What is pelvic inflammatory disease (PID)?

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs (the uterus, fallopian tubes and ovaries). Normally, the cervix (opening to the womb) prevents bacteria in the vagina from spreading up into these organs. However, if the cervix is exposed to a sexually transmitted infection (STI) such as gonorrhea or chlamydia, it becomes infected. This can allow bacteria to travel up into the internal organs, making them inflamed and infected. If this occurs, the woman's fallopian tubes may be damaged, making it difficult for her to become pregnant.

How do I know if I have PID?

PID causes different symptoms in different women. These may include the following:

• A dull pain and tenderness in the lower abdomen.
• Vaginal discharge that is usually yellow or green and may have an unpleasant smell.
• Irregular menstrual periods, such as extra long periods, spotting or cramps throughout the month.
• Chills, high fever, nausea, diarrhea and vomiting.
• Pain during sex.
• Low back pain.
• Painful urination.

Some women who have PID do not experience these symptoms and do not know they have it.

What should I do if I have symptoms of PID?

Women who have these symptoms or who think they have been exposed to an STI should see their doctor right away. Your doctor can only diagnose PID by doing a pelvic exam, swabbing the area and having the sample tested. The sooner you see your doctor, the better. Waiting can allow the infection to spread and cause more pain and damage.

How does a woman get PID?

There are several ways women can get PID. The most common way is by having sex with a person who has gonorrhea or chlamydia. These diseases are carried in the semen and other body fluids of infected people. During sexual contact, the germs spread to the woman's cervix. The germs can also infect the glands at the opening of the vagina, the urethra (passageway for urine) or the anus.

Sometimes women get PID without being exposed to gonorrhea or chlamydia. In these cases, doctors aren't sure why the bacteria in the vagina spread into the uterus and fallopian tubes, causing PID.

Rarely, PID can also occur if bacteria infect your internal organs as a result of giving birth, or having a miscarriage, an abortion or a procedure to take a sample from the inside of the womb for laboratory testing. Sometimes PID can occur after the cervix is treated because of an abnormal Pap smear or after the insertion of an intrauterine device (IUD). However, this is not common.

What are the risk factors for PID?

The same things that put you at risk for STIs also put you at risk for PID. Risk factors for PID include:

• Being a sexually active woman younger than 25 years of age.
• Having multiple sexual partners.
• Having unsafe sexual habits.
• Douching regularly (which can flush the bacteria up into your genital tract).

How is PID treated?

There is no over-the-counter treatment for PID. PID can usually be cured with antibiotics. Most women do not need to be admitted into the hospital and can have outpatient treatment. If you are treated as an outpatient, you must take your medicine exactly as your doctor prescribes. If you don't take all the medicine, your symptoms may get worse and you may have to go to the hospital. A few days after you start taking the medicine, your doctor will want to see you for a checkup.

Hospitalization may be recommended if you are very sick with PID, or if you are pregnant, under the age of 18 or have the human immunodeficiency virus (HIV).

Should my partner be treated if I have PID?

If you are treated for PID, especially if it's caused by an STI, your partner must also be treated. Unless your partner is treated, you may be infected again. Making good choices about sexual contact is important. If you think you might have PID, talk to your family doctor right away.

What can happen to my body if I get PID?

Early and complete treatment can help prevent complications of PID. However, if PID isn't treated, it can cause permanent damage to your internal organs. Scar tissue can form in the fallopian tubes and around the abdomen. This tissue can prevent pregnancy or cause the pregnancy to form outside the uterus (called a tubal or ectopic pregnancy). Scarring can cause pain that lasts for months or even years. Occasionally, the effects of PID can be so severe that surgery is required to remove pus, get rid of scar tissue or remove damaged organs.

PID is more likely to come back if you are exposed to STIs again. Each time you have PID causes more damage and a greater possibility of complications.

How do I practice safe sex?

Avoid sexual contact with people who are at risk of infection. If you decide to have sex, first ask your partner if he or she has any risks for infection. Both men and women can carry STIs and not have any symptoms, which is why regular screening for STIs is important. A male partner should always wear a condom during sexual activity. Even though the condom will not prevent 100% of STIs, it will greatly reduce your chances of getting infected.

Remember, only a condom can provide some protection against STIs. Other forms of birth control don't provide this protection.

• What is the likely cause of my pelvic inflammatory disease?
• Do I need any tests?
• What do my test results mean?
• What treatment option do you recommend?
• Does my sexual partner need to be treated too?
• Is it safe for me to have sex now, or do I need to wait until after treatment?
• Do I have scar tissue or other damage to my organs?
• Will I have trouble getting pregnant?