Pelvic Inflammatory Disease: Causes & Treatment
What is pelvic inflammatory disease?
Pelvic inflammatory disease (PID) is an infection in the female reproductive system, including the uterus, fallopian tubes, or ovaries. About 85% of cases are caused by a sexually transmitted infection (STD), such as gonorrhea or chlamydia.
Sometimes tubo-ovarian abscesses develop—pockets of infection next to the fallopian tube or ovary.
PID is treated with antibiotics. If symptoms do not improve with antibiotics, then the abscess may need to be drained. Or you may need surgery to remove the fallopian tube or ovary. Untreated PID can lead to infertility.
What are the symptoms of PID in a female?
Ask your doctor: Has anything been noted during my work up that may have a negative impact on future fertility? —Dr. Jessica White-Videa, DO, FACOG
The most common symptom of PID is lower abdominal or pelvic pain. The pain may be worse during intercourse or a pelvic exam. This is due to inflammation of the cervix, the area connecting the vagina and uterus.
You may also have uterine bleeding that is not related to your normal period. And fever/chills and a foul-smelling vaginal discharge.
- Lower abdominal or pelvic pain.
- Unusual vaginal discharge.
- Bleeding that’s not related to your period.
What makes you more likely to have PID?
Sexual activity, particularly with multiple partners, is the main risk factor for PID. Especially when you don’t use condoms. A partner with a history of STDs increases your risk of PID.
Younger women are also at increased risk, especially if they’ve had an STD in the past. Having gynecologic surgery also increases the risk.
Call your doctor right away if you have abdominal or pelvic pain that is not helped by over-the-counter pain relievers. Or if you have fever, vaginal discharge, or vaginal bleeding not related to your period. Depending on symptoms, your doctor might ask you to come in or send you to the ER.
What happens if you have pelvic inflammatory disease?
Most cases of PID infections are caused by an STD from sexual activity. The infection occurs when bacteria from the STD spreads to the upper reproductive tract, such as the uterus, fallopian tubes, and ovaries. The infection causes inflammation, which leads to pain. Sometimes PID develops after gynecologic surgery, such as surgery to remove a uterine fibroid or polyp or after an abortion.
Treatment for pelvic inflammatory disease
If a patient has PID that goes untreated it can result in a hydrosalpinx (water filled fallopian tube) or an abscess also known as a Tubo-Ovarian abscess (TOA). The presence of a hydrosalpinx can decrease fertility rates even in patients who undergo IVF treatments. —Dr. White-Videa
PID is diagnosed based on a doctor’s exam and blood tests. A doctor will check for pelvic and abdominal pain. A high white blood cell count in your blood test is also a sign of an infection. Typically, a pelvic ultrasound is also done to look for abscesses.
Antibiotics are the most common treatment. Mild cases can be treated with antibiotics for about two weeks. Severe symptoms will require you to be hospitalized and get intravenous (IV) antibiotics.
Certain abscesses (based on size) may need to be drained and treated with IV antibiotics. This procedure is done in the hospital.
When symptoms don’t get better with drainage and IV antibiotics, you may need surgery. You may need to have the abscess removed along with the fallopian tube and ovary. Sometimes the uterus will also need to be removed (hysterectomy).
A ruptured abscess is life-threatening and requires immediate surgery.
After finishing all antibiotics, see your gynecologist. You want to be sure that you no longer have any symptoms and the PID is gone. PID can lead to infertility if left untreated.
You can help prevent PIDs by following these steps:
- Practice safe sex to prevent STDs.
- Always use a condom during any sexual encounter.
- Have routine screenings for STDs at least once a year, particularly if you are under 26.
- Always ask partners to be checked for STDs before engaging in sexual activity.
OB/GYNs recommend that patients do not douche to avoid developing vaginitis. However, it should also be noted that douching is also a risk factor for developing PID. —Dr. White-Videa
Dr. Huma Farid is an obstetrician/gynecologist at Beth Israel Deaconess Medical Center and an instructor in obstetrics and gynecology at Harvard Medical School. She directs the resident colposcopy clinic and is the rotation director for labor and delivery at BIDMC. Dr. Farid graduated from Harvard Medical School. When not involved in resident education or patient care, she enjoys reading and writing.