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Pelvic inflammatory disease (PID)

Definition

Pelvic inflammatory disease (PID) is an infection of a woman's womb (uterus), ovaries, or fallopian tubes.

Alternative Names

PID; Oophoritis; Salpingitis; Salpingo - oophoritis; Salpingo - peritonitis

Causes

PID is an infection caused by bacteria. When bacteria from the vagina or cervix travel to your womb, fallopian tubes, or ovaries, they can cause an infection.

Most of the time, PID is caused by bacteria from chlamydia and gonorrhea. These are sexually transmitted infections (STIs). Having unprotected sex with someone who has an STI can cause PID.

Bacteria normally found in the cervix can also travel into the uterus and fallopian tubes during a medical procedure such as:

In the United States, nearly 1 million women have PID each year. About 1 in 8 sexually active girls will have PID before age 20.

You are more likely to get PID if:

  • You have a sex partner with gonorrhea or chlamydia.
  • You have sex with many different people.
  • You have had an STI in the past.
  • You have recently had PID.
  • You have contracted gonorrhea or chlamydia and have an IUD.
  • You have had sex before age 20.

Symptoms

Common symptoms of PID include:

  • Fever
  • Pain or tenderness in the pelvis, lower belly, or lower back
  • Fluid from your vagina that has an unusual color, texture, or smell

Other symptoms that may occur with PID:

  • Bleeding after intercourse
  • Chills
  • Being very tired
  • Pain when you urinate
  • Having to urinate often
  • Period cramps that hurt more than usual or last longer than usual
  • Unusual bleeding or spotting during your period
  • Not feeling hungry
  • Nausea and vomiting
  • Skipping your period
  • Pain when you have intercourse

You can have PID and not have any severe symptoms. For example, chlamydia can cause PID with no symptoms. Women who have an ectopic pregnancy or who are infertile often have PID caused by chlamydia. An ectopic pregnancy is when an egg grows outside of the uterus. It puts the mother's life in danger.

Exams and Tests

Your health care provider may do a pelvic exam to look for:

  • Bleeding from your cervix. The cervix is the opening to your uterus.
  • Fluid coming out of your cervix.
  • Pain when your cervix is touched.
  • Tenderness in your uterus, tubes, or ovaries.

You may have lab tests to check for signs of body-wide infection:

Other tests include:

  • A swab taken of your vagina or cervix. This sample will be checked for gonorrhea, chlamydia, or other causes of PID.
  • Pelvic ultrasound or CT scan to see what else may be causing your symptoms. Appendicitis or pockets of infection around your tubes and ovaries, called tubo-ovarian abscess (TOA), may cause similar symptoms.
  • Pregnancy test.

Treatment

Your provider will often have you start taking antibiotics while waiting for your test results.

If you have mild PID:

  • Your provider will give you a shot containing an antibiotic.
  • You will be sent home with antibiotic pills to take for up to 2 weeks.
  • You will need to follow-up closely with your provider.

If you have more severe PID:

  • You may need to stay in the hospital.
  • You may be given antibiotics through a vein (IV).
  • Later, you may be given antibiotic pills to take by mouth.

There are many different antibiotics that can treat PID. Some are safe for pregnant women. Which type you take depends on the cause of the infection. You may receive a different treatment if you have gonorrhea or chlamydia.

If your PID is caused by an STI like gonorrhea or chlamydia, your sexual partner must be treated as well.

  • If you have more than one sexual partner, they must all be treated.
  • If your partner is not treated, he or she can infect you again, or can infect other people in the future.
  • Both you and your partner must finish taking all of the prescribed antibiotics.
  • Use condoms until you both have finished taking antibiotics.

Possible Complications

PID infections can cause scarring of the pelvic organs. This can lead to:

If you have a serious infection that does not improve with antibiotics, you may need surgery.

When to Contact a Medical Professional

Call your provider if:

  • You have symptoms of PID.
  • You think you have been exposed to an STI.
  • Treatment for a current STI does not seem to be working.

Prevention

Get prompt treatment for STIs.

You can help prevent PID by practicing safer sex.

  • The only absolute way to prevent an STI is to not have sex (abstinence).
  • You can reduce your risk by having a sexual relationship with only one person. This is called being monogamous.
  • Your risk will also be reduced if you and your sexual partners get tested for STIs before starting a sexual relationship.
  • Using a condom every time you have sex also reduces your risk.

Here is how you can reduce your risk of PID:

  • Get regular STI screening tests.
  • If you are a new couple, get tested before starting to have sex. Testing can detect infections that are not causing symptoms.
  • If you are a sexually active woman age 24 or younger, get screened each year for chlamydia and gonorrhea.
  • All women with new sexual partners or multiple partners should also be screened.

References

McKinzie J. Sexually transmitted diseases. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 88.

Smith RP. Pelvic inflammatory disease (PID). In: Smith RP, ed. Netter's Obstetrics & Gynecology. 3rd ed. Philadelphia, PA: Elsevier; 2018:chap 155

Workowski KA, Berman S; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1-137. PMID: 26042815 www.ncbi.nlm.nih.gov/pubmed/26042815.

Review Date:8/26/2017
Reviewed By:Peter J Chen, MD, FACOG, Associate Professor of OBGYN at Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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