Pelvic Inflammatory Disease (PID): Causes, Symptoms, and Treatment

Pelvic inflammatory disease (PID) develops when harmful bacteria spread and cause infection in the reproductive organs of women. These organs include the uterus, ovaries, fallopian tubes, and cervix.. It is typically brought on by an STI, such as Chlamydia or Gonorrhoea. However, common vaginal bacteria can occasionally bring on PID. If PID is not effectively managed, it can cause lower abdominal pain and impair your ability to become pregnant. Each year, more than 770,000 women in the United States are affected by PID.

Causes

Pelvic Inflammatory Disease (PID) is primarily triggered by bacterial infections that travel from the lower genital tract into the upper reproductive organs, such as the uterus, fallopian tubes, and ovaries. Under normal conditions, the cervix acts as a barrier, preventing harmful bacteria from ascending. However, when this barrier is compromised due to infection, medical procedures, or hormonal changes, bacteria can spread deeper into the reproductive system.

The most common culprits behind PID are sexually transmitted infections, particularly chlamydia and gonorrhea, which account for the vast majority of cases. These bacteria are typically transmitted through unprotected sexual contact. Mycoplasma genitalium is another emerging bacterium that is now widely recognized as an important cause of PID.

In less frequent cases, PID can also result from non-sexually transmitted bacteria that are naturally present in the vagina. These bacteria may enter the reproductive organs under certain conditions, such as:

• After childbirth, miscarriage, or abortion
• Especially within the first few weeks after an intrauterine device (IUD) is inserted
• Following pelvic or uterine surgery
• Around the time of menstruation, when the cervical barrier may be more susceptible

In rare instances, bacteria associated with other infections, such as strep, flu, or pneumonia, may also lead to PID if they enter the reproductive tract.

Risk Factors

Having gonorrhea, chlamydia, or a history of an STI increases your chance of developing pelvic inflammatory disease. However, PID can occur even if you have never had an STI.

Additionally, the following things may make you more susceptible to PID:

• Having intercourse before the age of 25
• Several sexual partners
• Not using a condom while having intercourse
• Having just had an intrauterine device (IUD) implanted
• Douching
• Pelvic inflammatory illnesses in the past

Symptoms

Some female patients with pelvic inflammatory disease don’t exhibit any symptoms. However, if a woman does have symptoms, these can include:

• Lower abdominal ache (the most common symptom)
• The upper abdomen aches
• Fever
• Painful intercourse
• Unpleasant urination
• Irregular bleeding
• More frequent or unpleasant vaginal discharge
• Tiredness

Pain from pelvic inflammatory disease may be minimal to intense. However, some women have extreme discomfort and symptoms, including:

• A severe abdominal ache
• Vomiting
• Fainting
• High fever (more than 101°F)

STI Signs

Getting an STI treated as soon as possible helps prevent PID. STI symptoms overlap with PID symptoms quite a bit. They include painful urination, excessive vaginal discharge, and bleeding between periods.

Diagnosis

Your doctor will likely perform a pelvic exam on you when you visit. In addition, your uterus, cervix, and other nearby organs will be examined for tenderness (ovaries and fallopian tubes).

Moreover, they’ll

• Look for any abnormally coloured fluid in the cervix or vagina.
• Inquire about your symptoms, medical history, and sexual history.
• Check your temperature.

Your doctor may use a microscope to examine fluid samples and send gonorrhea and chlamydia lab cultures. They could also suggest the following tests:

• A blood test for sexually transmitted infections
• Using an ultrasound to create an image of your internal organs

Your doctor will discuss your treatment options with you if the examination or your tests indicate a strong suspicion that you have PID.

Treatment

Pelvic Inflammatory Disease (PID) requires timely treatment to avoid lasting complications. The standard approach involves a 14-day course of antibiotics, often including a combination of medications to target various bacteria. In many cases, both oral tablets and an injection are prescribed to ensure more effective results.

Even if symptoms improve early on, it’s essential to complete the full course of antibiotics. This helps eliminate the infection entirely and prevents it from returning. If PID has caused any internal scarring, it’s important to know that while antibiotics can stop the infection, they cannot reverse existing damage to reproductive tissues.

Your sexual partner(s) should also be tested and treated, even if they don’t show any symptoms, to avoid reinfection. During the treatment period, sexual activity should be avoided until the infection is fully cleared and both partners have completed their medications.

Sometimes, if the infection is more severe or doesn’t respond to oral antibiotics, hospitalization may be necessary. In such cases, stronger antibiotics may be administered intravenously. Hospitalization may be required for pregnant individuals, those unable to take oral medications, or patients who develop complications like an abscess, which is a buildup of pus in the fallopian tubes or ovaries.

Though surgery is rarely needed, it might be recommended if an abscess ruptures or fails to respond to antibiotics, or if the diagnosis remains uncertain and symptoms persist.

Complications

If pelvic inflammatory disease goes untreated, abscesses, pockets of infected fluid, can form in the reproductive system. The reproductive organs may suffer long-lasting harm as a result of this.

These complications might result from this damage:

• Ectopic pregnancy: PID is a significant cause of tubal (ectopic) pregnancy. If left untreated, PID may cause scar tissue to form in the fallopian tubes, which can increase the risk of ectopic pregnancy. Because of the scar tissue, the fertilized egg cannot pass through the fallopian tube to become implanted in the uterus; instead, it implants in the fallopian tube. Ectopic pregnancies may cause severe, potentially life-threatening bleeding and require urgent medical attention.
• Infertility: Infertility, or the inability to conceive, can result from damage to your reproductive organs. Your chance of experiencing infertility increases with the frequency of PID. Delaying PID treatment also significantly raises your chance of infertility.
• Chronic pelvic pain: Pelvic inflammation can lead to discomfort that can continue for months or even years. In addition, pain during sexual activity and ovulation may be brought on by scarring in your fallopian tubes and other pelvic organs.
• Ovarian Tubal Abscess: In your reproductive tract, PID may lead to the formation of an abscess or pus collection. Abscesses can occur in the uterus or other pelvic organs, although they most frequently affect the fallopian tubes and ovaries. A potentially fatal infection might develop if an abscess is not treated.

Prevention

In some cases, pelvic inflammatory disease is not caused by a sexually transmitted infection. Your reproductive organs may be exposed to common vaginal bacteria, which can cause it. It could be safer to refrain from douching. Most often, PID is primarily caused by unprotected sexual activity. Therefore, take action to engage in safe sex.

Take the following precautions to avoid STIs that might lead to PID.

• Limit the number of sexual partners because doing so reduces your risk.
• Choose birth control options that are barrier-free, such as condoms and diaphragms.
• Get tested: Make an appointment with your doctor for testing if you think you may have an STI. If needed, work with your doctor to establish a regular screening schedule. The best chance of preventing PID is to treat an STI as soon as possible.
• Ask to get your partner tested: Encourage your partner to be tested and treated if you have an STI or pelvic inflammatory disease. By doing this, STI transmission and potential PID recurrence can be stopped.

Antibiotics can treat PID if you receive a timely diagnosis and treatment for an infection. Therapy won’t be able to undo the harm. Take care of yourself right away. Schedule a prompt visit with your doctor to get the appropriate care and protect your health.

What Questions Should You Ask Your Doctor?

Ask your provider whether you have a PID:

• What kind of care will I require?
• Do I need to be rechecked?
• Will PID have an impact on my ability to conceive?
• What may the PID complications be?
• When can I start having intercourse again?
• What steps should be taken to prevent PID?

Frequently Asked Questions