Pelvic Inflammatory Disease

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is pelvic inflammatory disease?

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs, including the uterine lining, ovaries, and fallopian tubes. It may produce severe symptoms, including pain, infertility, and reproductive dysfunction.

Pelvic inflammatory disease is a common disease that affects nearly 1 million women each year. It appears most frequently in women who are younger than 20 years old. About one in every eight women in this age range develops PID.

PID is commonly caused by bacteria from a sexually transmitted disease, such as chlamydia or gonorrhea. The bacteria spread through the vagina after sexual contact with an infected person and then move up into the uterus, fallopian tubes, or ovaries, eventually infecting the reproductive system.

PID can also be caused by normal vaginal bacteria not related to sexually transmitted disease. Less commonly, the bacteria that cause pelvic inflammatory disease can enter the body after a pelvic procedure through the cervix, including getting an intrauterine device (IUD), hysteroscopy, endometrial biopsy, or D and C (dilation and curettage).

Women with pelvic inflammatory disease may not experience any symptoms, or symptoms may be mild. Typically, the disease is detected when complications arise, such as severe symptoms, infertility, or ectopic pregnancy (life-threatening pregnancy growing outside the uterus).

The most common symptoms of pelvic inflammatory disease include abdominal pain, vaginal discharge, and fever. More severe symptoms may include painful sexual intercourse, painful urination, fatigue, and nausea with or without vomiting. Antibiotic therapy is the treatment for PID and can prevent serious complications.

Left untreated, pelvic inflammatory disease can lead to potentially life-threatening complications. Severe infection can occur, resulting in shock, coma, and even death. Seek immediate medical care (call 911) if you have symptoms of severe infection, such as confusion, lethargy, loss of consciousness, high fever (higher than 101°F), rapid heart rate, weak pulse, difficulty breathing, or reduced urine production.

What are the symptoms of pelvic inflammatory disease?

Women with pelvic inflammatory disease may not experience any symptoms. However, because the disease causes inflammation of the reproductive organs, a number of symptoms may occur. The symptoms can vary in intensity among individuals.

Common symptoms of pelvic inflammatory disease

Common symptoms that may occur with PID include:

  • Abdominal, pelvic, or lower back pain that can be severe

  • Abnormal vaginal discharge

  • Fever

  • Urinary discomfort

Other symptoms of pelvic inflammatory disease

Other symptoms that may occur with PID include:

  • Bleeding following sexual intercourse

  • Chills

  • Difficult or painful urination, or burning with urination (dysuria)

  • Fatigue

  • Frequent urination

  • Increased pelvic cramping or pain

  • Loss of appetite

  • Missed menstrual periods

  • Nausea with or without vomiting

  • Pain during sexual intercourse

  • Vaginal discharge, spotting, or abnormal bleeding

Serious symptoms that might indicate a life-threatening condition

In some cases, infection resulting from pelvic inflammatory disease is so severe that a life-threatening situation may develop within hours. Seek immediate medical care (call 911) if you or someone you are with has any of the following symptoms:

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness

  • Fast heart rate (tachycardia)

  • High fever (higher than 101°F)

  • Greatly reduced or no urine output

  • Rapid breathing rate (tachypnea)

  • Weak pulse

What causes pelvic inflammatory disease?

Pelvic inflammatory disease (PID) is infection of the female reproductive organs. The disease is most commonly caused by bacteria from a sexually transmitted disease, such as chlamydia or gonorrhea, which spread through the vagina after sexual contact with an infected person. These bacteria then spread to the uterus, fallopian tubes, or ovaries, eventually infecting the reproductive system.

Bacteria normally found in the vagina and cervix can enter the uterus or fallopian tubes during medical procedures through the cervix including:

  • Childbirth (more common with C-section delivery)

  • D and C (dilation and curettage)

  • Endometrial biopsy

  • Hysteroscopy

  • Placement of an intrauterine device (IUD)

  • Miscarriage or abortion

How do you prevent pelvic inflammatory disease?

You may be able to prevent or lower your risk of developing pelvic inflammatory disease by:

  • Abstaining from sexual intercourse

  • Engaging in a monogamous relationship with a partner who has been screened for sexually transmitted infections

  • Practicing safe sex

  • Using a condom consistently and correctly

  • Having a yearly chlamydia screening if you are sexually active, or being screened if you change sex partners or become pregnant

What are some conditions related to pelvic inflammatory disease?

Conditions related to pelvic inflammatory disease include inflammation or infections of the female reproductive organs including:

  • Cervicitis, inflammation of the cervix 

  • Endometritis, inflammation or irritation of the lining of the uterus (endometrium) 

  • Salpingitis, inflammation of the fallopian tubes 

  • History of pelvic inflammatory disease

  • Sexually transmitted disease

When should you see a doctor for pelvic inflammatory disease?

Contact your doctor if you are experiencing abdominal or pelvic pain, especially if it is getting worse or interfering with your daily activities. If pain comes on suddenly and is severe, seek immediate medical treatment.

Other symptoms of PID can vary in intensity and include:

  • Abdominal, pelvic, or lower back pain that can be severe

  • Abnormal vaginal discharge

  • Fever

  • Pain or bleeding following sexual intercourse

  • Urinary discomfort, or frequent urination

  • Vaginal discharge, spotting, or abnormal bleeding

You should also contact your doctor if you think you might have been exposed to a sexually transmitted disease, such as chlamydia or gonorrhea, or if you think you have PID. If you have had PID in the past, you have a higher risk of getting it again.

Early diagnosis and treatment can prevent the complications of PID.

How do doctors diagnose pelvic inflammatory disease?

To diagnose the underlying cause of your symptoms, your doctor or healthcare provider will take a medical history, perform a physical exam (including a pelvic exam), and possibly order testing or imaging.

During a pelvic exam, a doctor will look for:

  • Bleeding or discharge from the cervix

  • Tenderness or pain from the uterus, fallopian tubes, ovaries or cervix 

To check for signs of inflammation or infection, your doctor may order lab tests including:

  • C-reactive protein (CRP), a type of blood test that measures the level of c-reactive protein in your blood. High levels of this protein made by the liver may be a sign of a serious infection.

  • Erythrocyte sedimentation rate (ESR), a type of blood test that measures how quickly red blood cells settle to the bottom of a test tube. A faster than normal rate may indicate inflammation or infection.

  • White blood count (WBC), a type of blood test that measures the number of white cells in your blood. White blood cells help your body fight infection and other diseases.

  • Pregnancy test to check for ectopic or tubal pregnancy (life-threatening pregnancy growing outside the uterus)

  • Tests on a swab taken of the cervix or vagina to check for gonorrhea, chlamydia or other causes of PID

Your doctor may also order a pelvic ultrasound or CT scan to see what else may be causing symptoms.

How do you treat pelvic inflammatory disease?

Treatment for pelvic inflammatory disease (PID) begins with seeking medical care from your healthcare provider. Prompt treatment is needed to prevent serious complications.

PID is usually treated with antibiotic therapy. Because the disease may be caused by several different bacteria, more than one antibiotic may be prescribed. With proper antibiotic therapy, PID can be successfully eliminated.

Your healthcare provider will prescribe antibiotics to reduce the duration of the infection and lessen the severity of your symptoms. Follow all instructions from your doctor, including refraining from sexual intercourse until you complete antibiotic therapy and your doctor confirms the infection is cleared. It’s important to finish the full course of antibiotics, even if symptoms disappear.

For severe PID, you may need to stay in the hospital to receive antibiotics through an IV. If symptoms continue or if you have an abscess that does not go away with antibiotics, surgery may be needed.

Antibiotics for pelvic inflammatory disease

Many different antibiotics are used to treat pelvic inflammatory disease. Which type your doctor orders depends on the cause of your infection and if you are pregnant. Broad spectrum antibiotics used to treat PID include:

  • Azithromycin (Zithromax)

  • Ceftriaxone (Rocephin)

  • Cefuroxime (Ceftin)

  • Erythromycin (E-Mycin, E.E.S., Ery-Tab)

  • Metronidazole (Flagyl)

  • Tetracycline (Brodspec, Emtet-500, Ala-Tet)

Additionally, your sexual partner(s) should be treated with antibiotics—even if they have no symptoms—to decrease the risk of reinfection.

What are the potential complications of pelvic inflammatory disease?

Severe pelvic inflammatory disease has the potential to cause serious damage to female reproductive organs. Fortunately, such damage can be prevented by prompt treatment with antibiotics.

Left untreated, pelvic inflammatory disease can cause serious complications including:

  • Abscess in the fallopian tubes or ovaries

  • Chronic abdominal or pelvic pain

  • Ectopic pregnancy, a life-threatening pregnancy growing outside the uterus

  • Fitz-Hugh-Curtis syndrome, a serious infection of the fallopian tubes that spreads to the liver

  • Infertility, inability to become pregnant

  • Long-term chronic pelvic pain

  • Peritonitis, a serious abdominal infection

  • Recurrent infections

  • Scar tissue inside and outside the fallopian tubes leading to blocked tubes; one cause of infertility

  • Spread of infection

  • Tubal pregnancy, a life-threatening pregnancy growing in a fallopian tube
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jul 15
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Pelvic inflammatory disease (PID) - CDC fact sheet. Centers for Disease Control and Prevention. http://www.cdc.gov/std/pid/stdfact-pid.htm
  2. Pelvic inflammatory disease (PID). MedlinePlus, National Library of Medicine, National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000888.htm
  3. Pelvic Inflammatory Disease (PID). Merck Manual. https://www.merckmanuals.com/home/women-s-health-issues/vaginal-infections-and-pelvic-inflammatory-disease/pelvic-inflammatory-disease-pid