Pelvic inflammatory disease: causes, symptoms, and treatment

There are plenty of reasons to practice safe sex, and pelvic inflammatory disease is a good one. 

Pelvic inflammatory disease (PID, for short) is an infection of the uterus. It’s often caused by sexually transmitted infections (STIs) like gonorrhea or chlamydia, but that’s not always the case (Wiesenfeld, 2021). 

If an infection travels from the vagina, up into uterus, and makes its way into the abdomen, PID can result. Some estimates say that roughly 1 in every 25 sexually-active women will be diagnosed with PID (CDC, 2017). 

And while PID is very treatable––especially when caught early––it often has no symptoms, making treatment difficult. Left untreated, PID can cause long-term problems including chronic pelvic pain and infertility (Jennings, 2021).

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About 85% of PID cases are caused by STIs like chlamydia or gonorrhea. These common infections are easily detected through routine testing. Treatment typically involves a simple course of antibiotics. Just because you have an STI doesn’t mean PID will develop, but it’s important to get diagnosed to catch infections early. 

About 15% of PID cases are caused by other types of bacteria like Gardnerella vaginalis, which is abundantly present in conditions like bacterial vaginosis (BV), which is common among people who are sexually active. Bacteria like E. coli from the digestive tract can also reach reproductive areas and cause PID. 

It’s possible to develop PID even if you aren’t having sex or have a sexual partner who’s tested negative for all STIs. In these cases, bacteria that naturally thrives in the vagina moves up the genital tract where it causes problems in reproductive organs. In rare cases, an intrauterine device (IUD) or tubal ligation (tube tying surgery) can cause PID (Jennings, 2021).

The warning signs of PID differ based on what caused the infection. And again, many people have no idea they have it. 

When STIs are the culprit, gonorrhea typically causes more severe PID than chlamydia. In fact, chlamydia often has no symptoms at all. That’s why regular STI testing is so important. 

Common symptoms of PID include (Ross, 2018; Jennings, 2021): 

• Pain or discomfort in the lower abdomen

• Tenderness during a pelvic exam (which is when a healthcare provider uses a gloved hand or a speculum to examine your vagina, abdomen, and rectum)

• Fever

• Abnormal vaginal discharge or bleeding, such as bleeding between periods or after sex

• Pain during sex (dyspareunia)

If you experience any of these symptoms or severe pain, schedule an appointment with a healthcare provider. 

PID treatment is pretty straightforward. It involves the use of one or more types of antibiotics administered by mouth or IV (through a vein) at a hospital. But PID can’t be treated if it isn’t detected, which is why getting tested is so crucial.

If you suspect you have PID, a healthcare provider can perform a gynecological exam and collect a sample to test for bacteria. The exam involves using a gloved hand and a speculum to examine the vaginal canal and cervix. They may also collect a sample of fluid or discharge using a sterile cotton swab. You’ll probably be tested for STIs as well, which usually involves a urine or blood sample. 

Gynecological exams can be uncomfortable, and if you have PID, the exam may even be painful. Be sure to communicate any discomfort you are experiencing to your healthcare provider. 

Samples are sent for laboratory analysis, which can take a few days to process. It’s not uncommon for healthcare providers to start antibiotic treatment for a person with suspected PID before test results return. After you get the results, your treatment may be adjusted to ensure the antibiotics you’re taking are most effective for your specific infection. 

If left untreated, PID can have severe long-term effects. It can cause chronic pain as well as the development of scarring in the abdomen, which can cause fertility problems. As many as one-third of people who have PID deal with chronic pelvic pain. 

Because of the scarring that can form in the abdomen, PID increases the risk of ectopic pregnancy, which is when an embryo implants outside of the uterus (usually in the fallopian tube). Those with fallopian tube damage due to PID are about six times more likely to have an ectopic pregnancy than those without damage (Jennings, 2021). 

If PID causes severe scar tissue or trauma to the fallopian tubes or ovaries, the infection can cause infertility. While PID does not automatically cause infertility, it is a risk factor for having trouble getting pregnant or carrying a high-risk pregnancy (Jennings, 2021).  

If left untreated, PID can also spread throughout the abdomen, causing a rare condition called Fitz-Hugh-Curtis syndrome, which is where scar tissue forms next to the liver and stomach. 

Practice safe sex using barrier contraception like a condom. Using condoms cuts down on the amount of bacteria exchanged between the sheets. Getting tested and encouraging your sex partners to do the same is also key to curbing your risk of PID (Jennings, 2021). 

If you are diagnosed with PID, let your partner or partners know so they can get tested and treated if necessary. 

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

February 08, 2022

Written by

Kaitlin Sullivan

Fact checked by

Yael Cooperman, MD

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About the medical reviewer

Yael Cooperman, MD, Ro

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.