Pelvic inflammatory disease (PID): symptoms, treatment and complications

The NHS says not everyone with pelvic inflammatory disease has symptoms, and NHS inform says PID often does not cause any obvious symptoms and that most symptoms are mild, which makes it difficult to diagnose. Symptoms may start quickly over a few days, or develop slowly and get worse over time.

NHS inform lists fewer common symptoms too: severe tummy pain, a high temperature (fever), and feeling and being sick. It also lists pain when peeing.

• Pain in the area between your tummy and thighs (pelvic pain) or in your lower tummy.

• Pain felt deep inside when you have sex.

• Heavy or painful periods that are unusual for you.

• Bleeding between periods or after sex.

• Vaginal discharge that looks, smells or feels unusual for you.

• Pain when peeing (NHS inform).

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you think you have symptoms of PID, if you have pelvic pain that comes and goes, if you have symptoms of PID and you are pregnant or think you might be, or if you have been diagnosed with PID and do not feel better after 3 days of taking antibiotics.

It says to call 999 or go straight to A&E if you think you have symptoms of PID and you have any of the following. Do not drive yourself to A&E.

• Pelvic pain that is severe, getting worse, or hurts when you move or touch the area.

• Pelvic pain with heavy bleeding from the vagina.

• A sharp, sudden and intense pain in your lower tummy.

• Pain under your ribs on the right side and in your right shoulder.

• Feeling dizzy or faint.

• A very high temperature, or feeling hot, cold or shivery.

• Feeling or being sick, or feeling very unwell.

The NHS says PID is usually easy to treat if it is diagnosed early. The main treatment is antibiotics: the doctor will usually give you an injection of antibiotics and prescribe antibiotic tablets for you to take for 2 weeks. NHS inform says oral antibiotics will probably be given for at least 2 weeks, and that you should finish the entire course.

NICE Clinical Knowledge Summaries says empirical antibiotic treatment should start as soon as a working diagnosis is made, which may be before test results are available, and that the person should be reviewed within 72 hours in primary care to assess the response. This fits with the NHS advice to seek help if you do not feel better after 3 days of antibiotics.

In more severe cases, NHS inform says you may be admitted to hospital for observation and treatment with antibiotic injections, and the NHS says that if PID is left untreated or the infection is severe you may need to go to hospital. For pain, the NHS says an everyday painkiller such as paracetamol or ibuprofen can help.

You will be advised to stop having sex until you and your sexual partners have finished any antibiotics, you no longer have symptoms, and your test results show the infection has gone. If you do have sex, the NHS says to use a condom.

There is no single test for PID. NHS inform says your doctor or nurse will discuss your symptoms before an internal examination, and will look for tenderness in the pelvic region and abnormal vaginal discharge. The NHS says a GP will ask about your symptoms, recent sexual partners, the contraception you use and whether you could be pregnant.

You may also need a blood test, a pregnancy test or an ultrasound scan, or a referral to a sexual health clinic. A swab of discharge from the cervix and vagina is usually taken, but NHS inform says a swab cannot be relied on to diagnose PID because some women with PID have a negative result. It also says scans can identify severe PID but will not show up mild disease, so it is possible to have a normal scan and still have PID.

NICE Clinical Knowledge Summaries says the diagnosis should be made clinically, and mentions tests such as a pregnancy test, vaginal swabs for STI testing, and blood tests including inflammatory markers and HIV and syphilis serology.

The NHS says you can ask for a female doctor and for a chaperone, and that you are in control of the examination and can ask the doctor or nurse to stop at any time.

The NHS says PID is usually caused by sexually transmitted infections such as chlamydia and gonorrhoea, but can also be caused by common bacteria that live in the vagina. NHS inform explains that most cases are due to a bacterial infection spreading from the vagina or cervix to the reproductive organs higher up. In some cases the cause is unknown, and may be normally harmless bacteria that get past the cervix.

NICE Clinical Knowledge Summaries says PID is usually due to a sexually transmitted infection and lists chlamydia, gonorrhoea and Mycoplasma genitalium as common causes, noting that mixed infections are common. That is why recent sexual partners are tested and treated even if they have no symptoms.

The NHS says bacteria from the vagina are more likely to cause PID if you have had PID before, have previously given birth or had a miscarriage (which can damage the cervix), or have had a coil (IUD or IUS) fitted, a hysteroscopy, an abortion or any other procedure that opens up the cervix.

The NHS says PID can cause complications if it is not treated early. These include lumps or swellings filled with pus (abscesses) in the fallopian tubes or ovaries, long-term pelvic pain, problems with fertility and a higher risk of ectopic pregnancy, where a baby grows outside the womb. You can also keep getting PID.

NICE Clinical Knowledge Summaries says the risk of complications is increased with severe or repeated infection, and that non-infective complications include ectopic pregnancy, tubal factor infertility and chronic pelvic pain.

PID and pregnancy matter in two directions. If you have symptoms of PID and are pregnant or think you might be, the NHS advises asking for an urgent GP appointment or getting help from NHS 111. NICE Clinical Knowledge Summaries lists pregnancy and suspected ectopic pregnancy among reasons for urgent hospital admission, and a pregnancy test is part of the assessment.

On the NHS you can see your GP or book directly with a local sexual health service. NHS inform says you can get checked for free by booking an appointment at your local sexual health service or contacting your GP practice, and that you should be tested for all STIs including chlamydia, gonorrhoea and syphilis if you are diagnosed with PID.

Some people choose to be seen privately by a gynaecologist or sexual health doctor. If you do, make sure that your partners are also tested and treated, and keep your NHS GP informed so your records stay complete. The urgent-help advice above applies whichever route you use.