Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infection of the female upper genital tract, including the womb, fallopian tubes and ovaries.

How do I get PID?

Most cases of PID are caused by an infection in the vagina or the neck of the womb (cervix) that has spread higher up.

Many different types of bacteria can cause PID, but most cases are the result of a chlamydia or gonorrhoea infection.

In some cases, the cause of the infection that leads to PID is unknown. Such cases may be the result of normally harmless bacteria found in the vagina. These bacteria can sometimes get past the cervix and into the reproductive organs. Although harmless to the vagina, these types of bacteria can cause infection and symptoms in other parts of the body.

Symptoms of PID

The symptoms of Pelvic Inflammatory Disease (PID) are fairly general, which means the condition can be difficult to diagnose. The symptoms may include:

• pain around the pelvis or lower abdomen
• discomfort or pain during sex that is felt deep inside the pelvis
• bleeding between periods and after sex
• unusual vaginal discharge, especially if it's yellow or green
• fever and vomiting
• pain in the rectum (back passage)

Other consequences of PID can include abscesses, ectopic pregnancies and infertility.

Abscesses

Sometimes, PID can cause abscesses in the fallopian tubes and/or ovaries.

An abscess is a collection of infected fluid. It can usually be treated with antibiotics. If an abscess does not respond to antibiotics, you may require surgery to drain the infected fluid.

It's important that abscesses inside the pelvis are either treated or removed, as an abscess that bursts inside you can be potentially life threatening.

Ectopic pregnancy

The word 'ectopic' means in the wrong place. In a normal pregnancy, the fertilised egg implants in the womb lining. An ectopic pregnancy is one that occurs outside the womb.

Over 95% of ectopic pregnancies occur in a fallopian tube. If PID develops in the fallopian tubes, it can scar the lining of the tubes, making it more difficult for eggs to pass through.

If a fertilised egg gets stuck and begins to grow inside the tube, it can cause the tube to burst, which can sometimes lead to severe internal bleeding. Ectopic pregnancy is a potentially fatal condition if not recognised and treated.

Infertility

It's estimated that one in 10 women may become infertile as a result of PID, with the highest risk in those with delayed treatment, severe infection and/or repeated episodes.

Infertility means that it can be more difficult to get pregnant naturally. PID can cause infertility by scarring the fallopian tubes so an egg can’t travel down into the womb.

Testing for PID

If you think you have PID you can make an appointment with your GP or local sexual health services.

There is no single test for diagnosing PID. Your doctor will diagnose PID based on your symptoms and on an examination, in addition to tests.

When your doctor examines you, they will look for tenderness in your pelvic region and an abnormal vaginal discharge. This will usually involve a gentle internal examination by the doctor or nurse which might feel a little uncomfortable.

The doctor will usually take swabs from inside your vagina and cervix, which will be sent to a lab to try to identify the type of bacteria causing the infection. However, a swab test can't be relied on to diagnose PID, as some women with PID have a negative swab result.

You may have a blood test or an ultrasound scan. Scans can identify severe PID but will not show up mild disease. It's possible to have a normal scan and still have PID.

Treatment for PID

If it's diagnosed at an early stage, PID can be treated quickly and efficiently with antibiotics. You will probably be given antibiotics to take by mouth for at least two weeks.

Severe cases may be admitted to hospital for observation and treatment with antibiotic injections.

Always see your doctor or nurse if you think you might have PID, as the sooner you are treated, the better. If you're given treatment, always make sure that you take all of your antibiotics and finish the entire course.

It's advised that your partner(s) are treated and that you avoid sex until your treatment is completed

Reducing the risk of PID

The most effective way to prevent PID is to protect yourself from sexually transmitted infections (STIs).

This means using a condom for vaginal or anal or oral sex.

STI’s

If you have been diagnosed with pelvic inflammatory disease it’s recommended you get tested for all STI's including:

• chlamydia
• gonorrhoea
• syphilis