Pelvic Inflammatory Disease (PID) - CDC Fact Sheet
What is PID?
Pelvic inflammatory disease (PID) refers to infection of the
uterus (womb), fallopian tubes (tubes that carry eggs from the
ovaries to the uterus) and other reproductive organs that causes
symptoms such as lower abdominal pain. It is a serious complication
of some sexually transmitted diseases (STDs), especially chlamydia and gonorrhea. PID can damage the
fallopian tubes and tissues in and near the uterus and ovaries. PID
can lead to serious consequences including infertility, ectopic
pregnancy (a pregnancy in the fallopian tube or elsewhere outside
of the womb), abscess formation, and chronic pelvic pain.
How common is PID?
Each year in the United States, it is estimated that more than
750,000 women experience an episode of acute PID. Up to 10-15% of
these women may become infertile as a result of PID. A large
proportion of the ectopic pregnancies occurring every year are due
to the consequences of PID.
The more sex partners a woman has, the
greater her risk of developing PID. Also, a woman whose partner has
more than one sex partner is at greater risk of developing PID,
because of the potential for more exposure to infectious
agents.
How do women get PID?
PID occurs when bacteria move upward from a woman's vagina or
cervix (opening to the uterus) into her reproductive organs. Many
different organisms can cause PID, but many cases are associated
with gonorrhea and chlamydia, two very common bacterial STDs. A
prior episode of PID increases the risk of another episode because
the reproductive organs may be damaged during the initial bout of
infection.
Sexually active women in their childbearing years are most at
risk, and those under age 25 are more likely to develop PID than
those older than 25. This is partly because the cervix of teenage
girls and young women is not fully matured, increasing their
susceptibility to the STDs that are linked to PID.
The more sex partners a woman has, the greater her risk of
developing PID. Also, a woman whose partner has more than one sex
partner is at greater risk of developing PID, because of the
potential for more exposure to infectious agents.
Women who douche may have a higher risk of developing PID
compared with women who do not douche. Research has shown that
douching changes the vaginal flora (organisms that live in the
vagina) in harmful ways, and can force bacteria into the upper
reproductive organs from the vagina.
Women who have an intrauterine device (IUD) inserted may have a
slightly increased risk of PID near the time of insertion compared
with women using other contraceptives or no contraceptive at all.
However, this risk is greatly reduced if a woman is tested and, if
necessary, treated for STDs before an IUD is inserted.
What are the signs and symptoms of PID?
Symptoms of PID vary from mild to severe. When PID is caused by
chlamydial infection, a
woman may be more likely to experience only mild symptoms even when
serious damage is being done to her reproductive organs. Chlamydia
can also cause fallopian tube infection without any symptoms.
Because of vague symptoms, PID often goes unrecognized by women and
their health care providers. Women who have symptoms of PID most
commonly have lower abdominal pain. Other signs and symptoms
include fever, unusual vaginal discharge that may have a foul odor,
painful intercourse, painful urination, irregular menstrual
bleeding, and pain in the right upper abdomen (rare).
What are the complications of PID?
Prompt and appropriate treatment can help prevent complications
of PID, including permanent damage to the female reproductive
organs. Infection-causing bacteria can silently invade the
fallopian tubes, causing normal tissue to turn into scar tissue.
This scar tissue blocks or interrupts the normal movement of eggs
into the uterus. If the fallopian tubes are totally blocked by scar
tissue, sperm cannot fertilize an egg, and the woman becomes
infertile. Infertility also can occur if the fallopian tubes are
partially blocked or even slightly damaged. Up to 10-15% of women
with PID may become infertile, and if a woman has multiple episodes
of PID, her chances of becoming infertile increase.
In addition, a partially blocked or slightly damaged fallopian
tube may cause a fertilized egg to remain in the fallopian tube. If
this fertilized egg begins to grow in the tube as if it were in the
uterus, it is called an ectopic pregnancy. As it grows, an ectopic
pregnancy can rupture the fallopian tube causing severe pain,
internal bleeding, and even death.
Scarring in the fallopian tubes and other pelvic structures can
also cause chronic pelvic pain (pain that lasts for months or even
years). Women with repeated episodes of PID are more likely to
suffer infertility, ectopic pregnancy, or chronic pelvic pain.
How is PID diagnosed?
PID is difficult to diagnose because the symptoms are often
subtle and mild. Many episodes of PID go undetected because the
woman or her health care provider fails to recognize the
implications of mild or nonspecific symptoms. Because there are no
precise tests for PID, a diagnosis is usually based on clinical
findings. If symptoms such as lower abdominal pain are present, a
health care provider should perform a physical examination to
determine the nature and location of the pain and check for fever,
abnormal vaginal or cervical discharge, and for evidence of
gonorrheal or chlamydial infection. If the findings suggest PID,
treatment is necessary.
The health care provider may also order tests to identify the
infection-causing organism (e.g., chlamydial or gonorrheal
infection) or to distinguish between PID and other problems with
similar symptoms. A pelvic ultrasound is a helpful procedure for
diagnosing PID. An ultrasound can view the pelvic area to see
whether the fallopian tubes are enlarged or whether an abscess is
present. In some cases, a laparoscopy may be necessary to confirm
the diagnosis. A laparoscopy is a surgical procedure in which a
thin, rigid tube with a lighted end and camera (laparoscope) is
inserted through a small incision in the abdomen. This procedure
enables the doctor to view the internal pelvic organs and to take
specimens for laboratory studies, if needed.
What is the treatment for PID?
PID can be cured with several types of antibiotics. A health
care provider will determine and prescribe the best therapy.
However, antibiotic treatment does not reverse any damage that has
already occurred to the reproductive organs. If a woman has pelvic
pain and other symptoms of PID, it is critical that she seek care
immediately. Prompt antibiotic treatment can prevent severe damage
to reproductive organs. The longer a woman delays treatment for
PID, the more likely she is to become infertile or to have a future
ectopic pregnancy because of damage to the fallopian tubes.
Because of the difficulty in identifying organisms infecting the
internal reproductive organs and because more than one organism may
be responsible for an episode of PID, PID is usually treated with
at least two antibiotics that are effective against a wide range of
infectious agents. These antibiotics can be given by mouth or by
injection. The symptoms may go away before the infection is
cured. Even if symptoms go away, the woman should finish taking all
of the prescribed medicine. This will help prevent the infection
from returning. Women being treated for PID should be re-evaluated
by their health care provider three days after starting treatment
to be sure the antibiotics are working to cure the infection. In
addition, a woman’s sex partner(s) should be treated to decrease
the risk of re-infection, even if the partner(s) has no symptoms.
Although sex partners may have no symptoms, they may still be
infected with the organisms that can cause PID.
Hospitalization to treat PID may be recommended if the woman (1)
is severely ill (e.g., nausea, vomiting, and high fever); (2) is
pregnant; (3) does not respond to or cannot take oral medication
and needs intravenous antibiotics; (4) has an abscess in the
fallopian tube or ovary (tubo-ovarian abscess); or (5) needs to be
monitored to be sure that her symptoms are not due to another
condition that would require emergency surgery (e.g.,
appendicitis). If symptoms continue or if an abscess does not go
away, surgery may be needed. Complications of PID, such as chronic
pelvic pain and scarring are difficult to treat, but sometimes they
improve with surgery.
How can PID be prevented?
Women can protect themselves from PID by taking action to
prevent STDs or by getting early treatment if they do get an
STD.
The surest way to avoid transmission of STDs is to abstain from
sexual intercourse, or to be in a long-term mutually monogamous
relationship with a partner who has been tested and is known to be
uninfected.
Latex male condoms, when used consistently and correctly, can
reduce the risk of transmission of chlamydia and gonorrhea.
CDC recommends yearly chlamydia testing of all sexually active
women age 25 or younger, older women with risk factors for
chlamydial infections (those who have a new sex partner or multiple
sex partners), and all pregnant women. An appropriate sexual risk
assessment by a health care provider should always be conducted and
may indicate more frequent screening for some women.
Any genital symptoms such as an unusual sore, discharge with
odor, burning during urination, or bleeding between menstrual
cycles could mean an STD infection. If a woman has any of these
symptoms, she should stop having sex and consult a health care
provider immediately. Treating STDs early can prevent PID. Women
who are told they have an STD and are treated for it should notify
all of their recent sex partners so they can see a health care
provider and be evaluated for STDs. Sexual activity should not
resume until all sex partners have been examined and, if necessary,
treated.