Pelvic inflammatory disease (PID) is an infection that affects the upper genital tract, including the cervix, uterus, ovaries, and fallopian tubes. It can spread throughout the pelvic area and cause symptoms such as lower abdominal or pelvic pain, abnormal bleeding between periods, and fever.
PID is usually caused by sexually transmitted infections (STIs) that start in the vagina, most commonly untreated chlamydia or gonorrhea. It tends to occur more often in women between 15 and 25 years of age.
Treatment for pelvic inflammatory disease is managed by a gynecologist and involves antibiotics to eliminate bacteria and prevent complications such as abscess formation, ectopic pregnancy, infertility, and chronic pelvic pain.
Common symptoms
The main symptoms of pelvic inflammatory disease include:
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Abdominal or pelvic pain, especially in the lower abdomen;
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Yellow or green vaginal discharge with a foul odor;
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Vaginal bleeding between periods or after sex;
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Pain during sex;
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Burning sensation while urinating;
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Fever of 100.4°F (38°C) or higher, or chills.
In many cases, pelvic inflammatory disease can be mild, and some women may not notice symptoms. This allows bacteria to continue spreading, which can lead to more severe inflammation.
It’s important to see a gynecologist whenever symptoms of PID or other STIs appear so the condition can be diagnosed and treated as soon as possible.
Serious complications
Pelvic inflammatory disease can become serious if not properly treated. It can lead to complications such as severe abdominal infection (peritonitis), abscess formation, blockage of the fallopian tubes, ectopic pregnancy, or infertility.
Confirming a diagnosis
A gynecologist can diagnose pelvic inflammatory disease based on symptoms, medical and sexual history, a pelvic exam, and imaging or lab tests.
Diagnostic tests
The main tests used to confirm PID include:
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Pregnancy test to rule out ectopic pregnancy;
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Analysis of vaginal discharge;
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Urine tests;
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Blood tests such as a complete blood count (CBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR);
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Pelvic or transvaginal ultrasound;
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CT scan or MRI.
The doctor may also recommend tests for other sexually transmitted infections, such as syphilis or HIV.
To confirm pelvic inflammatory disease, it’s important to see a gynecologist as soon as symptoms appear. The doctor will order tests to identify the infection, determine its stage, and start the most appropriate treatment.
Stages of PID
Based on test results, the doctor can determine the stage of the disease:
- Stage 1: Inflammation of the endometrium and fallopian tubes, without peritoneal infection;
- Stage 2: Inflammation of the fallopian tubes with peritoneal infection;
- Stage 3: Inflammation of the fallopian tubes with tubal blockage or tubo-ovarian abscess;
- Stage 4: Rupture of the tubo-ovarian abscess or pus in the pelvic cavity.
Identifying the stage of PID and the microorganism causing the infection helps determine the best treatment plan.
Possible causes
Pelvic inflammatory disease is mainly caused by sexually transmitted infections such as Chlamydia trachomatis, Neisseria gonorrhoeae, or Mycoplasma genitalium.
Other infections that can lead to PID include bacterial vaginosis, trichomoniasis, ureaplasma, or herpes simplex virus type 2.
In some cases, bacteria from the intestinal, urethral, or vaginal tract, such as Escherichia coli, Bacteroides fragilis, or group B Streptococcus, can also cause pelvic inflammatory disease.
Risk factors
The main factors that increase the risk of pelvic inflammatory disease include:
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Previous history of PID or STIs;
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Not using condoms during sex;
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Having multiple sexual partners;
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Untreated sexually transmitted infections;
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Bacterial contamination during childbirth;
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Frequent vaginal douching;
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IUD placement less than three weeks previous;
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Pelvic surgery or tubal ligation.
Women between 15 and 25 years old who do not consistently use condoms are at higher risk for developing pelvic inflammatory disease.
Treatment options
Treatment for pelvic inflammatory disease should always be managed by a gynecologist. The goal is to eliminate the infection, relieve symptoms, and prevent complications.
1. Medications
Antibiotics for PID are usually given orally or by intramuscular injection for about 14 days. Common antibiotics prescribed by doctors include ceftriaxone, metronidazole, doxycycline, and azithromycin, all of which are FDA-approved and widely used in the United States.
These medications must be taken for the entire duration prescribed, even if symptoms improve quickly. Sexual partners should also be treated in order to prevent reinfection, even if they don't have any symptoms.
It’s also recommended to rest and avoid sexual intercourse during treatment to allow the tissues to heal properly.
2. IUD removal
If pelvic inflammatory disease is related to a recent intrauterine device (IUD) placement, the doctor may recommend removing the IUD in addition to antibiotic treatment.
3. Surgery
Surgery may be necessary in cases of severe infection or when there is no improvement after treatment with antibiotics.
Surgery may be performed to treat inflammation of the fallopian tubes, drain abscesses, or manage an ectopic pregnancy.
Is there a cure for PID?
Pelvic inflammatory disease can be cured if it’s diagnosed and treated early. However, any damage already caused to reproductive organs is permanent.
Without proper treatment, complications may develop and cause long-term problems.
Possible complications
Pelvic inflammatory disease can lead to complications such as:
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Abscesses in the ovaries and fallopian tubes;
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Severe abdominal infection (peritonitis);
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Inflammation of the liver capsule (Fitz-Hugh–Curtis syndrome);
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Blockage of the fallopian tubes (salpingitis);
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Chronic pelvic pain.
Pelvic inflammatory disease also increases the risk of ectopic pregnancy and infertility.
Prevention and screening
Pelvic inflammatory disease can be prevented by using condoms during all sexual encounters and ensuring that STIs such as chlamydia and gonorrhea are properly treated. Sexual partners should also receive treatment.
Women who are sexually active should have regular gynecologic checkups and screening tests for STIs.
It’s also advisable to avoid vaginal douching, as it can disrupt the natural vaginal microbiota and increase the risk of developing pelvic inflammatory disease.