Pelvic Inflammatory Disease

Pelvic inflammatory disease, commonly referred to as PID, is an infection of the upper genital tract in women.

It is usually caused by an infection spreading from the vagina and cervix to the uterus (womb), fallopian tubes, ovaries and pelvic area. If severe, the infection may result in an abscess (collection of pus) forming inside the pelvis. This is most commonly a tubo-ovarian abscess (an abscess affecting the tubes and ovaries). If left untreated PID can cause ongoing pain. It can also leave you unable to have a baby, because PID can cause scars to form on the fallopian tubes.

PID is mostly caused by an infection you catch during sex. Chlamydia and gonorrhea are two of the most common infections that lead to PID, although other bacteria found normally in the vagina may also be involved. PID may also be contracted after pelvic surgery or having a baby.

  • Age less than 25 years
  • Young age at first sex
  • Nonbarrier contraception
  • New, multiple, or symptomatic sexual partners
  • Oral contraception (this is because women using the pill are less likely to use condoms, not because the pill itself makes you more likely to contract an STI)
  • Cervical ectopy
  • Previous episode of PID
  • Sex during your period
  • Vaginal douching
  • Bacterial vaginosis
  • Intrauterine device

Symptoms vary from person to person. PID often does not cause symptoms. But you may have some or all of the following:

  • smelly or unusual vaginal discharge
  • a high temperature (more than 38°C)
  • pain in the lower abdomen
  • pain or bleeding during or after sex or a pelvic examination
  • vaginal bleeding between periods.

Many of these symptoms are common and can be caused by other conditions such as:

  • irritable bowel syndrome
  • urine infection
  • cyst on the ovary
  • appendicitis

Bleeding between periods can also have many other causes Because of this, PID can be difficult to diagnose. If you have any of these symptoms, it is important to seek medical advice as soon as possible.

There is no single, simple test that can show whether or not you have PID.

Firstly your doctor will examine you for signs of infection. This will include a pelvic exam. Then, they may perform a urine test, vaginal swabs or blood tests to check for infection. If you have pain they will usually perform a pregnancy test. It may take a few days for these results to come back.

Swab

A negative swab result does not mean you are definitely clear from PID.

Swabs can give ‘false negative’ results, which means that the swab has not picked up exactly which infection is causing your PID other tests

Ultrasound scan

This is usually a transvaginal scan (where the probe is gently inserted into your vagina) to look more closely at the uterus, fallopian tubes and ovaries. Sometimes it is possible to detect an abscess using ultrasound. Usually this is not painful, however, if you have pelvic pain it may cause some tenderness.

If you have mild to moderate PID, you will be offered a course of oral antibiotics. Some antibiotics can interfere with the effectiveness of the pill. Because of this and to avoid passing on the infection you should not have sex until treatment is finished.

It is very important to complete your course of antibiotic tablets, even if you are feeling better. Most women who complete their course of antibiotics have no long-term health or fertility problems.

You may also be given medication for pain relief.

Your doctor may recommend treatment in hospital if:

  • your diagnosis is unclear
  • you are very unwell
  • he or she suspects an abscess
  • you are pregnant
  • you are not getting better within a few days of starting antibiotics
  • you are unable to take antibiotics by mouth

When you are in hospital, antibiotics may be given intravenously (directly into the blood-stream through a drip). This treatment is usually continued until 24 hours after your symptoms have improved. After that, you will be given a course of antibiotic tablets.

It is rare to develop PID when you are pregnant but if there is any chance you are pregnant you should notify your doctor as certain antibiotics should be avoided.

If your symptoms of PID are not improving within a few days of starting treatment your doctor may recommend you have your IUD/coil removed. If you have had sex in the previous seven days, you will be at risk of pregnancy and emergency hormonal contraception (morning after pill) may be an option.

The results of STI testing are completely confidential. All notifiable diseases (including chlamydia, gonorrhoea, syphilis, HIV) are recorded by relevant health departments for the purpose of keeping statistical records.

Yes. It is important to contact anyone you have had sex with during the last six months. You should suggest that they have screening for chlamydia and gonorrhoea – even if they are well. Your doctor can help you with this, or do it for you anonymously.

You should avoid having sex until you and your partner have completed the course of treatment. If this is not possible, use a condom.

If you have a moderate to severe infection, you will usually be given an appointment to return to the clinic to check that the antibiotics are working. It is particularly important to attend this appointment so your doctor can see that your symptoms are responding to the antibiotics.

Women whose symptoms are not improving may be advised to attend hospital for further investigations and treatment.

If your doctor confirms your symptoms are improving, you will usually be given a further follow-up appointment to check:

  • your treatment has been effective
  • if a repeat swab test is needed to confirm the infection has been successfully treated – this is particularly important if you have ongoing symptoms
  • you have all the information you need about the long-term effects of PID
  • if another pregnancy test is needed
  • you have all the information you need about future contraceptive choices or your plans for pregnancy
  • your sexual partner(s) have been screened and treated.

If you are diagnosed with PID your doctor will also recommend to test for other sexually acquired infections such as syphilis, hepatitis B and C and HIV.

PID is an infection that is usually treated successfully. Long-term problems can arise if PID is unrecognised, if treatment is delayed or if there is a severe infection. The long-term effects can be:

Scarring of the fallopian tube, which can cause:

  • an increased risk of ectopic pregnancy
  • difficulties in becoming pregnant

Persistent pain in your lower abdomen

You can reduce the risk of further infection by using condoms and by making sure that your sexual partner(s) are treated for sexually transmitted infections.

For further information regarding STIs refer to the following link http://www.sti.health.gov.au/internet/sti/publishing.nsf