Also Known As
PID
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This article waslast modified on December 4, 2017.
What is pelvic inflammatory disease?

Pelvic inflammatory disease (PID) is an infection of a woman's reproductive organs. It usually occurs when sexually transmitted bacteria spread from the vagina through the cervix, into the uterus, the fallopian tubes, and the ovaries.

The majority of cases of PID are a complication of sexually transmitted diseases (STDs), most commonly due to chlamydia (Chlamydia trachomatis) and gonorrhea (Neisseria gonorrhoeae) infections. Other bacteria normally found in the vagina, such as Gardnerella vaginalis, or the digestive tract, such as Escherichia coli, have also been associated with PID, though it is not well understood why this occurs.

Prompt and appropriate early treatment of STDs can prevent PID. Left untreated, PID can cause irreversible damage to one or more reproductive organs, leading to severe abdominal pain, infertility, ectopic pregnancy, and other problems, including abscess formation. Infertility, caused by scarring of the fallopian tubes, is one of the most common yet preventable consequences of PID.

Though cases of PID have been declining recently, it is still a significant disease with serious consequences. About 5% of women in the U.S. report being treated for PID at least once in their lives, according to the Centers for Disease Control and Prevention (CDC). About 1 in 8 women who have had PID experience some difficulty getting pregnant.Because infections such as chlamydia may show no obvious signs or symptoms, or subtle, nonspecific symptoms, yet result in serious long-term problems, the CDC recommends annual screening for all sexually active women age 25 and younger and for other women who are at increased risk. (For more on this, see the articles on chlamydia and gonorrhea screening for TeensYoung Adults, Adults, and Adults 50 and Up.)

Accordion Title
About Pelvic inflammatory Disease (PID)
  • Risk Factors

    Although PID can affect any woman at any age, with or without sexual transmission, most cases occur in sexually active women of childbearing age. Examples of situations that put women at increased risk for PID include:

    • Not getting treated for an STD
    • Being sexually active and 25 years old or younger
    • Having multiple sex partners
    • Having a sex partner with multiple sex partners
    • Having a past history of any STD
    • Having a past history of PID
    • Undergoing an insertion of an IUD within the last weeks
    • Douching (which can flush bacteria into the uterus)
  • Signs and Symptoms

    A woman with pelvic inflammatory disease (PID) may have no symptoms, mild discomfort, chronic and/or progressive pain, or she may be severely and acutely ill. The severity of symptoms is unrelated to the damage caused as, for example, chlamydia may cause fallopian tube infection with only mild discomfort. Many of the signs and symptoms of PID are nonspecific and may be seen with a variety of other conditions that affect the pelvic area. Signs and symptoms may include:

    • Pain in the lower abdomen – the most common symptom
    • Vaginal discharge with an unpleasant smell
    • Fever
    • Painful sexual intercourse, sometimes with bleeding
    • Pain or burning sensation when urinating
    • Irregular periods (menstrual bleeding), bleeding between periods
    • Sometimes, nausea, vomiting later in the disease


    Complications of PID include difficulty getting pregnant (infertility), chronic pelvic pain, formation of scar tissue on or inside fallopian tube, and ectopic pregnancy. Even a small amount of scarring in the fallopian tubes can impair fertility by preventing an egg from becoming fertilized or a fertilized egg from reaching the uterus. If a fertilized egg begins to develop in a fallopian tube, it can rupture the tube, causing a life-threatening emergency with internal bleeding and severe pain.

  • Tests

    There is no one single laboratory test that can definitely diagnose pelvic inflammatory disease (PID). Most cases are diagnosed based on signs and symptoms and other clinical findings from a physical examination. During an examination, a healthcare practitioner will check for an abnormal discharge from the vagina or cervix or for the presence of an abscess near the ovaries or fallopian tubes.

    Some cases are diagnosed when a woman is screened for sexually transmitted diseases (STDs) as part of a routine health examination. According to the Centers for Disease Control and Prevention (CDC), PID often goes undiagnosed because the symptoms are nonspecific. Several tests may be performed to help diagnose the condition.

    Laboratory Tests
    Some tests that may be ordered to determine the cause of PID or rule out other causes of pelvic pain include:

    • Chlamydia trachomatis test – to detect chlamydia infection as cause of PID
    • Neisseria gonorrhoeae test – to detect gonorrhea infection as cause of PID
    • Wet prep – a sample of vaginal/cervical discharge is placed on a slide and examined under a microscope. It is primarily performed to evaluate the number of white blood cells (WBCs) in the discharge and is often elevated with PID.
    • Cervical culture – ordered to help identify the presence of bacteria as the cause of PID
    • Urinalysis and urine culture – performed to detect a urinary tract infection


    Tests that are not specific for PID may also be done to detect and evaluate associated inflammation and immune response. They may include:


    Non-laboratory Tests

    • Physical examination – an evaluation of the cervix, presence of a discharge, and the degree of pain or tenderness; pain associated with movement of the cervix and uterine pain are characteristic of PID. A diagnosis may be made based upon clinical findings.
    • Pelvic or transvaginal ultrasound – may be performed to examine reproductive organs and may reveal enlarged fallopian tubes or the presence of an abscess
    • Laparoscopy – minimally invasive surgery sometimes used to confirm the diagnosis, collect biopsy samples, and evaluate the health of organs
    • CT (computed tomography) scan or MRI (magnetic resonance imaging) scan – to detect an abscess or enlargement of the fallopian tubes
    • Power Doppler ultrasound – scan that allows evaluation of blood flow and inflammation
  • Treatment

    If a healthcare practitioner suspects that a woman has pelvic inflammatory disease (PID), then she will be treated regardless of whether the diagnosis can be confirmed. This is done because it takes very little scarring as a result of PID to cause infertility.

    In most cases, treatment involves taking one or more antibiotics that are effective against several types of bacteria, including Chlamydia trachomatis and Neisseria gonorrhoeae. If specific bacteria are identified through testing, then the treatment is tailored to address that type of infection. A woman's sexual partner must also be treated so that the woman is not re-infected.

    It is important to get diagnosed early and treated, and to take all the antibiotic prescribed even if symptoms improve. The earlier a woman gets successfully treated, the less likely she will develop complications from PID. Treatment will not reverse the damage already incurred but may prevent further damage to reproductive organs.

    In most cases, treatment can be given on an outpatient basis, but if the woman is acutely ill, pregnant, or not responding to treatment, then she may require hospitalization. With more complicated cases, for example if an abscess has formed, surgery may be required.

View Sources

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used. To access online sources, copy and paste the URL into your browser.

Sources Used in Current Review

(December 11, 2015) Centers for Disease Control and Prevention. Pelvic Inflammatory Disease Fact Sheet. Available online at http://www.cdc.gov/std/PID/STDFact-PID.htm. Accessed September 2016.

(©2016) MayoClinic.com. Pelvic inflammatory disease (PID) (Online Information). Available online at http://www.mayoclinic.com/health/pelvic-inflammatory-disease/DS00402. Accessed September 2016.

(2010 May 18) U.S. Department of Health and Human Sevices, WomensHealth.gov. Pelvic Inflammatory Disease. Available online at http://www.womenshealth.gov/publications/our-publications/fact-sheet/pelvic-inflammatory-disease.html. Accessed September 2016.

(Updated September 28, 2015) Shepherd S. Pelvic Inflammatory Disease. Medscape Reference. Available online at http://emedicine.medscape.com/article/256448-overview. Accessed September 2016.

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