Pelvic Inflammatory Disease
What is pelvic inflammatory disease (PID)?
Pelvic inflammatory disease (PID) is an infection of a woman’s reproductive organs. See a picture of the organs inside the pelvis.
Treating PID right away is important, because PID can cause scar tissue in the pelvic organs and lead to infertility. It can also lead to other problems, such as pelvic pain and tubal (ectopic) pregnancy.
What causes PID?
PID is caused by bacteria entering the reproductive organs through the cervix. When the cervix is infected, bacteria from the vagina can more easily get into and infect the uterus and fallopian tubes.
You may be more likely to get PID if you:
- Have a sexually transmitted disease (STD). The most common causes of PID are gonorrhea and chlamydia.
- Are at risk for STDs. You are at higher risk for STDs if you are young and you don't use condoms when you have sex. Having more than one sex partner also increases your risk for STDs.
- Have bacterial vaginosis, which is not an STD.
- Have recently had an IUD inserted or had an abortion.
- Had PID before.
What are the symptoms?
At first, PID may not cause any symptoms or may cause only mild symptoms, such as bleeding or discharge from the vagina. Some women don't even know they have it. They only find out later, when they can't get pregnant or they have pelvic pain.
As the infection spreads, the most common symptom is pain in the lower belly. The pain has been described as crampy or as a dull and constant ache. It may be worse during sex, bowel movements, or when you urinate. Some women also have a fever.
How is PID diagnosed?
Even though PID causes mild or no symptoms, it can still cause serious problems. So you need to understand what put you at risk for PID or STDs and see your doctor if you have any unusual symptoms.
Your doctor will ask about your lifestyle and symptoms. He or she will examine you and do tests to see if you have PID. The test results may take some time. For this reason, your doctor will treat you for the disease before the test results are ready. Treating PID early is important to prevent problems later on.
Your doctor may test you for the most common causes of PID and may also do blood tests to look for signs of infection. Your doctor may also order an ultrasound to see if there are other possible causes of your symptoms. An ultrasound may also show if there is damage to the fallopian tubes, uterus, or ovaries from PID.
How is it treated?
To treat PID, you will need to take antibiotics. Take them as directed. If you don't take all of the medicine, the infection may come back.
If your infection was caused by an STD, your sex partner(s) will also need to be treated so you don't get infected again. Do not have sex until both of you have finished your medicine, and be sure to follow up with your doctor to make certain that the treatment is working.
If you have a very bad case of PID or are pregnant and infected, you may need to stay in the hospital and get antibiotics through a vein (intravenous). Sometimes surgery is needed to drain a pocket of infection, called an abscess. If you have an IUD for birth control, it may be removed.1
Can you prevent PID?
Your risk of infertility increases each time you have PID, so it is very important to prevent future infections. Using a condom each time you have sex can reduce your chance of getting an STD that could lead to PID.
Frequently Asked Questions
Learning about pelvic inflammatory disease (PID):
PID, sexually transmitted disease (STD), and bacterial vaginosis
Pelvic inflammatory disease (PID) is usually caused by a sexually transmitted disease (STD) that infects the cervix, which connects the upper vagina to the uterus. When the cervix is infected with an STD, it becomes easier for other bacteria present in the vagina to get into and infect the uterus and fallopian tubes. PID can also develop as a result of bacterial vaginosis (BV), which is a drop in the vagina's "good" organisms and an increase in its potentially "bad" organisms. When this happens and the problem organisms spread into the uterus and fallopian tubes, PID can result. (BV is not sexually transmitted.) See a picture of the female pelvic organs.
The most common causes of PID are:
- Gonorrhea , a sexually transmitted bacterial infection.
- Chlamydia , a sexually transmitted bacterial infection. PID caused by chlamydia is most common among teenagers and young adult women.
PID caused by chlamydia may have milder symptoms or no symptoms (compared with PID caused by gonorrhea), which can delay diagnosis.
Practicing safe sex by using condoms prevents STD infection. This greatly lowers PID risk. For more information, see the Prevention section of this topic.
PID and intrauterine devices (IUDs)
Women who have an intrauterine device (IUD) inserted for birth control have a higher risk of getting PID in the first month after insertion, especially if bacterial vaginosis or an STD is present at the cervix at the time of insertion. The insertion procedure may transfer bacteria from the vagina or cervix to the uterus. Your risk of infection can be reduced if:
- You are tested and treated for STDs and bacterial vaginosis (if detected) before IUD insertion.
- The insertion is done carefully to minimize the chance of infection (clean technique).
PID that spreads to abdominal organs
- Given birth.
- Had uterine tests or other procedures, such as:
- Had an abortion.
Symptoms of pelvic inflammatory disease (PID) range from none at all to severe.
It's common to think that PID symptoms are a sign of something less serious. Many women who have pelvic organ damage caused by PID report that they've never been diagnosed with PID. This is particularly true of PID that is caused by chlamydia, which may cause no symptoms.
PID symptoms often do not appear until infection and inflammation have spread to the fallopian tubes or the lining of the abdomen (peritoneum). Symptoms of PID tend to be more noticeable during menstrual bleeding and sometimes in the week following.
The main symptom of PID is lower abdominal pain, usually described as crampy or as constant and dull. This pain may get worse during bowel movements, sexual intercourse, or urination. You may also have one or more other symptoms, including:
- A sense of pressure in the pelvis.
- Low back pain. Sometimes this pain spreads down one or both legs.
- Abnormal discharge—such as yellow-, brown-, or green-colored discharge—or an increased amount of discharge from the vagina.
- Fever [usually over 101°F (38.33°C)]. But you can have PID without fever.
- A vague feeling of body weakness or discomfort (malaise).
- Nausea or vomiting.
- Pain during sex (dyspareunia).
- Irregular menstrual bleeding.
- Urinary symptoms, such as burning or pain with urination.
Be sure to see your doctor when you have any of the above symptoms, because PID and several other conditions with similar symptoms require prompt treatment.
Pelvic inflammatory disease (PID) usually starts with a bacterial infection and inflammation of the cervix (cervicitis). This is usually caused by gonorrhea or chlamydia. PID is also linked to an imbalance of the organisms normally found in the vagina (bacterial vaginosis). The bacteria then spread to other female reproductive organs.
Sometimes PID starts after bacteria are carried beyond the cervix by an invasive procedure. This could be the insertion of an intrauterine device (IUD), a dilation and curettage (D&C), an induced abortion, or a hysterosalpingogram test (which uses a tube to inject dye through the cervix into the uterus and fallopian tubes for X-ray imaging).
In some cases, infection moves into a fallopian tube and ovary. This can form a pocket of pus called a tubo-ovarian abscess. After having this problem, as many as 93% of women cannot become pregnant.2
PID causes inflammation in the uterus and fallopian tubes. In turn, the inflammation can form scar tissue (adhesions) in the abdominal cavity and the reproductive organs. This does not always cause symptoms. The scar tissue can lead to:
- Infertility . Scarring inside the fallopian tubes is permanent and can twist or block the tubes with scar tissue or fluid, leading to tubal infertility. About 1 out of 10 women cannot become pregnant after having PID once. After having PID three or more times, as many as 7 out of 10 women become infertile.2
- Chronic pelvic pain , affecting nearly 2 out of 10 women who have had PID.3 Chronic (ongoing) pelvic pain is usually caused by internal scarring (adhesions) and is difficult to treat. For more information, see the topic Chronic Female Pelvic Pain.
- Tubal (ectopic) pregnancy. About 1 out of 10 pregnancies that follow PID are in a fallopian tube.3 Scar tissue can trap a fertilized egg in a fallopian tube, where it begins to grow. This can become a life-threatening problem. It must be treated right away with medicine or surgery to end the pregnancy.
PID may also occur inside the abdomen as:
- A pocket of pus (abscess) in the pelvis.
- An infection and inflammation of the lower abdomen (pelvic peritonitis).
- Inflammation around the outside of the liver (perihepatitis).
The longer PID treatment is delayed, the more likely you are to have permanent damage. Similarly, each recurrent pelvic infection increases your risks of tubal infertility, chronic pelvic pain, and ectopic pregnancy.2
What Increases Your Risk
You have an increased risk for developing pelvic inflammatory disease (PID) if you:
- Are at risk for getting a sexually transmitted disease (STD). Sexually active teens and young women have the highest rate of STD infection. This is almost always from having sex without using a condom. The cells of the transformation zone in a younger woman's cervix are most likely to be infected with chlamydia and gonorrhea, two common STDs.
- Have had PID before. If you have had PID once, your reproductive tract may be less able to clear a new infection because of scar tissue from past PID.
- Have had chlamydia before, which can lead to a "hypersensitive response" when you are exposed to the bacteria again. A second infection can cause more irritation and pelvic organ damage that is worse than the first time.
Doctors advise against douching because it increases your risk for vaginal and
- Douching may change the acidity of the vagina. This can help more "bad" bacteria grow, while killing off "good" bacteria, such as lactobacilli.
- Douching done incorrectly may flush bacteria from the vagina into the uterus.
Use condoms to avoid exposure to sexually transmitted diseases.
Some gynecological procedures can increase your risk of PID by introducing bacteria into the reproductive tract. Such medical procedures include:
- Taking a tissue sample of the uterine lining (endometrial biopsy).
- Scraping the lining of the uterus (dilation and curettage, or D&C).
- Inserting an intrauterine device (IUD) when an infection is present at the cervix or in the vagina at the time of insertion.
- Examining the uterus or fallopian tubes with a lighted viewing tube (hysteroscopy or hysterosalpingogram).
- Inducing abortion.
PID is rare in women who are not sexually active, don't have menstrual periods, are pregnant, or have had their uterus or ovaries removed during a hysterectomy.
When To Call a Doctor
Pelvic inflammatory disease (PID) symptoms often don't develop until inflammation or scar tissue (adhesions) develop. Scar tissue can cause ongoing (chronic) pelvic pain, infertility, and ectopic pregnancy. For this reason, immediate medical attention is necessary to treat possible PID symptoms or complications.
Call your doctor immediately if you have abdominal pain and any of the following:
- A positive home pregnancy test (possible ectopic pregnancy)
- Fever of 101°F (38.3°C) or higher
- Pain or difficulty urinating
Call your doctor to find out when an evaluation is needed if you:
- Have a dull pain, unusual or persistent cramping, or a feeling of pressure in the lower abdomen.
- Need to urinate frequently or have pain, burning, or itching with urination for longer than 24 hours.
- Have pain during sex (dyspareunia), especially in the abdomen.
- Have abnormal vaginal bleeding.
- Suspect that you have been exposed to a sexually transmitted disease (STD).
- Have a vaginal discharge that is yellow or green or smells bad.
- Have bleeding between menstrual periods.
- Bleed after sexual intercourse or after vaginal douching.
- Have a sex partner who has any symptoms of an STD (such as discharge, genital sores, or pain in the genital area).
If you have not been diagnosed with PID but you have symptoms that concern you, see the following topics:
- Exposure to Sexually Transmitted Diseases (STDs)
- Abnormal Vaginal Bleeding
- Abdominal Pain, Age 12 and Older
Any symptoms or other changes that suggest PID or a sexually transmitted disease should be evaluated by a doctor as soon as possible. Watchful waiting is not appropriate.
- Early treatment (within 48 to 72 hours after symptoms begin) may reduce or prevent complications of PID.
- To prevent spreading a possible infection, avoid sexual intercourse until you are evaluated.
To prevent reinfection from an STD, be sure that anyone you have had sexual contact with has been tested, treated if necessary, and uses condoms when you resume sexual relations.
Who To See
The following health professionals can diagnose and treat pelvic inflammatory disease (PID):
- Physician assistant (PA)
- Nurse practitioner
- Family medicine physician
- Emergency medicine specialist
Complications of PID are usually treated by a gynecologist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Pelvic inflammatory disease (PID) is often difficult to diagnose because:
- PID symptoms vary and can be mistakenly linked to other health conditions.
- There is no single test that can detect PID. It is diagnosed by the combination of your medical history, your symptoms, a physical exam, and lab test results.
- It is hard to examine the inside of the abdomen or a fallopian tube to see whether an infection is present.
Guidelines for PID care urge prompt treatment, even when only the minimal clinical criteria for the diagnosis of PID are met and even before laboratory test results are available.1 This means that you may be given antibiotic treatment right away, based on your risk factors, medical history, and physical exam. Delaying treatment for several days could increase your risks of fallopian tube damage and infertility.4
To learn about your medical history, your doctor may ask you the following questions.
- Is it possible that you are pregnant?
- Do you think you were exposed to any sexually transmitted diseases (STDs)? How do you know? Did your partner tell you?
- What are your symptoms?
- Do you have vaginal discharge? If you have discharge from the vagina, it is important to note any smell or color.
- Do you have sores in the genital area or anywhere else on your body?
- Do you have any urinary symptoms, including frequent urination, burning or stinging with urination, or urinating in small amounts?
- What method of birth control do you use? Do you use condoms to protect against STDs?
- Do you or your partner engage in high-risk sexual behaviors, including sex without a condom?
- Do you or your partner have other sexual contact outside of your relationship?
- Have you had an STD in the past? How was it treated?
- Have you had PID in the past? How was it treated?
- When was your last menstrual period?
After your medical history is taken, the initial exam for PID will include a pelvic exam.
Laboratory and imaging tests
Other tests may be done to confirm the diagnosis of PID, to rule out other problems (such as appendicitis), or to find out whether the infection has spread. These tests include:
- Blood tests such as a complete blood count (CBC), sedimentation rate (ESR), or C-reactive protein test to detect signs of inflammation or infection.
- A blood or urine culture, which screens for infection.
- A pelvic or transvaginal ultrasound, which can show internal organs on a computer screen.
- Laparoscopy, which is the insertion of a lighted viewing instrument into the abdomen to look for signs of infection and scar tissue.
- Magnetic resonance imaging (MRI) or computed tomography (CT) scan, which, in rare cases, is used if symptoms aren't improving with treatment or an ultrasound has shown a possible growth or abscess that needs to be further evaluated.
Laparoscopy and ultrasound are considered the best procedures for diagnosing PID. But these tests are not done unless the diagnosis is in doubt or the results from the procedure will change the method used for treatment.
There is no standard screening for pelvic inflammatory disease (PID) at this time. But routine annual screening of young, sexually active women for chlamydia is thought to reduce the number of cases of PID and is recommended by experts.
Be sure to have a gynecologic exam promptly whenever you notice pelvic infection symptoms or pelvic pain. If you have been exposed to an STD, see your doctor for testing right away. If you are diagnosed with an STD, especially gonorrhea or chlamydia, you will be treated and evaluated for PID. Your partner(s) must also have treatment for the STD.
Women who have recently been infected with the human immunodeficiency virus (HIV) also should be checked for other STDs.
Untreated pelvic inflammatory disease (PID) can produce scar tissue (adhesions) that can cause ongoing (chronic) pelvic pain, ectopic pregnancy, and infertility. This is why PID must be treated right away, even if you have only one or two signs of PID.1 This means that you may be given antibiotic treatment before lab results have come back, based on your medical history and a physical exam. This is because waiting several days to treat you could raise your risks of fallopian tube damage and infertility.4
Antibiotic treatment for pelvic inflammatory disease (PID) usually takes 14 days. But the number of days you continue to take antibiotics depends on your infection and the type of antibiotic medicine. Your partner will also need treatment. Although you may feel better before the 2 weeks are up, be sure to finish taking the medicine. If you don't, the infection may return. You may also be able to use a nonsteroidal anti-inflammatory drug (NSAID) to relieve PID pain or discomfort.
Follow-up evaluations are important for making sure that treatment is working. Close monitoring may be able to prevent complications, such as chronic pelvic pain and infertility. Your doctor will want to check you 2 to 3 days after you've started treatment, then 7 to 10 days later. You will also have a checkup 4 to 6 weeks after treatment has ended, to monitor your recovery.
What to think about
Your doctor will recommend hospitalization if you are pregnant, are very ill, are vomiting, may need surgery for a tubo-ovarian abscess or ectopic pregnancy (which can result from PID), or aren't able to treat yourself at home.
Anyone with whom you have had sexual contact in the last 60 days should be evaluated and treated for sexually transmitted diseases (STDs) to prevent reinfection and passing infection on to someone else. Treatment for gonorrhea or chlamydia is not the same as treatment for PID. Different antibiotics are sometimes prescribed for PID, and they are taken for a longer period of time. Your partner will probably also need to take antibiotics.
To prevent reinfection, do not have sex until both you and your sex partner(s) have completed antibiotic treatment.
If initial antibiotic treatment cures the infection that caused pelvic inflammatory disease (PID), you will not need ongoing treatment. But it is important to make sure the infection is cured by following up with your doctor.
Avoiding a recurrent pelvic infection, particularly involving a sexually transmitted disease (STD), is the key to preventing another episode of PID. Regular condom use has been proved to reduce the risk of recurrent PID.5 (Having repeat episodes of PID increases your risks of tubal infertility, chronic pelvic pain, and ectopic pregnancy. For more information, see the Prevention section of this topic.)
Treatment if the condition gets worse
Most cases of PID are cured with antibiotic therapy. Surgery is not usually necessary to treat PID. But surgery may be needed to:
- Drain or remove a pocket of infection (abscess).
- Cut scar tissue (adhesions) that is causing pain. (Surgery to remove adhesions from pelvic inflammatory disease has not been proved to relieve pain unless adhesions are severe.6)
Exploratory surgery is sometimes used when a diagnosis is still unclear after other tests are done or when antibiotic treatment is not working. Diagnostic laparoscopy (which involves using a small lighted viewing instrument) is usually used.
What to think about
To avoid reinfection, it is critically important that you and your sex partner(s) be treated.
After having PID, it's important that you have any further pelvic symptoms checked promptly. Your doctor will want to examine you for signs of another infection, possible pelvic organ damage (adhesions), and other possible causes of your symptoms.
If you have had chlamydia (a common cause of PID) one time in the past, you might now be more sensitive to this bacteria. A second chlamydia infection can cause more irritation and pelvic organ damage that is worse than before. For this reason, it's very important that you use condoms to avoid being exposed to STDs. After having had PID, using a condom every time you have sex lowers your risk of recurrent PID and ongoing (chronic) pelvic pain.5
Practice safe sex
Preventing an STD is easier than treating an infection after it occurs. Abstaining from sexual contact is the only certain way to avoid exposure to STDs. Consistent condom use will greatly reduce your risk of an STD infection that can lead to PID. Even if you are using another birth control method to prevent pregnancy, use condoms to reduce infection risk.
- Talk with your partner about STDs before beginning a sexual relationship. Find out whether he or she is at risk for an STD. Remember that most STDs, like chlamydia and herpes, can infect you without causing symptoms, so only test results can tell whether your partner is infection-free. Some STDs, such as HIV, can take up to 6 months before they can be detected in the blood.
- Be responsible.
- Avoid sexual contact if you have symptoms of an STD or are being treated for an STD.
- Avoid all intimate sexual contact with anyone who has symptoms of an STD or who may have been exposed to an STD.
- Don't have more than one sex partner at a time. Your risk for an STD increases if you have several sex partners at the same time.
Use a condom every time you have sex. This lowers your risk of getting an STD or PID. You must put on a condom before beginning any sexual contact. Use condoms with a new partner until you are certain he or she does not have an STD.
You can use a male or female condom. A female condom is a good option for a woman whose partner does not have or will not use a male condom. For information about male and female condoms, see how to use a condom.
Avoid douching, which increases your risk for vaginal and pelvic infections.
Pelvic inflammatory disease (PID) and sexually transmitted diseases (STDs) require prompt medical treatment. If you have any unusual pelvic symptoms or pain, see your doctor without delay, even if your symptoms don't seem serious.
After you have started medical treatment for PID, your doctor will give you specific instructions for home care. Be sure to follow those instructions and keep all follow-up appointments.
Use the following home treatment measures to support your recovery.
- Rest as much as possible until your symptoms start to get better (usually a couple of days), then return to your usual activities slowly.
- Take regular doses of a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, for pain. If pain does not improve within 48 to 72 hours after you start treatment, tell your doctor.
- Do not have sex until you've taken all antibiotic medicine, your pain is gone entirely, and you feel completely well. Also, do not have sex until your partner or partners have finished treatment for any sexually transmitted diseases (STDs).
- Make and keep follow-up appointments. Your doctor will want to see you 2 to 3 days after you've started antibiotics to make sure they are working. You may also be seen for follow-up 7 to 10 days later to make sure you are getting better and to talk about how to avoid another infection. You may have an additional follow-up exam at 4 to 6 weeks to see whether you've fully recovered.
- Call your doctor if your symptoms get worse or come back.
The treatment of choice for pelvic inflammatory disease (PID) is usually 2 weeks of a broad-spectrum antibiotic, which kills more than one type of bacteria. But the number of days you continue to take antibiotics depends on your infection and the type of antibiotic medicine. If taken properly, antibiotics will destroy the bacteria causing PID. Prompt antibiotic treatment may prevent complications from PID or reduce their severity.
Treatment is started even when you meet only the minimum criteria for PID with or without other symptoms. Treatment for gonorrhea or chlamydia is not the same as treatment for PID. Different antibiotics are sometimes used for PID, and they are taken for a longer period of time.
To prevent reinfection, sex partners with or without symptoms must also be tested for sexually transmitted diseases (particularly gonorrhea and chlamydia). Any infection must be immediately treated.
It sometimes takes more than one course of medicine to cure PID. Sometimes bacteria can become resistant to an antibiotic, meaning that the antibiotic is no longer effective against the bacteria. This makes it necessary to try another type of antibiotic.
Reinfection from an untreated sex partner also requires another round of antibiotic treatment.
- Antibiotics for pelvic inflammatory disease
What To Think About
The treatment for PID usually takes 2 weeks. But the number of days you continue to take antibiotics depends on your infection and the type of antibiotic medicine. It is very important that you take all the medicine, or the infection can come back.
Surgery is not usually done to treat pelvic inflammatory disease (PID) unless it is needed to:
- Drain or remove an abscess, such as a tubo-ovarian abscess.
- Cut scar tissue (adhesions) that is causing pain.
Surgery is sometimes used when a diagnosis is still unclear after other tests are done or when antibiotic treatment is not working. Diagnostic laparoscopy is usually used.
Procedures that may be used to diagnose and treat the complications of pelvic inflammatory disease (PID) include:
- Laparoscopy, which allows the surgeon to insert a lighted viewing instrument through a very small abdominal incision, look for signs of ectopic pregnancy or infection and scar tissue, and make repairs if necessary.
- Laparotomy, which allows the surgeon to directly inspect the abdominal cavity through a small incision in the abdomen and make repairs if necessary.
- Drainage of an abscess using a needle and syringe. The doctor usually uses ultrasound to clearly see where the needle is going, which makes an incision unnecessary.
What To Think About
The need for surgical treatment of PID has decreased over the past several years because of earlier diagnosis and better antibiotic treatment.
Laparoscopy or laparotomy may be done for diagnosis of pelvic symptoms, and treatment can be done at the same time. Laparoscopy is used more often. Laparotomy typically requires a longer recovery period.
There is no other treatment available for pelvic inflammatory disease at this time.
- American Academy of Pediatrics (2006). Pelvic inflammatory disease. In LK Pickering et al., eds., Red Book: 2006 Report of the Committee on Infectious Diseases, 27th ed., pp. 493–498. Elk Grove Village, IL: American Academy of Pediatrics.
- Soper DE, Mead PB (2005). Infections of the female pelvis. In GL Mandell et al., eds., Principles and Practice of Infectious Diseases, 6th ed., pp. 1372–1381. Philadelphia: Elsevier Churchill Livingstone.
- Golden MR (2003). Vaginitis and sexually transmitted diseases. In DC Dale, DD Federman, eds., Scientific American Medicine, vol. 2, part 7, chap. 22. New York: WebMD.
- Centers for Disease Control and Prevention (2006, updated 2007). Pelvic inflammatory disease section of Sexually transmitted diseases treatment guidelines, 2006. MMWR, 55(RR-11): 56–61.
- Ness RB, et al. (2004). Condom use and the risk of recurrent pelvic inflammatory disease, chronic pelvic pain, or infertility following an episode of pelvic inflammatory disease. American Journal of Public Health, 94(8): 1327–1329.
- Howard FM (2003). Chronic pelvic pain. Obstetrics and Gynecology, 101(3): 594–611.
|Author||Sandy Jocoy, RN|
|Associate Editor||Tracy Landauer|
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||Kirtly Jones, MD - Obstetrics and Gynecology|
|Last Updated||June 3, 2009|
Last Updated: June 3, 2009