Pelvic inflammatory disease (PID) is an infection of the female reproductive system, including the cervix * , uterus * , ovaries * , and especially the fallopian tubes * . PID usually is the result of an untreated or poorly treated sexually transmitted bacterial infection. It can cause scarring, and reduce or eliminate a woman's ability to get pregnant.
Two years after Carrie and Reg got married, they decided to start a family. Carrie began looking at the ads for strollers and baby clothes. But after a year, she had not gotten pregnant. She was sure she did not have a medical problem. After another six months of trying, Carrie and Reg decided to see a doctor who specializes in fertility problems.
The doctor asked Carrie if she had ever had pelvic inflammatory disease (PID). She said no, and that she had not even heard of it. But in a series of tests, her body told a different story. Carrie's fallopian tubes (the place where the egg meets sperm in conception) had been scarred by PID.
After the doctor used laser surgery to remove the scar tissue, the blocked passages were opened, and Carrie finally got pregnant.
When healthy young women have difficulty getting pregnant, damage from PID is one of the many possible causes. In most cases, the women did not know they had the disease and never got treated. Quick treatment of PID can reduce the chances that it will cause infertility.
Most often, women get PID as a result of having a sexually transmitted bacterial * infection that was not treated, often because it was not noticed. The bacteria Chlamydia trachomatis and Neisseria gonorrhoeae are the most common bacteria involved in PID. The infections they cause are called a chlamydial (kla-MIH-dee-ul) infection and gonorrhea (gon-o-REE-a). PID can involve more than one type of bacterium. In many cases, doctors do not identify the specific bacterium involved.
Most often, bacteria enter the vagina * during sexual activity and then move up into the cervix, uterus, and other parts of the reproductive system where they rapidly reproduce. PID also can develop after a woman gives birth or has an abortion in unsanitary conditions. In rare cases, certain medical procedures done on reproductive organs, such as injecting dye for special x-rays, can lead to PID.
To understand the effect of PID, one has to understand the basic facts of conception. The ovary releases an egg each month into one of a woman's two fallopian tubes, where it meets with the sperm * . The newly formed embryo * travels through the tube to the uterus, which is an expandable organ. The embryo attaches to the wall of the uterus and grows into a fetus * .
The body usually fights off the infection, but in the course of fighting the infection, tissues can be damaged and scar tissue may form. Scar tissue can block the delicate fallopian tubes. That means the egg and sperm may not be able to meet; or if they do, the fertilized embryo may not be able to reach the uterus.
Of women who have PID one time, about one in eight becomes infertile. Each repeat episode of PID doubles the chance of becoming infertile. The Centers for Disease Control and Prevention (CDC) estimates that 5 percent of U.S. women have reported being treated for PID in their lifetime. Women with PID are more likely to have tubal factor infertility (ranging from 8 percent after the first episode to as high as 40 percent after three episodes) and chronic pelvic pain (18 percent following one episode). Prompt treatment within three days of symptoms can help prevent infertility and other complications.
Women who have had PID are 50 percent more likely than other women to have an ectopic (ek-TAH-pik) pregnancy. Ectopic means that the embryo starts growing outside the uterus, usually in the fallopian tubes. Such a pregnancy cannot produce a baby, and if it is not ended it poses a very serious risk to the woman's life because the growing embryo will rupture the fallopian tubes and cause a life-threatening hemorrhage * .
About 1 million American women have a case of PID each year, of which about 150,000 are hospitalized due to complications of the infection. PID is rare among women who do not engage in sex. Sexually active teenagers are at the highest risk, followed by women in their early 20s. The risk increases if a woman has many sexual partners; has sex with a man who has many sexual partners; or has sexual intercourse very frequently even with a single partner. Frequent douching (inserting fluid into the vagina for cleansing) also increases the risk of PID. Women who use an intrauterine device (IUD) for birth control have a slightly increased risk of developing PID for a short time after the IUD has been inserted.
About 60 percent of all cases of PID have symptoms so mild that they go unnoticed. At the other extreme, symptoms can be quite severe. Noticeable symptoms are not specific to PID. They include the following:
Sometimes, long after an untreated PID infection occurs, women have chronic (persistent) pain in the pelvis, which is sometimes called chronic PID.
PID can be difficult to diagnose. Many conditions cause similar symptoms, and no one test can tell for sure whether a woman has PID. Because it is so important to treat PID promptly, doctors usually start treatment if the symptoms even suggest PID.
To try to confirm the diagnosis, doctors can administer blood tests and take pelvic cultures to look for general evidence of infection. They test for chlamydial infection and gonorrhea, and they perform a pregnancy test to determine whether the symptoms are being caused by an ectopic pregnancy * . All women with PID should be tested for syphilis * and offered the opportunity to be tested for HIV * .
Ultrasound, a painless procedure that uses sound waves to create an image of the organs, can help doctors look for a tubo-ovarian abscess.
The most definitive test for PID is laparoscopy (lap-uh-ROS-kuhpee”), a surgical procedure in which a slender device is inserted through a small incision into the abdomen so that the doctor can look inside the belly. Laparoscopy usually is done only if treatment is not working or if the doctor suspects the woman may have another condition, such as appendicitis * (ah-pen-dih-SY-tis), that requires emergency surgery.
As it is difficult to determine exactly which bacteria are causing PID, combinations of two or three different antibiotics (an-tie-by-AH-tiks) that fight a wide range of bacteria are given for at least two weeks, usually in pills to be taken at home. If a woman is pregnant or particularly ill, she is usually hospitalized for at least a few days and given intravenous * antibiotics.
If a woman has an abscess, it may need to be drained through a tube or catheter * inserted into the abdomen. If an abscess ruptures, or breaks open, immediate surgery is necessary. If a woman has PID, any man who had sex with her in the previous two months should be treated for possible chlamydial infection and gonorrhea. Even if he has no symptoms, chances are high that he is infected and could reinfect the woman or other partners.
Like chlamydial infections and gonorrhea, PID is best prevented by not having sex. A sexually active woman is most protected if she has sex only with one faithful partner; that is, a partner who has sex only with her. Short of that, a woman should limit the number of her sexual partners.
Latex condoms worn by the man during sexual activity can prevent PID if they are used correctly at all times.
A woman should seek immediate treatment if she suspects that she or a sexual partner has a sexually transmitted infection. Because these diseases often cause no symptoms, health officials recommend that all sexually active young women, especially teenagers, get tested routinely for chlamydial infections and gonorrhea. When chlamydial infection screening of young women was tried as an experiment, it reduced the number of cases of PID.
See also Bacterial Infections • Chlamydial Infections • Ectopic Pregnancy • Gonorrhea • Infection • Infertility • Sexually Transmitted Infections (STIs): Overview • Syphilis
Carr, Shannon, and Eve Espey. “Intrauterine Devices and Pelvic Inflammatory Disease among Adolescents.” Journal of Adolescent Health 52 (2013): 522–28. http://www.jahonline.org/article/S1054-139X(13)00059-1/pdf (accessed March 11, 2016).
Hammer, Gary D., and Stephen J. McPhee. Pathophysiology of Disease: An Introduction to Clinical Medicine. 7th ed. New York: McGraw-Hill Education, 2014.
Centers for Disease Control and Prevention. “Pelvic Inflammatory Disease (PID): CDC Fact Sheet.” http://www.cdc.gov/std/pid/stdfact-pid-detailed.htm (accessed March 11, 2016).
National Institute of Allergy and Infectious Diseases. “Pelvic Inflammatory Disease.” (accessed March 11, 2016).
American Congress of Obstetricians and Gynecologists. 409 12th St. SW, PO Box 70620, Washington, DC 20024-9998. Telephone: 202-638-5577. Website: http://www.acog.org (accessed March 11, 2016).
Centers for Disease Control and Prevention. 1600 Clifton Rd., Atlanta, GA 30329-4027. Toll-free: 800-232-4636. Website: http://www.cdc.gov (accessed March 11, 2016).
National Institute of Allergy and Infectious Diseases. 5601 Fishers Lane, MSC 9806 Bethesda, MD 20892. Toll-free: 866-284-4107. Website: (accessed March 11, 2016).
* cervix (SIR-viks) is the lower narrow end of the uterus that opens into the vagina.
* uterus (YOO-teh-rus) is the muscular pear-shaped internal organ in a woman where a baby develops until birth.
* ovaries (Oh-vuh-reez) are the sexual glands from which ova, or eggs, are released in women.
* fallopian tubes (fa-LO-pee-an tubes) are the two slender tubes that connect the ovaries and the uterus in females. They carry the ova or eggs from the ovaries to the uterus.
* bacteria (bak-TEER-ee-a) are single-celled microorganisms that typically reproduce by cell division. Some, but not all, types of bacteria can cause disease in humans. Many types can live in the body without causing harm.
* vagina (vah-JY-nah) is the canal, or passageway, in a woman that leads from the uterus to the outside of the body.
* sperm are the tiny tadpole-like cells males produce in their testicles. Sperm can unite with a female's egg to result in conception.
* embryo (EM-bree-o), in humans, is the developing organism from the end of the second week after fertilization to the end of the eighth week.
* fetus (FEE-tus) is the term for an unborn human after it is an embryo, from nine weeks after fertilization until childbirth.
* membrane (MEM-brain) is a thin layer of tissue that covers a surface, lines a cavity, or divides a space or organ.
* hemorrhage (HEH-muh-rij) is uncontrolled or abnormal bleeding.
* abdomen (AB-do-men), commonly called the belly, is the portion of the body between the thorax (THOR-aks) and the pelvis.
* ectopic pregnancy (ek-TAH-pik) is an abnormal pregnancy in which the fertilized egg develops outside the uterus, usually within one of the fallopian tubes.
* syphilis (SIH-fih-lis) is a sexually transmitted disease that, if left untreated, can lead to serious life long problems throughout the body, including blindness and paralysis.
* HIV, or human immunodeficiency virus (HYOO-mun ih-myoono-dih-FIH-shen-see), is the virus that causes AIDS (acquired immunodeficiency syndrome), an infection that severely weakens the immune system.
* appendicitis (ah-pen-dih-SY-tis) is an inflammation of the appendix, the narrow finger-shaped organ that branches off the part of the large intestine in the lower right side of the abdomen.
* intravenous (in-tra-VEE-nus), or IV, means within or through a vein. For example, medications, fluid, or other substances can be given through a needle or soft tube inserted through the skin's surface directly into a vein.
* catheter (KAH-thuh-ter) is a small plastic tube placed through a body opening into an organ (such as the bladder) or through the skin directly into a blood vessel. It is used to give fluids to or drain fluids from a person.