Pelvic inflammatory disease (PID) is a serious infection of the female reproductive system that can develop from an untreated sexually transmitted disease (STD). In most cases, it occurs when bacteria from the STD in the vagina or cervix move into the uterus and upper genital tract. The most common organisms that lead to PID are gonorrhea and chlamydia, both of which are highly contagious STDs.

Untreated PID can damage the fallopian tubes, ovaries, and uterus, which can lead to chronic pelvic pain and serious damage to the reproductive system. PID is the most common, preventable cause of infertility, and can also lead to ectopic pregnancies.

The good news is that when PID causes symptoms, it can be diagnosed and treated with antibiotics. The essential part is to detect it before it leads to serious health problems. However, since symptoms can be mild, many cases of PID are unrecognized and, therefore, may be untreated if people aren't screened for STDs. So women who are sexually active should take precautions to keep from contracting STDs, and eventually PID, and be screened for STDs regularly.

Symptoms

Signs and symptoms of PID can range from mild to severe, and can appear weeks after exposure to an STD. Sometimes, there are no symptoms at all.

When symptoms of PID occur, they may include:

• abnormal vaginal discharge, possibly with an odor
• pain during urination or more frequent urination
• aching pain in the lower abdomen
• pain in the upper abdomen or more frequent urination
• fever and chills
• nausea and vomiting
• irregular menstrual bleeding
• pain during sex
• fatigue
• diarrhea
• back pain

If your daughter complains of any symptoms associated with PID, she should see her doctor as soon as possible. You should be especially alert to these symptoms if she has had PID before because they may signal a repeat infection.

The STDs that can lead to PID are very contagious. All sexual partners of someone who is diagnosed with chlamydia or gonorrhea should be notified and treated with antibiotics, even if they have no signs or symptoms.

Complications

If PID is not treated or goes unrecognized, it can continue to spread through a girl's reproductive organs. Untreated PID may lead to long-term reproductive problems, including:

• Scarring in the ovaries, fallopian tubes, and uterus. Widespread scarring may lead to infertility (the inability to have a baby) and chronic pelvic pain. A teen girl or woman who has had PID multiple times has more of a chance of being infertile.
• Ectopic pregnancy. If someone who has had PID does get pregnant, scarring of the fallopian tubes may cause the fertilized egg to implant in one of the tubes rather than in the uterus. The fetus would then begin to develop in the tube, where there is no room for it to keep growing. This is called an ectopic pregnancy. An untreated ectopic pregnancy could cause the fallopian tube to burst suddenly, which might lead to life-threatening bleeding.
• Tubo-ovarian abscess (TOA). A TOA is a collection of bacteria, pus, and fluid that occurs in the ovary and fallopian tube. A woman with a TOA often looks sick and has a fever and pain that makes it difficult to walk. The abscess will be treated in the hospital with antibiotics, and surgery may be needed to remove it.

Prevention

Because STDs can lead to PID, the best way to prevent it is to abstain from having sex (abstinence). Sexual contact with more than one partner or with someone who has more than one partner increases the risk of contracting any STD.

When properly and consistently used, condoms decrease the risk of STDs. Latex condoms provide greater protection than natural-membrane condoms. The female condom, made of polyurethane, is also considered effective against STDs.

Although birth control pills offer no protection against STDs, they may provide some protection against PID by causing the body to create thicker cervical mucus, making it more difficult for bacteria to reach the upper genital tract.

Using douche can actually increase a female's risk of contracting STDs and developing PID because it can change the natural flora of the vagina and flush bacteria higher into the genital tract.

A teen who is being treated for PID also should be tested for other STDs, and should have time alone with the doctor to openly discuss things like sexual activity. Not all teens will be comfortable talking with parents about these issues. But it's important to encourage them to talk to a trusted adult who can provide the facts.

Treatment

PID can be treated with antibiotics, which kill the bacteria that cause the disease. If damage has already occurred in the reproductive organs, antibiotics will not be able to reverse it but will stop further spread of the infection. In some cases, girls with PID do have to be hospitalized, particularly if they develop a high fever, severe nausea, and vomiting; if they need intravenous antibiotics; or if the diagnosis is uncertain.

In trying to diagnose PID, the doctor will likely ask questions about your daughter's medical history, method of birth control, and her sexual activity and that of her partner. The doctor may then perform a pelvic exam to find out if her reproductive organs are tender or swollen and to identify the location of the infection.

It’s not always easy to diagnose PID. Some other conditions, like appendicitis, can cause symptoms similar to PID. During the pelvic exam, the doctor may take samples to look for the germs that cause gonorrhea and chlamydia infections. Blood tests also may be done. Other procedures may be required to determine whether the fallopian tubes are swollen or if an abscess (collection of pus) is present.

Prompt treatment of PID and follow-up care can cure the infection and prevent complications. Rest can help your daughter recover. Hot baths and heating pads applied to the lower back and abdomen can help relieve discomfort.

Your daughter should finish all medicines as prescribed because the PID infection may continue even after the symptoms disappear. To prevent re-infection, her partner also should be examined and treated. It's important to abstain from sex until treatment of both partners is completed and the doctor determines that the infection is gone.

Getting Help

If your teen is thinking of becoming sexually active or already has started having sex, it's important to discuss it. Make sure your teen knows how STDs can be spread (during anal, oral, or vaginal sex) and that these infections often don't have symptoms, so a partner might have an STD without knowing it.

It can be difficult to talk about STDs, but just as with any other medical issue, teens need this information to stay safe and healthy. Provide the facts, and let your child know where you stand.

It's also important that all teens have regular full physical exams — which can include screening for STDs. Your teen may want to see a gynecologist or a specialist in adolescent medicine to talk about sexual health issues. Community health organizations and sexual counseling centers in your local area also may be able to offer some guidance.

Reviewed by: Larissa Hirsch, MD
Date reviewed: July 2010