Pelvic Inflammatory Disease

What is pelvic inflammatory disease and what causes it?

Pelvic inflammatory disease (PID) is an infection of the uterus (womb) and Fallopian tubes (and sometimes the ovaries too). The bacteria (germs) that cause the infection usually travel into the uterus from the vagina or cervix (neck of the uterus).

A common cause of PID is from a sexually transmitted infection (the bacteria are passed on when you have sex). A bacterium called chlamydia is the most common cause. Gonorrhoea is another quite common cause of PID. A mixture of chlamydia plus gonorrhoea sometimes occurs. Sometimes the bacteria can be in the cervix for quite some time without causing symptoms before travelling into the uterus. This is why some women develop PID weeks or months after having sex with an infected person.

Some cases of PID are not due to a sexually transmitted infection. The vagina normally contains various bacteria. These are usually harmless and are not passed on by sexual contact. However, these bacteria sometimes cause PID. This is more of a risk after having a baby, or after a procedure such as an insertion of an intrauterine device (IUD).

What are the symptoms of pelvic inflammatory disease?

• Pain in the lower abdomen (pelvic area) is the most common symptom. It can range from mild to severe.
• Other symptoms that may also occur include:
  • Abnormal vaginal bleeding occurs in about 1 in 4 cases. This may be periods that are heavier than usual, or bleeding between periods, or bleeding after having sex.
  • Pain during sex.
  • Abnormal vaginal discharge.
  • Fever.
  • Low back pain.

Symptoms may develop quickly. You can become quite ill over a few days. Sometimes symptoms are mild and develop slowly. For example, you may just have a mild abdominal pain that may 'grumble on' for weeks. In some cases no symptoms develop and you do not know that you are infected. However, you are still at risk of complications even if you have no symptoms at first.

Who gets pelvic inflammatory disease?

About 1 in 50 sexually active women in the UK develop PID each year. It most commonly develops in women aged between 15 and 24. The risk of developing PID is higher if you have had:

• A recent change of sexual partner. The risk goes up with the number of changes of partner.
• A previous episode of PID or sexually transmitted disease.
• A recent termination of pregnancy (abortion).
• A recent operation or procedure to the uterus.
• An IUD inserted recently.

What tests may be done?

If PID is suspected then a swab (small sample of discharge) is usually taken from the cervix. This is to test for bacteria. A swab from the urethra (urine tube), and blood and urine tests may also be taken to look for infecting bacteria or the effects of infection.

However, even in women who have PID, the swabs and tests may not show any bacteria. Therefore, to help confirm a diagnosis of PID, other tests may be considered. For example, an ultrasound scan may be able to show inflamed Fallopian tubes. Other scans are sometimes done. Sometimes a doctor may need to look inside your abdomen to assess your uterus and Fallopian tubes. This is done by pushing a special thin telescope (laparoscope) through the wall of the abdomen. This procedure, called a laparoscopy, is done under anaesthetic. (But a laparoscopy is not routinely needed to diagnose PID.)

PID may not be diagnosed for some time if symptoms are mild, or do not occur at first.

A pregnancy test is also usually done in women suspected of having PID. This is to rule out an ectopic pregnancy which can sometimes be confused with PID, as some of the symptoms are similar.

What are the possible complications?

Complications do not develop in most cases if PID is diagnosed and treated early. Possible complications include one or more of the following.

• Difficulty becoming pregnant (infertility). PID can cause scarring or damage to the Fallopian tubes. This can occur whether or not the PID caused symptoms.
• An increased risk of an ectopic pregnancy if you become pregnant. (This is a pregnancy that develops in a Fallopian tube and can cause serious problems.) This is due to damage to the Fallopian tube by the infection. If you have had PID and become pregnant, you have about a 1 in 10 chance that it will be ectopic.
• Chronic (persistent) pain develops in about 1 in 5 cases. This often includes pain during sex.
• The risks of developing some complications of pregnancy such as miscarriage, premature birth and stillbirth are increased in pregnant women with untreated PID.
• Reiter's syndrome. This is an uncommon cause of arthritis and eye inflammation. It is an uncommon complication of PID. It is thought to be due to the immune system 'over-reacting' to pelvic infection in some cases.
• An abscess (collection of pus) sometimes develops next to the uterus if the infection is severe.

You are less likely to develop complications if you begin treatment within 2-3 days of symptoms starting. This may be possible if symptoms develop quickly. However, some women with PID have mild symptoms, or no symptoms at all. The infection may progress for quite some time before it is diagnosed or treated.

What is the treatment of pelvic inflammatory disease?

The usual treatment is a course of antibiotics for at least two weeks.

Two antibiotics are commonly prescribed. This is to cover the range of possible bacteria that can cause PID. It is important to take the full course of treatment. Treatment will usually be started as soon as possible if PID is suspected by your doctor - even before the results of swabs or other tests are available. This is because the earlier the treatment, the better the outlook, and the lower the risk of future fertility problems.

Tell your doctor if you are (or may be) pregnant. This may affect the choice of antibiotic.

Occasionally, an operation is needed. For example, to drain an abscess if one develops (which is uncommon).

You should not have sex until both you and your sexual partner have finished treatment.

Does my partner need to be treated?

Yes. Also, any other sexual partner within the past six months should be tested for infection. (If you have not had sex within the last six months then your latest sexual partner, however long ago the relationship was, should be tested and treated.) A course of antibiotics is usually advised whether or not infection is found on testing. This is because:

• A significant proportion of PID is caused by chlamydia. It is often passed on during sex.
• Men often have no symptoms with chlamydia, but can still pass on the infection.
• The test for chlamydia is not 100% reliable. Treatment makes sure that any possible infection which may have been missed by the tests is cleared.
• If your sexual partner is infected and not treated, chlamydia may be passed back to you again after you are treated.

Can pelvic inflammatory disease be prevented?

Wearing a condom during sex helps to protect you from sexually transmitted infections. The risk of infection increases with the number of changes of sexual partner.

Will it happen again?

About 1 in 5 women who have PID have a further episode. This is usually within two years. Reasons why this may occur include:

• If your sexual partner was not treated. You are then likely to get the infection back again.
• If you did not take the antibiotics properly, or for long enough. The infection may then not clear completely, and may flare up again later.
• If you change your sexual partner and do not practise 'safer sex'.
• Some women are more prone to infection once their uterus or Fallopian tubes have been damaged by a previous episode of PID.

The risk of developing complications such as infertility or persistent pelvic pain is greatly increased with repeated episodes of PID.

Further help and information

National Chlamydia Screening Programme

Web: www.chlamydiascreening.nhs.uk
On this site you can learn more about chlamydia, the National Chlamydia Screening Programme, and be able to access local services for chlamydia screening.

Sexual Health Helpline

Tel: 0800 567 123

Women's Health Concern

4-6 Eton Place, Marlow, Bucks SL7 2QA
Tel (helpline) Nurse Counselling Service: 0845 123 2319 (local rate)
Web: www.womens-health-concern.org
A leading charity providing help and advice to women on a wide variety of gynaecological, urological and sexual health conditions.