Overview

Pelvic inflammatory disease (PID) is a bacterial infection that affects the female reproductive organs, including the uterus, fallopian tubes, and ovaries. It commonly results from sexually transmitted infections (STIs), particularly chlamydia and gonorrhea, when left untreated. PID can cause significant long-term complications, including chronic pelvic pain, ectopic pregnancy, and infertility. Although it often produces noticeable symptoms, some individuals may be asymptomatic, which makes early detection and treatment even more critical.

Common Symptoms

PID symptoms can vary in severity and may resemble those of other reproductive or urinary tract conditions. Common symptoms include:

  • Pelvic or lower abdominal pain

  • Painful or burning urination

  • Unusual or foul-smelling vaginal discharge

  • Pain during intercourse

  • Irregular menstrual bleeding

  • Bleeding between periods

  • Nausea or vomiting

  • Fever and chills

  • Lower back pain

Some individuals experience very mild or no symptoms, increasing the risk of undetected progression to more serious reproductive damage.

Underlying Causes

PID typically develops when bacteria travel upward from the vagina or cervix into the reproductive organs. The most frequent causes include:

  • Chlamydia trachomatis

  • Neisseria gonorrhoeae

  • Trichomonas vaginalis

  • Mycoplasma genitalium

In some cases, PID may stem from non-sexually transmitted infections, including:

  • Bacterial vaginosis

  • Infections by E. coli or streptococcus

These bacteria can be introduced through improper hygiene practices, medical procedures, or postpartum infections.

Risk Factors

Certain behaviors and medical histories increase the likelihood of developing PID:

  • Being sexually active and under the age of 25

  • Having multiple sexual partners

  • Inconsistent condom use

  • A history of STIs or PID

  • Vaginal douching, which disrupts the vaginal microbiome

  • Recent insertion of an intrauterine device (IUD)

People with weakened immune systems or those who have recently undergone pelvic surgery may also be more susceptible.

Diagnosis

There is no single definitive test for PID. Diagnosis typically involves a combination of:

  • Detailed medical and sexual history

  • Pelvic examination to detect tenderness or swelling

  • Tests for STIs (e.g., chlamydia, gonorrhea)

  • Blood tests to identify signs of infection or inflammation

  • Urinalysis to rule out urinary tract infections

  • Vaginal or cervical swab cultures

  • Imaging studies like pelvic ultrasound

  • In rare cases, laparoscopy or endometrial biopsy to assess internal reproductive structures

A prompt and accurate diagnosis is essential to begin treatment before complications arise.

Treatment Options

Treatment for PID focuses on eliminating the infection and preventing further reproductive damage. The primary treatments include:

  • Oral antibiotics: A combination of antibiotics like doxycycline and metronidazole is typically prescribed for 14 days.

  • Intravenous (IV) antibiotics: Recommended for severe infections, those with abscesses, or if the patient cannot tolerate oral medication.

  • Hospitalization: Required in cases of high fever, pregnancy, severe symptoms, or abscess formation.

It is crucial for sexual partners to be tested and treated to prevent reinfection. Additionally, patients are advised to abstain from sexual activity until completing the full course of treatment.

Prevention Strategies

Though not all cases of PID can be prevented, reducing risk is possible with the following steps:

  • Use condoms consistently during sexual activity

  • Get tested regularly for STIs

  • Limit the number of sexual partners

  • Avoid vaginal douching

  • Seek prompt treatment for any STI symptoms

  • Discuss contraception and risk factors with a healthcare provider

Regular gynecologic checkups and open conversations with your provider about sexual health are vital components of prevention.

Possible Complications

Without timely treatment, PID can lead to serious and lasting health complications:

  • Infertility: Up to 10% of people with untreated PID may develop infertility due to damage and scarring of the fallopian tubes.

  • Ectopic pregnancy: Scarring can prevent a fertilized egg from reaching the uterus, increasing the risk of life-threatening tubal pregnancies.

  • Chronic pelvic pain: Persistent inflammation or scarring can cause long-term pelvic discomfort.

  • Abscess formation: Pus-filled sacs (tubo-ovarian abscesses) may form, requiring drainage or surgery.

  • Complicated pregnancies: Higher risks of miscarriage and preterm birth have been linked to PID history.

Addressing PID early can drastically reduce the chances of these complications.

Living With PID

For individuals who have had PID, ongoing care is essential. Steps to manage the condition and reduce future risk include:

  • Following your full treatment plan without missing doses

  • Scheduling follow-up appointments to confirm infection clearance

  • Practicing safer sex

  • Seeking early treatment for any STI symptoms in the future

  • Consulting a fertility specialist if pregnancy difficulties arise

While PID can have long-term consequences, proper medical care and prevention can support full recovery and future reproductive health.