What is PID?

Pelvic Inflammatory Disease (PID) is a general term that refers to infection of the uterus (womb), fallopian tubes (tubes that are the path of the eggs from the ovaries to the uterus), and other reproductive organs. It is a common and serious complication of some sexually transmitted diseases (STDs), especially chlamydia and gonorrhea. PID can damage the fallopian tubes and tissues in and near the uterus and ovaries. Untreated PID can lead to serious consequences, including infertility, ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere outside of the womb), abscess formation, and chronic pelvic pain.

How common is PID?

Each year in the United States, it is estimated that more than 1 million women experience an episode of acute PID. More than 100,000 women become infertile each year as a result of PID, and many of the ectopic pregnancies that occur every year are due to PID.  Annually, more than 150 women die from PID or its complications.

How do women get PID?

PID occurs when bacteria move upward from a woman’s vagina or cervix (opening to the uterus) into her reproductive organs. Many different organisms can cause PID, but many cases come from gonorrhea and chlamydia. A first episode of PID increases the risk of another because the reproductive organs may be damaged during the first bout of infection.

Sexually active women in their childbearing years are most at risk. Those under age 25 are more likely to develop PID. The more sex partners a woman has the greater her risk of developing PID. Research has shown that douching can negatively affect the vaginal flora (organisms that live in the vagina) and can force bacteria into the upper reproductive organs from the vagina.

What are the symptoms of PID?

Symptoms of PID vary from none to severe. When PID is caused by chlamydia, a woman may have mild symptoms or no symptoms at all while serious damage is being done to her reproductive organs. Because of vague symptoms, PID goes unrecognized by women and their healthcare providers about two-thirds of the time. Women who have symptoms of PID usually have lower abdominal pain. Other signs and symptoms include fever, unusual vaginal discharge that may have a foul odor, painful intercourse, painful urination, irregular menstrual bleeding, and pain in the upper abdomen (rare).

What are the complications of PID?

Early and complete treatment can help prevent complications of PID. Without treatment, PID can cause permanent damage to the reproductive organs. Infection-causing bacteria can silently invade the fallopian tubes, turning normal tissue into scar tissue. This scar tissue blocks the normal movement of eggs into the uterus. If the fallopian tubes are totally blocked by scar tissue, sperm cannot fertilize an egg and the n woman becomes infertile. Infertility also can occur if the fallopian tubes are partially blocked or even slightly damaged. About one in five women with PID becomes infertile, and if a woman has PID multiple times, her chances of becoming infertile increase. A partially blocked or damaged fallopian tube may also cause a fertilized egg to remain in the fallopian tube. If this fertilized egg begins to grow in the tube as if it were in the uterus, it is called an ectopic pregnancy. As it grows, an ectopic pregnancy can rupture the fallopian tube, causing severe pain, internal bleeding, and even death. Scarring in the fallopian tubes and other pelvic structures can also cause chronic (ongoing) pelvic pain that lasts for months or even years. Women who have PID over and over are more likely to suffer infertility, ectopic pregnancy, or chronic pelvic pain.

How is PID diagnosed?

PID is difficult to diagnose because the symptoms are often mild. Many episodes of PID go undetected because the woman or her healthcare provider doesn’t understand how important mild symptoms can be. Because there are no precise tests for PID, a diagnosis is usually based on clinical findings. If symptoms such as lower abdominal pain are present, a healthcare provider should perform an examination to find out the nature and location of the pain and check for fever, abnormal vaginal or cervical discharge, and signs of gonorrhea or chlamydia. If the findings suggest PID, treatment is necessary.

The healthcare provider may also order tests to identify what is causing the infection (chlamydia or gonorrhea, for example) or to tell if it is really PID or another problem with similar symptoms. A pelvic ultrasound is helpful for diagnosing PID. In some cases, a laparoscopy may be necessary to confirm the diagnosis. A laparoscopy is a minor surgical procedure in which a thin, flexible tube with a lighted end is inserted through a small incision in the lower abdomen. This allows the doctor to view the internal pelvic organs.

What is the treatment for PID?

PID can be cured with antibiotics prescribed by a healthcare provider. However, antibiotic treatment does not reverse any damage that has already happened to the reproductive organs. If a woman has pelvic pain and other symptoms of PID, it is critical that she gets care immediately. Prompt antibiotic treatment can prevent severe damage to reproductive organs.

The symptoms may go away before the infection is cured. Even if symptoms go away, the woman should finish taking all of the medicine prescribed. This will help prevent the infection from returning. Women being treated for PID should be re-evaluated by their healthcare provider two to three days after starting treatment to be sure the antibiotics are working to cure the infection.

Hospitalization to treat PID may be recommended if the woman (1) is severely ill (nausea, vomiting, and high fever), (2) is pregnant, (3) needs intravenous antibiotics, or (4) has an abscess in the fallopian tube or ovary. If symptoms continue or if an abscess does not go away, surgery may be needed. Complications of PID, such as chronic pelvic pain and scarring, are difficult to treat, but sometimes they improve with surgery.

How can PID be prevented?

The main preventable cause of PID is an untreated STD (caused by chlamydia or gonorrhea). Women can protect themselves from PID by taking action to prevent STDs or by getting early treatment if they do get an STD.

The surest way to avoid infection with any sexually transmitted disease is to practice sexual abstinence (abstain from any sexual contact) while single. If you marry, select a partner who is not infected with an STD and remain sexually faithful during marriage.

Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of chlamydia and gonorrhea. However, condoms do not provide complete protection from STDs. Infection can occur in both males and females whether or not a condom is used.

If you think you are infected, see a healthcare provider immediately and notify anyone that you have had sex with so that they can also get treatment.

Any genital symptoms such as an unusual sore, discharge with odor, burning during urination or bleeding between menstrual cycles could mean an STD infection. If a woman has any of these symptoms, she should consult a healthcare provider immediately. Treating STDs early can prevent PID.

Women get PID when bacteria move upward from a woman’s vagina or cervix (opening to the uterus) into her reproductive organs. Many different organisms can cause PID, but most cases are from gonorrhea and chlamydia. A first episode of PID increases the risk of another because the reproductive organs may be damaged during the first bout of infection.  Sexually active women in their childbearing years are most at risk. Those under age 25 are more likely to develop PID. The more sex partners a woman has the greater her risk of developing PID.