Pelvic Inflammatory Disease: Symptoms, Causes, Treatment

Not all pelvic pain is PID. Ectopic pregnancy, appendicitis and other conditions must also be considered. Treatment decisions combine the clinical picture with investigations.

Related reading: Gonorrhea and infection testing.

Lower abdominal pain, unusual discharge, painful sex, bleeding between periods or fever may occur. Symptoms can be subtle despite potential damage, so pain severity alone is not decisive.

Bacteria can ascend from the vagina or cervix, including gonorrhea, chlamydia and other organisms. Diagnosis does not automatically establish a recent sexually transmitted infection or identify its source.

Previous or current sexually transmitted infection, previous PID and certain uterine procedures increase risk. Disease can occur without an obvious risk factor, so symptoms still warrant assessment.

Assessment considers pregnancy and includes appropriate examination, swabs and tests. Imaging may investigate an abscess or another diagnosis. A negative swab does not exclude every cause of PID.

Combination antibiotics cover several organisms and are selected for the condition, pregnancy and allergies. Severe disease, abscess or pregnancy may require hospital care. Response is reviewed within about three days and management reconsidered if improvement is absent.

Abscess, chronic pelvic pain, reduced fertility or greater ectopic-pregnancy risk may follow. Antibiotics control infection but cannot necessarily reverse existing tubal damage.

Early infection testing and treatment, condoms and partner assessment reduce recurrence. Avoid sex until treatment is complete, symptoms resolve and partners have been treated according to the clinical plan.