Experiencing pain, unpleasant discharge or particularly heavy periods? Pelvic inflammatory disease (PID) is an infection of the female upper genital tract, including the womb, fallopian tubes and ovaries, characterised by pain or discomfort in the pelvic area.
In most cases, the cause of the infection that leads to PID is unknown, but it can be related to a sexually transmitted infection (STI).
Dr Ellie Cannon looks at the most common symptoms, causes and treatments for pelvic inflammatory disease:
What is pelvic inflammatory disease?
PID is the STI that no one really talks about it. In fact, we don't even have figures for how many women are affected by it in the UK, as it's thought to be under-diagnosed and often unrecognised: but since it is responsible for issues with pain and periods as well as future fertility problems, it's really worth knowing if you could be at risk.
⚠️ PID most commonly affects sexually active women under 25, but in reality any sexually active woman can get it, particularly if you have multiple partners.
PID is mainly a pain condition causing pain around the lower tummy where you get period pain but also pain while passing water and pain during sex. It can be responsible for changes in periods – so if you have particularly heavy or painful periods, or bleeding when you shouldn't have a period at all, including after sex, it is worth considering a test. Like most STIs it can also cause an unpleasant vaginal discharge.
What causes pelvic inflammatory disease?
The condition is caused by what we call an 'ascending infection': the infection starts in the vagina or cervix but travels up to affect the whole reproductive system including the ovaries, the Fallopian tubes and the lining of the womb. This is why it causes such significant pain.
PID is one of those conditions that can have a range of causes – and in fact is not always sexually transmitted. So the name PID describes the catalogue of symptoms you have, no matter which bug is the cause.
In at least 25 per cent of cases the cause is an STI including chlamydia or gonorrhoea: these bacteria usually cause infections lower in the genital area i.e just the vagina or cervix. PID develops when the infection is left untreated, and it therefore has the opportunity to travel up into the other regions. This is one of the reasons that quick treatment for these infections is so vital.
Is PID always sexually transmitted?
It's not just the sexual infections that can be the problem. All women have 'friendly' harmless bacteria within the vagina as part of the natural healthy physiology there. If for whatever reason these healthy bacteria travel up into the womb, tubes or ovaries they can also cause PID.
This may happen after damage to the cervix for example after childbirth, a miscarriage or a termination. It is also more likely to happen if you have a coil for contraception or if you have had PID before.
Pelvic inflammatory disease diagnosis
Diagnosing PID involves either the GP or sexual health clinic. It is not always an easy diagnosis to confirm as there is not one single test. Usually it is decided on the catalogue of symptoms as well as some confirmatory tests for example swabs.
It can be normal to have a vaginal examination to diagnose PID, as pain on this examination is a typical sign. Because the symptoms of PID can also be the symptoms of serious diagnoses such as appendicitis or even cervical cancer, you can end up having a lot of tests to rule these out, for example urine tests and an ultrasound scan. A pregnancy test is also essential at the time of diagnosis.
Pelvic inflammatory disease treatment
The initial treatment of PID always involves antibiotics. Usually there will be a local protocol of antibiotics used for PID and you will likely be given a mixture of them.
Most sexual health clinics will not wait for the results of swabs but start treatment straight away, adding in or changing types if necessary once swabs results are known. That is because often one single bacterial cause is not found, and if the diagnosis is suspected from your symptoms, prompt and aggressive treatment is really essential to avoid long term problems.
Pelvic inflammatory disease contact tracing
If you are diagnosed with PID, it is imperative at this point to treat any sexual partners you have had in the last six months.
Sexual health clinics can contact these partners for you, this is known as contact tracing, and can offer them treatment anonymously.
If you are in a long term, monogamous relationship you should both be treated at the same time and abstain until you're both fully treated.
Pelvic inflammatory disease complications
Delaying treatment for PID can unfortunately lead to long-term issues. Sadly infertility can be the result of PID when treatment has been delayed. The infection can damage the Fallopian tubes causing scarring which can prevent the easy passage of eggs to the womb for fertilisation.
The same scarring leads sufferers to be at risk from ectopic pregnancies: the fertilised egg gets stuck in the scarred tube as it can't travel down so implants in the tube, rather than the womb. Ectopic pregnancies are not only terribly distressing emotionally as the pregnancy is not sustainable, they can also cause life threatening bleeding and bursting of the tube.
⚠️ Seeking quick treatment for PID as soon as you suspect you may have any of the symptoms can avoid any of the long term issues.
Last updated: 06-12-19