Pelvic inflammatory disease (PID) is an infection of the fallopian tubes, uterus, or ovaries. Most girls develop PID as a result of sexually transmitted diseases (STDs), such as chlamydia or gonorrhea.

In the United States, each year more than 750,000 women will develop PID. Most of those infected will be teenagers and young women. Girls with multiple partners and those who don't use condoms are most likely to get STDs and are at risk for PID. If PID goes untreated, it can lead to internal scarring that can result in chronic pelvic pain, infertility, or an ectopic pregnancy.

What Are the Symptoms of PID?

PID can cause severe symptoms or very mild to no symptoms. Girls who do have symptoms may notice:

• pain and tenderness in the lower abdomen
• foul-smelling or abnormally colored discharge
• pain during sexual intercourse
• spotting between periods
• chills or fever
• nausea, vomiting, or diarrhea
• loss of appetite
• backache and perhaps even difficulty walking
• painful or more frequent urination
• pain in the upper abdomen on the right

What Can Happen?

Any girl with symptoms of an STD should get medical care as soon as possible. An untreated STD has a greater chance of becoming PID.

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 fallopian 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. Someone 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.

How Is PID Diagnosed and Treated?

If you think you may have PID, see your gynecological health care provider (your family doctor or nurse practitioner, gynecologist, or adolescent doctor) immediately. The longer a girl waits before getting treatment, the more likely it is that she will have problems like the ones listed above.

If a doctor thinks a girl has PID, he or she will do a physical exam, including a pelvic exam. The exam can reveal when someone has a painful cervix, abnormal discharge from the cervix, or pain over one or both ovaries.

The doctor may also take swabs of fluid from the cervix and vagina, and this fluid will then be tested for STDs. He or she may also do a pregnancy test. Sometimes health providers take blood or urine tests to look for signs of infection, including STDs like chlamydia and gonorrhea.

Sometimes doctors need an ultrasound or CAT scan of the lower abdomen to see what's going on with a girl's reproductive organs. Ultrasounds are often used to diagnose a TOA or ectopic pregnancy.

If it's found that a girl has PID, the doctor will prescribe antibiotics to take for a couple of weeks. It's vital to take every dose of the medication to completely treat the infection, even if symptoms go away before finishing the medicine. It's also important that girls with PID get rechecked 2-3 days after beginning treatment to make sure that they are improving.

Girls who have more severe cases of PID — for example, if they have a fever, vomiting, or are not responding to medicines by mouth — as well as those who are pregnant, are often treated in the hospital for a few days with antibiotics given directly into a vein through an IV. Surgery is sometimes needed if a girl has an abscess. Ectopic pregnancies can require emergency surgery.

If a girl has taken all her medication for PID but still isn't feeling better, she should follow up with her doctor. If a girl has PID, her sexual partners should be checked for STDs right away so they can get treatment. An untreated partner is likely to reinfect a girl with the same STD again.

Can PID Be Prevented?

The best way to prevent STDs or PID is to not have sex (abstinence). For those who choose to have sex, it's important to use protection and to have as few sexual partners as possible. Using a latex condom effectively and consistently helps protect against most STDs. However, it's also very important to have regular checkups with your doctor. And if either partner has any symptoms of STDs, both partners should be tested and treated as soon as possible.

So when you're making choices about sex, be smart and be safe.

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