Chapter 9 – Pelvic inflammatory disease

Chapter 9 – Pelvic inflammatory disease

Pelvic Inflammatory disease (PID) is an infection of the reproductive organs of a woman namely the uterus, the fallopian tubes and the ovaries. The PID infection usually originates from the vagina and moves upwards via the cervix to the pelvis. Sometimes PID may be a result of infection from other organs in the abdomen such as appendicitis or sometimes even from blood spread. If PID spreads to the blood, it can be extremely dangerous. Many women with PID will not experience any symptom. It may be detected only when investigations are performed for infertility or chronic pelvic pain.


The 2 most common causes of PID are gonorrhoea and chlamydia. Other causes include abortion, childbirth and pelvic surgical procedures.

Risk factors

Some of the risk factors for developing PID are:

1) Having sex and being under the age of 25

2) Having sex with more than one person

3) Being in a sexual relationship with a person who has more than one sex partner

4) Unprotected sex

5) Using an intrauterine device (IUCD) to prevent a pregnancy

6) Douching

7) A history of pelvic inflammatory disease

8) Miscarriage, abortion or endometrial biopsy


Some women with PID will not have symptoms at all and it is only discovered during laparoscopy. For others the symptoms are:

1) Pain in the lower abdomen (the most common symptom)

2) Pain in the upper abdomen

3) Fever, fatigue , diarrhoea or vomiting

4) Painful sex

5) Painful urination

6) Irregular menstrual bleeding

7) Lower back pain

8) Heavy vaginal discharge with unpleasant odour

9) Tiredness

Sharp pain associated with vomiting, fainting and high fever, may be an indication that the infection has spread to the blood, and immediate and emergency treatment is necessary.


A good history from the patient may lead to the suspicion of a PID. Pelvic examination may reveal vaginal discharge usually yellowish in nature and sometimes with a foul smell. Digital pelvic examination may elicit tenderness (pain) of the pelvis especially when rocking (moving) the cervix. Some of the discharge from the cervix may be taken for culture (g) to find out the cause of the infection. A urine test may be necessary to rule out urinary tract infection.

Pelvic transvaginal ultrasound is usually done to visualise the pelvic organs. An ultrasound may reveal enlarged fallopian tubes and ovaries with fluid in them or in the pelvis. A biopsy (g) of the endometrium may be performed. In some patients, a laparoscopy may be necessary to confirm the diagnosis and also to drain any pus collected in the pelvis, especially if it does not decrease with antibiotics.


Treatment of PID is usually with antibiotics. In mild cases oral antibiotics will suffice, but in severe PID admission and intravenous antibiotics may be necessary. Sometimes it may not be possible to determine the organism (bacteria) that is causing the pelvic infection. In such situations, empirical treatment with more than 1 type of antibiotic may be necessary.

Rarely, if the pelvic infection is not resolving (g) with antibiotics or there is collection of pus in the pelvis, laparoscopy may be necessary to drain the pus or even remove the affected organs (fallopian tubes and ovaries). This is performed especially in women who have recurrent pelvic infection in the same area.

Men may not exhibit any symptom and can be an asymptomatic carrier of the disease. It is essential for the partner to be treated as well, to prevent subsequent spread of the infection.

Watch Video 9.1
Pelvic Inflammatory disease


The risk of PID can be lowered by:

1) Practicing safe sex

2) Getting tested for sexually transmitted infections and treated if positive

3) Avoiding douches

4) Wiping from front to back, to stop bacteria from entering your vagina


Long term complications

Treatment of PID is essential to prevent long- term complications namely:

1)  Infertility

2)  Ectopic pregnancy (see chapter 7)

3)  Chronic pelvic pain : pain in the lower abdomen caused by scarring of the fallopian tubes or other pelvic organs


Pelvic Inflammatory disease (PID) is an infection of the reproductive organs of a women. The infection of PID usually originates from the vagina. Treatment of PID is usually with antibiotics. In rare cases, if the pelvic infection is not resolving with antibiotics, laparoscopy may be necessary to drain the pus or even remove the affected organs.

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