Pelvic Inflammatory Disease (PID)
Last Review Date: April 10, 2020
Pelvic inflammatory disease (PID) is an inflammation and infection of a woman’s upper reproductive organs. It occurs when move from the vagina, upward through a layer of mucus that protects the opening of the cervix, and into the uterus, fallopian tubes, and ovaries. PID can cause an illness, pain, or it may be present as an almost silent chronic infection. Left untreated, it can cause scarring and irreversible damage to one or more of the reproductive organs. Scarring in the fallopian tubes can cause infertility and significantly increase the risk of an .
Pelvic inflammatory disease is primarily associated with Chlamydia trachomatis and Neisseria gonorrhoeae, two common that cause the sexually transmitted diseases (STDs) chlamydia and gonorrhoea. PID may also be caused by bacteria typically found in the vagina or gastrointestinal tract - such as Gardnerella vaginalis or Escherichia coli, and by a variety of other .
Although PID can affect any woman at any age, with or without sexual transmission, most cases occur in sexually active women of childbearing age. Those at increased risk include women who began having sex at a young age, those with multiple sexual partners, and those who have had a previous STD or PID. A woman with an intrauterine device (IUD) may be at an increased risk for a few months after its insertion. Douching may increase the risk of PID because the practice can change the vaginal and can potentially flush bacteria into the uterus. Since the uterus is sealed off during gestation, an occurrence of PID during pregnancy is rare.
About 10,000 women in Australia are treated for PID in hospital each year. About 10 to 30 times that number are treated as outpatients.
A woman with PID may have no symptoms, mild discomfort, and/or progressive pain, or she may be severely and acutely ill. Many of the and of PID are nonspecific and may be seen with a variety of other conditions that affect the pelvic area. Symptoms may include:
- vaginal or cervical discharge with an unpleasant smell
- pain in the lower abdomen – this is the most common symptom
- abdominal tenderness
- intermittent fever
- painful sexual intercourse and bleeding with sex
- painful urination
- irregular menstrual bleeding
Complications of PID include infertility, chronic pelvic pain, lesions on an ovary or fallopian tube, and an . Even a small amount of scarring in the fallopian tubes can impair fertility. It can prevent an egg from becoming fertilized or prevent a fertilized egg from reaching the uterus. If a fertilized egg begins to develop in a fallopian tube, it can rupture the tube, causing a life-threatening emergency with internal bleeding and severe pain.
The goals with testing are to diagnose pelvic inflammatory disease, to determine the causing it, if possible, and to distinguish PID from other conditions with similar symptoms. There is not one single laboratory test that can definitely diagnose PID. Most cases are diagnosed based on clinical findings. Some are diagnosed when a person is screened for STDs as part of a physical examination. According to the CDC, PID goes unrecognized and undiagnosed as frequently as two-thirds of the time because the symptoms are nonspecific. PID is often called the ‘silent epidemic’ because it is common among sexually active women but does not always cause symptoms. There are several tests that may be performed to help diagnose the condition.
Some tests that may be ordered to determine the cause of PID or rule out other causes of pelvic pain include:
- Chlamydia trachomatis test – to detect chlamydia infection as cause of PID
- Neisseria gonorrhoeae test – to detect gonorrhoea infection as cause of PID
- Wet prep – a sample of vaginal/cervical discharge is placed on a slide and examined under a microscope. It is primarily performed to evaluate number of white blood cells (WBCs) in discharge; often elevated with PID
- Cervical – ordered to help identify causative microorganisms
- Urine culture – performed to detect a urinary tract infection
Tests that are not specific for PID but may be done to detect and evaluate the inflammation and immune response associated with it include:
A pregnancy test may be performed to determine whether a woman is pregnant and to help identify .
- Physical examination – an evaluation of the cervix, discharge, and degree of pain or tenderness present. Cervical motion pain and uterine pain are characteristic of PID. A diagnosis may be made based upon clinical findings.
- Pelvic or transvaginal ultrasound – may be performed to examine reproductive organs
- Laparoscopy – minimally invasive surgery sometimes used to confirm the diagnosis, collect samples, and evaluate organ status
- (computed tomography) scan or (magnetic resonance imaging) scan
- Power Doppler – scan that allows evaluation of blood flow and inflammation
The medical community has set a low diagnostic threshold for this condition. This means that if the doctor suspects that a woman has PID, then she should be treated regardless of whether the diagnosis can be confirmed. This is done because it takes very little PID scarring to cause infertility.
Treatment is typically one or more broad-spectrum antibiotics that will target Chlamydia trachomatis, Neisseria gonorrhoeae, and a range of other . If the causative are known, then the treatment is tailored to address them. A woman’s sexual partner should also be treated so that the woman is not re-infected after treatment.
In most cases, treatment can be given on an outpatient basis, but if the woman is acutely ill, pregnant, or not responding to treatment, then she may require hospitalization. In rare cases, for example if there is an , surgery may be required.
On this site
Tests: Chlamydia, Gonorrhoea, ESR, CRP, hCG
Elsewhere on the web
Better Health Channel
Healthdirect Australia: Pelvic inflammatory disease
CDC: Fact Sheet, PID (Pelvic Inflammatory Disease) (USA)
Medline Plus Medical Encyclopedia: Pelvic Inflammatory Disease (PID) (USA)
American College of Obstetrician and Gynecologists (ACOG): Pelvic Inflammatory Disease (.pdf USA)
Ooi C & Dayan L. Australian Family Physician 2003;32(5):305 available at http://www.racgp.org.au/afp/200611/20061103dayan.pdf