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Author: Dr D Lee
Role: Specialist Sexual Health Doctor
Date written: September 2010
Last reviewed: November 2015
Review date: November 2018
Version: 1.1
Code: PI0683
Pelvic Inflammatory Disease
(page 1 of 4)
What is pelvic inflammatory disease?
Pelvic inflammatory disease (PID) is an infection of the uterus (womb) and
Fallopian tubes (and sometimes the ovaries too). It is caused by bacteria
that spread from the vagina or cervix to the uterus.
What causes it?
A common cause of PID is a sexually transmitted infection (STI).
Chlamydia is the most common cause. Gonorrhoea is also often involved.
Some women develop PID weeks or months after having sex with an
infected person. This is because the bacteria can be in the cervix for quite
some time without causing symptoms before travelling into the uterus.
Sometimes PID is not caused by a STIn. The vagina normally contains
various bacteria which are usually harmless and are not passed on by
sexual contact. However, these bacteria can sometimes cause PID. This
is more likely to happen after having a baby, or after a procedure such as
an insertion of an intrauterine device (IUD).
What are the symptoms of PID?
Pain in the lower abdomen (pelvic area) is the most common symptom. It
can range from mild to severe.
Other symptoms that may also occur include:
• abnormal vaginal bleeding (in about one in four cases). This may be
periods that are heavier than usual, or bleeding between periods, or
bleeding after having sex
• pain during sex
• abnormal vaginal discharge
• fever
• low back pain.
Symptoms may develop quickly. You can become quite ill over a few
days.
Sometimes symptoms are mild and develop slowly. For example, you may
just have a mild abdominal pain that may ‘grumble’ for some weeks.
In some cases no symptoms develop and you do not know that you are
infected. However, you are still at risk of complications even if you have
no symptoms at first.
Salisbury Department of Sexual Health
01722 328595
© Salisbury NHS Foundation Trust
Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ
www.salisbury.nhs.uk
Pelvic Inflammatory Disease (2 of 4)
Who gets pelvic inflammatory disease?
About 1 in 50 sexually active women in the UK develop PID each year. Women aged between 15
and 24 years are most commonly affected.
The risk of developing PID is higher if you have had:
• a new sexual partner. The risk goes up with the number of changes of partner.
• PID before, or another sexually transmitted disease
• a recent termination of pregnancy (abortion)
• a recent operation or procedure to the uterus
• an IUD inserted recently.
How is it diagnosed?
If PID is suspected then a swab (small sample of discharge) is taken from the cervix. This is to
test for bacteria. A swab from the urethra (urine tube), and blood and urine tests may also be
taken.
However, even in women who have PID, the swabs and tests may not show any bacteria so other
tests may have to be done. For example, an ultrasound scan may be able to show inflamed
Fallopian tubes. Sometimes a doctor may need to look inside your abdomen to look at the
uterus and Fallopian tubes. This is done by pushing a special thin telescope (laparoscope)
through the wall of the abdomen. This procedure, called a laparoscopy, is done under
anaesthetic.
PID may not be diagnosed for some time if symptoms are mild, or do not occur.
A pregnancy test is also usually done in women suspected of having PID. This is to rule out an
ectopic pregnancy (this can sometimes be confused with PID, as some of the symptoms are
similar).
What are the possible complications?
If you begin treatment within two to three days of symptoms starting, complications do not
generally develop.
Possible complications include:
• difficulty becoming pregnant (infertility). PID can cause scarring or damage to the Fallopian
tubes. This can occur whether or not the PID caused you any symptoms.
• an increased risk of an ectopic pregnancy if you become pregnant. (This is a pregnancy
that develops in a Fallopian tube and can cause serious problems.) If you have had PID
and become pregnant, you have about a 1 in 10 chance that it will be ectopic.
• chronic (persistent) pain develops in about 1 in 5 cases. This often includes pain during
sex.
• the risks of developing some complications of pregnancy such as miscarriage, premature
birth and stillbirth are increased in pregnant women with untreated PID.
Salisbury Department of Sexual Health
01722 328595
© Salisbury NHS Foundation Trust
Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ
www.salisbury.nhs.uk
Pelvic Inflammatory Disease (3 of 4)
• Reiter’s syndrome. This is a rare cause of arthritis and eye inflammation. It is a rare
complication of PID.
• an abscess (collection of pus) sometimes develops next to the uterus if the infection is
severe.
If there are repeated episodes of PID the risk of developing complications is greatly increased.
What is the treatment of PID?
The usual treatment is a course of antibiotics for at least two weeks. Tell your doctor if you are
(or may be) pregnant. This may affect the choice of antibiotic.
You should not have sex until both you and your sexual partner have finished treatment.
Does my partner need to be treated?
Yes. Also, any other sexual partner within the past 3-6 months should be tested for infection. (If
you have not had sex within the last six months then your most recent sexual partner, however
long ago the relationship was, should be tested and treated.) A course of antibiotics is usually
advised whether or not infection is found. This is because:
• a significant proportion of PID is caused by chlamydia; this is often passed on during sex.
• men often have no symptoms with chlamydia, but can still pass on the infection.
• the test for chlamydia is not 100% reliable. Treatment makes sure that any possible
infection which may have been missed by the tests is cleared
• if your sexual partner is infected and not treated, chlamydia may be passed back to you
again after you are treated.
Can pelvic inflammatory disease be prevented?
The risk of infection increases with the number of changes of sexual partner. Wearing a condom
during sex helps to protect you from sexually transmitted infections.
Will it happen again?
About 1 in 5 women who have PID have a further episode. This is usually within two years.
Reasons why this may occur include:
• your sexual partner was not treated. You are then likely to get the infection back again.
• you did not take the antibiotics properly, or for long enough. The infection may then not
clear completely, and may flare up again later
• you change your sexual partner and do not practise ‘safer sex’
• some women are more prone to infection once their uterus or Fallopian tubes have been
damaged by a previous episode of PID.
Salisbury Department of Sexual Health
01722 328595
© Salisbury NHS Foundation Trust
Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ
www.salisbury.nhs.uk
Pelvic Inflammatory Disease (4 of 4)
Where can I get further help and information?
National Chlamydia Screening Programme
Web: www.chlamydiascreening.nhs.uk
On this site you can learn more about chlamydia, the National Chlamydia Screening Programme,
and be able to access local services for chlamydia screening.
Sexual Health Helpline
Tel: 0800 567 123
Women’s Health Concern
4-6 Eton Place, Marlow, Bucks SL7 2QA
Tel (helpline) Nurse Counselling Service: 0845 123 2319 (local rate)
Web: www.womens-health-concern.org
A leading charity providing help and advice to women on a wide variety of gynaecological,
urological and sexual health conditions.
Salisbury Department of Sexual Health
01722 328595
© Salisbury NHS Foundation Trust
Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ
www.salisbury.nhs.uk