Pelvic Inflammatory Disease (PID)

If you’re sexually active, you may know about sexually transmitted infections (STIs) and their symptoms. But if you don’t have symptoms, you might not think to get tested. The problem is that it’s possible to have certain infections without knowing it. 

One complication is pelvic inflammatory disease, or PID. If left untreated, PID can lead to health problems later on. Here’s what you need to know.

What is pelvic inflammatory disease (PID)?

Pelvic inflammatory disease (PID) is a bacterial infection of the female reproductive organs. It usually begins in the vagina and cervix (the opening of the uterus). Then it spreads into the uterus, fallopian tubes, and ovaries. PID is a serious complication of sexually transmitted infections (STIs), like chlamydia and gonorrhea.

PID is fairly common. In the U.S., more than 1 million women are diagnosed with PID each year. About 4.4% of women ages 18 to 44 have a history of PID.

What causes PID?

PID is usually caused by germs related to vaginal infections. Bacteria move from your vagina and cervix into your uterus, ovaries, or fallopian tubes. Once the bacteria spread, they can cause a full-blown infection. Inflammation from the infection causes scarring and other damage to your reproductive organs.

Gonorrhea and chlamydia were historically the biggest causes of PID. But newer research suggests that many different bacteria can cause PID, including:

• Neisseria gonorrhoeae

• Chlamydia trachomatis

• Mycoplasma genitalium

• Escherichia coli

• Haemophilus influenza

• Staphylococcus species

• Streptococcus species

In many cases, a combination of bacteria is to blame. PID has also been linked to bacteria found in bacterial vaginosis (BV). BV isn’t technically an infection — it’s a condition caused by an overgrowth of bacteria in the vagina.

What are the symptoms of PID?

Symptoms of PID can range from mild to severe. Some women have no symptoms at all. Even without symptoms, PID can still cause severe damage to your reproductive organs.

If you have any of the following symptoms of PID, it’s important to see a healthcare professional right away:

• Mild ache or pain in your lower abdomen, pelvis, or right upper abdomen

• Abnormal vaginal discharge or bleeding

• Painful urination

• Painful sex

• Nausea and vomiting

• Fever (100.4°F or higher) and chills

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How is pelvic inflammatory disease diagnosed?

There isn’t one specific test that can confirm PID. Instead, a healthcare professional will make the diagnosis based on your symptoms, health history, and physical examination. 

The most important part of diagnosing PID is a pelvic exam. This is to check for abnormal discharge and get vaginal swabs to test for infections such as chlamydia and gonorrhea. It’s also important to assess for any tenderness during a pelvic exam, because this can also indicate infection.

Additional tests can sometimes help figure out if you have PID or another condition. These tests may include:

• A urine test to check for a urinary tract infection (UTI)

• A urine or blood test to check for pregnancy

• Imaging tests, such as ultrasound, CT, or MRI, to look at your internal organs and check for an abscess

• An endometrial biopsy, which removes a sample of tissue from the lining of your uterus so it can be examined under a microscope

• A diagnostic laparoscopy, which uses a small camera to look inside your pelvis

If your healthcare team thinks you could have PID, they may recommend treatment even if you’re still waiting for certain test results. This is because any delay in starting treatment increases your risk of complications.

How is PID treated?

The best treatment for PID is antibiotics, either at home or in the hospital. People who are pregnant, very ill, or have other medical complications may need intravenous (IV) antibiotic treatment in the hospital.

Outpatient (at-home) treatment involves taking 2 or 3 antibiotics by mouth, for at least 2 weeks. In some cases, you may receive a one-time injection of antibiotics into your muscle before starting oral antibiotics.

It’s important to take the full course of antibiotics, even if you start feeling better. This helps improve your chances of fully getting rid of the infection.

Here’s a typical at-home treatment plan for PID:

• Doxycycline pills (100 mg) taken twice a day for 2 weeks

• Metronidazole pills (500 mg) taken twice a day for 2 weeks

• A one-time shot of a cephalosporin antibiotic, like ceftriaxone

Your sex partner(s) should also be treated to help prevent reinfection.

What happens if PID isn’t treated?

Untreated PID is known to cause harmful inflammation and scarring. This can cause permanent problems, such as:

• Infertility

• Chronic pelvic pain

• Abdominal infections

• Ectopic pregnancy (a pregnancy that develops outside your uterus)

• Adhesions (scar tissue that can cause organs in your abdomen and pelvis to stick together)

A rare complication of PID is Fitz-Hugh-Curtis syndrome (FHCS), also called perihepatitis. This condition occurs when the infection leads to inflammation and adhesions in the tissues around your liver. It causes right upper abdominal pain, fever, and vomiting. FHCS is treated with antibiotics, but it may require hospitalization.

How to prevent PID

Not every single case of PID can be prevented because it’s not always caused by an STI. But there are ways you can help prevent PID.

You can take the following steps to decrease your risk of getting STIs and PID:

• Use condoms every time you have sex, even if you’re using another form of birth control.

• Get tested for STIs regularly. Ask your partner to get tested, too, and share your results with each other.

• Limit your number of sex partners. The more sexual partners you have, the higher your risk of getting an STI.

• Don’t douche. Douching can remove the healthy bacteria that live in your vagina and it can cause unhealthy bacteria to travel into your reproductive tract.

Because STIs play a major role in developing PID, it’s important to get tested regularly. If you’re not sure about how and when to get tested, talk with your healthcare team and refer to this STI testing guide. There are even at-home testing kits to make testing more convenient.

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Written by:

Camille Moreno, DO, NCMP

Camille Moreno, DO, NCMP, is a women’s health specialist currently practicing at Duke University Medical Center in obstetrics and gynecology. She earned her bachelor of science degree in biology from Virginia Tech and her Doctor of Osteopathic Medicine from Virginia College of Osteopathic Medicine.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She is co-executive director at Nonclinical Physicians Network and has served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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