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What is Pelvic Inflammatory Disease (PID)?
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract including the uterus, fallopian tubes, and ovaries. It's usually caused by bacteria ascending from the cervix, most commonly chlamydia and gonorrhoea. PID can range from mild to severe and can cause permanent damage to reproductive organs. Prompt treatment is essential to prevent complications including infertility.
Symptoms
- Lower abdominal or pelvic pain
- Pain during sex (deep dyspareunia)
- Abnormal vaginal discharge
- Bleeding between periods or after sex
- Painful or heavy periods
- Fever (in more severe cases)
- Pain on cervical movement during examination
- Symptoms may be mild or absent in some cases
Causes
- Chlamydia trachomatis (most common)
- Neisseria gonorrhoeae
- Mycoplasma genitalium
- Normal vaginal bacteria can be involved
- Bacteria ascend from cervix to upper genital tract
- Risk increased after childbirth, miscarriage, or procedures
- IUD insertion can rarely trigger PID
Who Is at Risk?
- Women under 25 (highest rates)
- Women with STIs (especially untreated chlamydia/gonorrhoea)
- Women with multiple sexual partners
- Women with previous PID
- Women who douche
- Recently inserted IUD (first 3 weeks only)
- Women with bacterial vaginosis
Potential Complications
- Chronic pelvic pain (30% of women)
- Infertility (10-15% after single episode, higher with repeated PID)
- Ectopic pregnancy (6-10 times higher risk)
- Tubo-ovarian abscess
- Fitz-Hugh-Curtis syndrome (liver capsule inflammation)
- Recurrent PID
- Early treatment significantly reduces complication risk
How We Diagnose
PID is a clinical diagnosis based on pelvic pain plus either cervical motion tenderness or uterine/adnexal tenderness on examination. We test for chlamydia, gonorrhoea, and other STIs. Blood tests may show inflammation. Ultrasound can identify tubo-ovarian abscess. A low threshold for diagnosis is recommended as untreated PID has serious consequences.
Treatment Options
Antibiotics are given to cover likely organisms - typically a combination covering chlamydia, gonorrhoea, and anaerobes. Outpatient treatment is usually effective for mild-moderate PID. Severe cases, pregnant women, or those not responding may need hospital admission for IV antibiotics. Partners must be tested and treated. Follow-up ensures resolution.
Prevention
Frequently Asked Questions
Can PID affect my fertility?
Yes, PID can damage fallopian tubes causing scarring that affects fertility. About 10-15% of women have fertility problems after a single episode of PID, and risk increases with repeated infections or delayed treatment. However, prompt treatment significantly reduces this risk. If you have pelvic pain, don't delay seeking care.
I have an IUD - am I at higher risk of PID?
The risk of PID is slightly increased in the 3 weeks after IUD insertion, not from the IUD itself but from any existing cervical infection being pushed upward. After this period, IUDs don't increase PID risk. We recommend STI screening before or at IUD insertion. IUDs don't need removal if PID develops.
My symptoms are mild - is it still PID?
PID can cause minimal symptoms while still damaging reproductive organs. 'Silent' or subclinical PID is common. This is why we have a low threshold for diagnosis and treatment. Even mild pelvic symptoms warrant evaluation, especially with STI risk factors. Early treatment prevents complications.
Does my partner need treatment even without symptoms?
Yes. Male partners of women with PID should be tested and treated, typically with antibiotics covering chlamydia and gonorrhoea, even if their tests are negative (as they may have already cleared the infection while you developed PID). Treating partners prevents reinfection. Avoid sex until both have completed treatment.
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Concerned About Pelvic Inflammatory Disease (PID)?
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