Pelvic inflammatory disease (PID)
PID; Oophoritis; Salpingitis; Salpingo - oophoritis; Salpingo - peritonitisPelvic inflammatory disease (PID) is an infection of a woman's womb (uterus), ovaries, or fallopian tubes.
Causes
PID is an infection caused by bacteria. When bacteria from the vagina or cervix travel to your womb, fallopian tubes, or ovaries, they can cause an infection.
Most of the time, PID is caused by the bacteria chlamydia or gonorrhea. These are sexually transmitted infections (STIs). Having unprotected sex with someone who has an STI can cause PID.
Chlamydia
Chlamydia is an infection caused by the bacteria Chlamydia trachomatis. It is most often spread through sexual contact.
Read Article Now Book Mark ArticleGonorrhea
Gonorrhea is a common sexually transmitted infection (STI).
Read Article Now Book Mark ArticleBacteria normally found in the cervix can also travel into the uterus and fallopian tubes during a medical procedure such as:
- Childbirth
- Endometrial biopsy (removing a small piece of your womb lining to test for cancer)
Endometrial biopsy
Endometrial biopsy is the removal of a small piece of tissue from the lining of the uterus (endometrium) for examination.
Read Article Now Book Mark Article - Getting an intrauterine device (IUD)
- Miscarriage
Miscarriage
A miscarriage is the spontaneous loss of a fetus before the 20th week of pregnancy. Pregnancy losses after the 20th week are called stillbirths. Mi...
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In the United States, nearly 1 million women have PID each year. About 1 in 8 sexually active women will have PID before age 20.
You are more likely to get PID if:
- You have a sex partner with gonorrhea or chlamydia.
- You have sex with many different people.
- You have had an STI in the past.
- You have recently had PID.
- You have contracted gonorrhea or chlamydia and have an IUD.
- You have had sex before age 20.
Symptoms
Common symptoms of PID include:
- Fever
- Pain or tenderness in the pelvis, lower belly, or lower back
- Fluid from your vagina that has an unusual color, texture, or smell
Fluid from your vagina
Vaginal discharge refers to secretions from the vagina. The discharge may be:Thick, pasty, or thinClear, cloudy, bloody, white, yellow, or greenOdor...
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Other symptoms that may occur with PID:
- Bleeding after intercourse
- Chills
- Being very tired
Very tired
Fatigue is a feeling of weariness, tiredness, or lack of energy.
Read Article Now Book Mark Article - Pain when you urinate
- Having to urinate often
- Period cramps that hurt more than usual or last longer than usual
Period cramps
Painful menstrual periods are periods in which a woman has crampy lower abdominal pain, which can be sharp or aching and come and go. Back pain and/...
Read Article Now Book Mark Article - Unusual bleeding or spotting during your period
Spotting
This article discusses vaginal bleeding that occurs between a woman's monthly menstrual periods. Such bleeding may be called "intermenstrual bleedin...
Read Article Now Book Mark Article - Not feeling hungry
- Nausea and vomiting
- Skipping your period
- Pain when you have intercourse
You can have PID and not have any severe symptoms. For example, chlamydia can cause PID with no symptoms. Women who have an ectopic pregnancy or who are infertile often have PID caused by chlamydia. An ectopic pregnancy is when an egg grows outside of the uterus. It puts the mother's life in danger.
Ectopic pregnancy
An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus).
Read Article Now Book Mark ArticleInfertile
Infertility means you cannot get pregnant (conceive). There are 2 types of infertility:Primary infertility refers to couples who have not become preg...
Read Article Now Book Mark ArticleExams and Tests
Your health care provider may do a pelvic exam to look for:
- Bleeding from your cervix. The cervix is the opening to your uterus.
Cervix
The cervix is the lower end of the womb (uterus). It is at the top of the vagina. It is about 2. 5 to 3. 5 centimeters (1 to 1. 3 inches) long. Th...
Read Article Now Book Mark Article - Fluid coming out of your cervix.
- Pain when your cervix is touched.
- Tenderness in your uterus, tubes, or ovaries.
You may have lab tests to check for signs of body-wide infection:
- C-reactive protein (CRP)
C-reactive protein
C-reactive protein (CRP) is produced by the liver. The level of CRP rises when there is inflammation in the body. It is one of a group of proteins,...
Read Article Now Book Mark Article - Erythrocyte sedimentation rate (ESR)
Erythrocyte sedimentation rate
ESR stands for erythrocyte sedimentation rate. It is commonly called a "sed rate. "It is a test that indirectly measures the level of certain protei...
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WBC count
A WBC count is a blood test to measure the number of white blood cells (WBCs) in the blood. It is a part of a complete blood count (CBC). WBCs are a...
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Other tests include:
- A swab taken of your vagina or cervix. This sample will be checked for gonorrhea, chlamydia, or other causes of PID.
- Pelvic ultrasound or CT scan to see what else may be causing your symptoms. Appendicitis or pockets of infection around your tubes and ovaries, called tubo-ovarian abscess (TOA), may cause similar symptoms.
Pockets of infection
An abscess is a collection of pus in any part of the body. In most cases, the area around an abscess is swollen and inflamed.
Read Article Now Book Mark Article - Pregnancy test.
Pregnancy test
A pregnancy test measures a hormone in the body called human chorionic gonadotropin (HCG or hCG). HCG is a hormone produced during pregnancy. It ap...
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Treatment
Your provider will often have you start taking antibiotics while waiting for your test results.
If you have mild PID:
- Your provider will give you a shot containing an antibiotic.
- You will be sent home with antibiotic pills to take for up to 2 weeks.
- You will need to follow-up closely with your provider.
If you have more severe PID:
- You may need to stay in the hospital.
- You may be given antibiotics through a vein (IV).
- Later, you may be given antibiotic pills to take by mouth.
There are many different antibiotics that can treat PID. Some are safe for pregnant women. Which type you take depends on the cause of the infection. You may receive a different treatment if you have gonorrhea or chlamydia.
Gonorrhea
Gonorrhea is a common sexually transmitted infection (STI).
Read Article Now Book Mark ArticleChlamydia
Chlamydia is an infection caused by the bacteria Chlamydia trachomatis. It is most often spread through sexual contact.
Read Article Now Book Mark ArticleFinishing the full course of antibiotics you've been given is extremely important for treating PID. Scarring inside the womb or of the tubes from PID may lead to the need to have surgery or undergo invitro fertilization (IVF) to become pregnant. Follow up with your provider after you've finished the antibiotics to make sure that you no longer have the bacteria in your body.
It's very important that you practice safe sex in order to reduce your risk of getting infections, which could lead to PID.
If your PID is caused by an STI like gonorrhea or chlamydia, your sexual partner must be treated as well.
- If you have more than one sexual partner, they must all be treated.
- If your partner is not treated, they can infect you again, or can infect other people in the future.
- Both you and your partner must finish taking all of the prescribed antibiotics.
- Use condoms until you both have finished taking antibiotics.
Possible Complications
PID infections can cause scarring of the pelvic organs. This can lead to:
- Long-term (chronic) pelvic pain
- Ectopic pregnancy
Ectopic pregnancy
An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus).
Read Article Now Book Mark Article - Infertility
Infertility
Infertility means you cannot get pregnant (conceive). There are 2 types of infertility:Primary infertility refers to couples who have not become preg...
Read Article Now Book Mark Article - Tubo-ovarian abscess
If you have a serious infection that does not improve with antibiotics, you may need surgery.
When to Contact a Medical Professional
Contact your provider if:
- You have symptoms of PID.
- You think you have been exposed to an STI.
- Treatment for a current STI does not seem to be working.
Prevention
Get prompt treatment for STIs.
You can help prevent PID by practicing safer sex.
Safer sex
Safe sex means taking steps before and during sex that can prevent you from getting an infection, or from giving an infection to your partner. These...
Read Article Now Book Mark Article- The only absolute way to prevent an STI is to not have sex (abstinence).
- You can reduce your risk by having a sexual relationship with only one person. This is called being monogamous.
- Your risk will also be reduced if you and your sexual partners get tested for STIs before starting a sexual relationship.
- Using a condom every time you have sex also reduces your risk.
Here is how you can reduce your risk for PID:
- Get regular STI screening tests.
- If you are a new couple, get tested before starting to have sex. Testing can detect infections that are not causing symptoms.
- If you are a sexually active woman age 24 or younger, get screened each year for chlamydia and gonorrhea.
- All women with new sexual partners or multiple partners should also be screened.
References
Centers for Disease Control and Prevention website. Sexually transmitted infections treatment guidelines, 2021. www.cdc.gov/std/treatment-guidelines/default.htm. Updated June 13, 2023. Accessed September 27, 2023.
Lipsky AM, Hart D. Acute pelvic pain. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 29.
McKinzie J. Sexually transmitted infections. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 84.
Prescott LS, Yunker AC, Alvarez R. Gynecologic surgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 71.
Pelvic laparoscopy - illustration
Laparoscopy is performed when less-invasive surgery is desired. It is also called Band-Aid surgery because only small incisions need to be made to accommodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.
Pelvic laparoscopy
illustration
Female reproductive anatomy - illustration
Internal structures of the female reproductive anatomy include the uterus, ovaries, and cervix. External structures include the labium minora and majora, the vagina and the clitoris.
Female reproductive anatomy
illustration
Uterus - illustration
The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.
Uterus
illustration
Pelvic laparoscopy - illustration
Laparoscopy is performed when less-invasive surgery is desired. It is also called Band-Aid surgery because only small incisions need to be made to accommodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.
Pelvic laparoscopy
illustration
Female reproductive anatomy - illustration
Internal structures of the female reproductive anatomy include the uterus, ovaries, and cervix. External structures include the labium minora and majora, the vagina and the clitoris.
Female reproductive anatomy
illustration
Uterus - illustration
The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.
Uterus
illustration
Review Date: 7/12/2023
Reviewed By: John D. Jacobson, MD, Professor Emeritus, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.