic pregnancy. Scar tissue can prevent a fertilized egg from moving to the uterus and the egg implants and grows in the fallopian tube instead. Left untreated, the growing embryo can rupture the tube and cause massive abdominal bleeding.

According to the Centers for Disease Control and Prevention, more than 1 million women in the United States are diagnosed annually with PID. More than 80 percent of those cases are caused by sexually transmitted diseases. PID is responsible for 100,000 cases of infertility annually.

The types of pelvic inflammatory disease (PID) are defined by the part of the reproductive tract that becomes inflamed due to infection. These include:

• Salpingitis. Occurs in the fallopian tubes and is the most common form of the disease.
  
  
• Myometritis. Occurs in the uterine wall.
  
  
• Endometritis. Occurs in the endometrium (uterine lining). This should not be confused with endometriosis, an unrelated condition of the uterine lining.
  
  
• Parametritis. Occurs in the uterine serosa (the outer layer of the uterine wall) and the broad ligaments that give support to the uterus and pelvis.
  
  
• Oophoritis. Occurs in one or both ovaries.

Risk factors are any elements that increase the risk of a person developing a disease or condition. However, not everyone with one or more risk factors will develop the disease. It is also possible that the disease will develop in people with no risk factors. Those factors known to increase a woman’s risk of pelvic inflammatory disease (PID) include:

• Age. Younger women (age 15 to 25) are more susceptible to PID because their cervixes are thinner and are more likely to transmit disease. Younger women are also less likely to have certain antibodies that help protect the cervix from infection. Women under age 25 account for most of the PID cases in the United States.
  
  
• Sexual activity. Most cases of PID are caused by bacteria commonly found in two sexually transmitted diseases (STDs). Therefore, conditions that put a woman at risk for STDs (having unprotected sex or multiple male sexual partners) also put her at risk for PID.
  
  
• Medical history. Women who have had a previous occurrence of an STD or PID are at greater risk for PID after further exposure to an additional STD or other bacterial infection of the reproductive organs.
  
  
• Use of douches. Women who use vaginal douches may increase their risk of PID. Douches can force bacteria from the vagina into the upper reproductive organs. Douching also can change the composition of the naturally occurring bacteria in the vagina (vaginal flora) and make it easier for harmful outside bacteria to be introduced farther inside the body.
  
  
• Use of intrauterine devices (IUDs). Women with IUDs are at slightly higher risk for contracting PID, usually shortly after the IUD is inserted. Testing for and possibly treating any STDs before the IUD insertion reduces this risk.
  

  

  
  

• Gynecological events or procedures. Any surgical procedure or condition that involves the reproductive organs can increase the risk for PID. These include endometrial biopsy, dilation and curettage, miscarriage, abortion and childbirth.

PID is extremely rare among women who are not menstruating, either from pregnancy, menopause or amenorrhea. PID is also less likely to occur among women who are not sexually active.

Most cases of PID are caused by one or both of the following STDs:

• Chlamydia. The most common STD in the United States. It often has no visible symptoms, but may cause irregular bleeding, vaginal discharge or pain during sexual intercourse in women. The Centers for Disease Control and Prevention (CDC) estimates that 40 percent of women with untreated chlamydia will develop PID.
  
  
• Gonorrhea. Another common STD that often causes no symptoms in women. When they do occur, symptoms may include vaginal discharge, itching, burning or tenderness. Irregular bleeding, abdominal pain or painful urination may also develop with this STD. Some women with gonorrhea (treated or untreated) will develop PID.

In addition, some PID cases may be caused by normally occurring vaginal bacteria that migrate to the upper tract of the reproductive organs. This bacterial movement may occur if menstrual blood flows backwards from the uterus to the fallopian tube.

Many women with pelvic inflammatory disease (PID) experience no symptoms. Among those women who experience symptoms, the most common include:

• Lower abdominal pain or tenderness during examination
• Tender cervix during pelvic examination
• Unusual or odorous vaginal discharge
• Pain during sexual intercourse (dyspareunia)
• Bleeding between menstrual periods (irregular bleeding)
• Fever
• Nausea and vomiting

Tenderness in the abdomen or cervix particularly during examination are the most common signs of PID. A young, sexually active woman who experiences them will be treated for PID, regardless of the eventual diagnosis. The most common symptoms usually last less than a week and nausea or vomiting typically occurs when the disease is more advanced.

PID symptoms frequently appear shortly after menstruation. The cervix dilates during menstruation, which may allow bacteria to travel to the upper reproductive tract. This is common with PID caused by gonorrhea. PID caused by chlamydia is more likely to have no symptoms or milder symptoms, yet can cause severe inflammation. PID that occurs after insertion of an intrauterine device may be more advanced at the time of diagnosis. In those cases, the early signs and symptoms are frequently mistaken as related to the insertion itself.

It is important to note that all the symptoms listed may be caused by conditions other than PID, including appendicitis, ovarian cysts, adhesions or ectopic pregnancy. Any patient experiencing these symptoms should notify her physician immediately, preferably a gynecologist.

Even without symptoms, PID can permanently damage the reproductive organs. Women have been diagnosed with infertility problems caused by PID (such as tubal scarring) and cannot recall any symptoms that would have indicated an infection.

Physicians use several methods to diagnose pelvic inflammatory disease (PID). A thorough medical history, including a history of sexual partners, begins the process. Physicians then perform a pelvic examination, which includes swabs of the vaginal and cervical areas. Blood and urine tests may also be performed for infections (including sexually transmitted diseases) and pregnancy. However, PID may not produce enough white blood cells characteristic of an infection to be detected with the blood tests.

A pelvic ultrasound is sometimes used to determine the areas that may be affected by PID. This procedure creates a video image using sound waves. During an ultrasound, a small probe is placed on a patient’s abdomen or inside the vagina (transvaginal ultrasound). The probe releases sound waves, which echo as they enter the body’s organs. Ultrasound can be useful in identifying an abscess or enlarged areas, which reflect sound waves differently.

For women with severe symptoms, a physician may conduct a laparoscopic examination. During this procedure, the physician inserts a slender, lighted tube through an incision in the patient’s abdomen and examines the pelvic organs. This procedure provides a view of the patient’s organs that can help the physician diagnose and plan treatments. Additionally, laparoscopy allows physicians to manipulate small instruments through the patient’s incision to perform a biopsy, obtaining tissue for microscopic examination.

These diagnostic methods may rule out other conditions, or, combined with the patient’s symptoms, may indicate PID. Laparoscopy usually confirms the diagnosis but physicians may diagnose PID and begin treatment even without a laparoscopy.

Pelvic inflammatory disease (PID) can be treated with antibiotics. Physicians usually prescribe two antibiotics that fight a broad spectrum of infections. A patient can begin treatment with antibiotics immediately, even before the results of diagnostic tests are known. This is because the value of treating the infection early (and avoiding potential damage to the reproductive system) outweighs the risks of treatment should PID not actually be present. The Centers for Disease Control and Prevention (CDC) advises such aggressive treatment due to the potential consequences of not treating PID.

Patients are usually advised to return to the physician several days after beginning antibiotic treatment to determine if symptoms have improved. If they have not, the physician may recommend laparoscopy to examine the reproductive system for other potential causes of symptoms. Most cases are cured after 10 to 14 days of antibiotic treatment.

Most women can be treated as outpatients with oral or injected antibiotics. Some women need intravenous antibiotics and require hospitalization. This may include women who:

• Are pregnant
• Have immune system deficiencies associated with a chronic illness (e.g., HIV/AIDS)
• Have severe symptoms like nausea and vomiting
• Do not respond after several days of oral antibiotics
• Contract PID after insertion of an intrauterine device

When PID is caused by chlamydia or gonorrhea, a woman’s sexual partners should be informed so they can seek medical treatment. Some severe PID cases may require surgery to drain abscesses caused by the infection.

Women being treated for PID should abstain from sexual activity until the infection is cured and their partners have also been treated for any infection. A woman who continues to be sexually active with a partner who has not been treated for a sexually transmitted disease may be re-infected with the STD.

Although antibiotics can cure the infection, they cannot reverse any damage or scarring that may be caused by PID. Damage to the reproductive organs, especially the fallopian tubes, can limit the ability of an egg to be fertilized or can cause a fertilized egg to implant incorrectly (ectopic pregnancy). A woman who has had PID and wants to become pregnant should consult her gynecologist to determine if she sustained any damage that will affect fertility.

Most cases of pelvic inflammatory disease (PID) are caused by sexually transmitted diseases (STDs). Therefore, methods that prevent STDs also reduce the risk of PID. These include:

• Limiting the number of sexual partners.
  
  
• Knowing the sexual history of partners.
  
  
• Always using latex condoms during sex to minimize the risk of STD transmission. Condoms cannot completely prevent the transmission of disease, but they can greatly reduce the likelihood.
  
  
• Request an STD test from potential sexual partners before having sex.

Some studies indicate that the use of certain birth control pills can help reduce the risk of PID because they thicken the cervical mucus and therefore prevent bacteria from entering the uterus. Other studies indicate that birth control pills may increase the likelihood of PID, especially PID caused by chlamydia.

Other prevention methods include:

• Proper hygiene after urination and bowel movements (wiping from front to back).
  
  
• Prompt treatment for any symptoms.
  
  
• Eliminating or reducing the frequency of douches. Douching can push naturally occurring bacteria from the vagina (where it protects the body) into the upper reproductive organs. There, the bacteria may change, becoming harmful, or make the organs more susceptible to infection.

Women who have had one incidence of PID are more susceptible to another infection. Each incidence of PID increases a woman’s likelihood of infertility and ectopic pregnancy. About half of ectopic pregnancies occur because a fallopian tube has been damaged by PID.

One of the most common causes of PID is also the most common STD in the United States – chlamydia. Because it may occur without any symptoms, the Centers for Disease Control and Prevention recommends annual chlamydia testing for all sexually active women age 25 and younger and for older women at risk for chlamydia (women with multiple sex partners or a new sex partner). Chlamydia tests for women include a vaginal and cervical swab or a urine test. Chlamydia testing for men is also important because men have even fewer symptoms for chlamydia yet can still transmit the disease.

Women are encouraged to discuss their risk factors for PID and sexually transmitted diseases with their physicians, preferably a gynecologist, and have regular gynecological examinations.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about pelvic inflammatory disease (PID):

1. Why do you suspect I have PID?
   
   
2. Which tests will I need to confirm the diagnosis?
   
   
3. Will I need a laparoscopy and if so, will it be performed as an inpatient or outpatient procedure?
   
   
4. How serious is the condition?
   
   
5. Will this affect my ability to conceive or reduce the chances of a healthy pregnancy?
   
   
6. What tests can be performed to determine if PID has affected my fertility?
   
   
7. Which medications will be prescribed for my condition?
   
   
8. What are the side effects of the treatment?
   
   
9. What if I’m allergic to antibiotics?
   
   
10. How long should I avoid sexual activity during or following treatment?
    
    
11. Am I at greater risk for developing PID again in the future?