Pelvic inflammatory disease (PID)

What is pelvic inflammatory disease (PID)?

Pelvic inflammatory disease (PID) is an infection or inflammation of the female reproductive system. It can affect one or more organs including the:

• cervix
• uterus (womb) and endometrium (lining of the uterus)
• fallopian tubes
• ovaries.

PID can cause chronic pelvic pain in some people, while in others symptoms can be mild or silent – meaning some people may not even know they have PID.

PID is treatable, if left untreated it can cause:

• infertility
• ectopic pregnancy
• damage to the reproductive system.

PID can affect anyone, but sexually active women in their 20s are commonly affected.

PID usually occurs over 3 stages:

1. starting in the cervix
2. followed by the endometrium
3. then the fallopian tubes.

Pelvic inflammatory disease (PID) causes

PID is usually caused by a bacterial infection. The most common cause are sexually transmissible infections (STIs) mainly:

• chlamydia
• gonorrhoea
• mycoplasma genitalium.

Other causes of PID include:

• ruptured (burst) appendix
• bowel infection (such as gastroenteritis)
• vaginal infections (such as bacterial vaginosis or BV)
• some surgical procedures (such as dilatation and curettage (D&C), insertion of an intrauterine device (IUD) or surgical abortion).

Pelvic inflammatory disease (PID) symptoms

For some, it can be hard to tell if you have PID because there may not be any obvious symptoms. That’s why it’s important to have regular health checks and get tested for STIs at least once a year if you are sexually active.

Signs and symptoms of PID can include:

• lower abdominal pain or tenderness that may worsen with movement
• menstrual problems (such as painful periods, ovulation pain, heavy discharge)
• change in smell, colour or amount of vaginal discharge (such as unpleasant or ‘fishy’ odour)
• bleeding and spotting after sex
• painful sex (dyspareunia)
• fever
• nausea and vomiting.

Pelvic inflammatory disease (PID) and infertility risk

If left untreated, PID can cause long-term scarring and blockage of the fallopian tubes. This may lead to infertility because the fertilised egg is unable to pass through the fallopian tube to the uterus (womb).

If you have had PID, you may be at a greater risk of having an ectopic pregnancy (where the foetus develops outside the uterus).

Having PID may have an impact on your fertility in the following ways:

• One episode of PID can double your risk of tubal infertility.
• If you have had 3 or more episodes of PID, your risk of fallopian tube blockage increases 75%
• One episode of PID increases the risk of ectopic pregnancy (where the fetus develops outside the uterus) sevenfold.

Pelvic inflammatory disease (PID) diagnosis

If you have any symptoms, see your doctor. Your doctor will do a physical examination and test for possible causes (such as chlamydia and gonorrhoea).

Depending on the cause of your PID, diagnosis may include:

• a physical examination of your pelvic area to check for tenderness and swelling
• blood tests
• urine test
• swabs of the vagina and cervix
• ultrasound (pelvic or transvaginal)
• laparoscopy – in some cases, this is required to correctly diagnose PID. During this procedure, a sample of tissue (biopsy) may be taken.

Laparoscopy is performed under general anaesthetic. A thin tube with a small camera at the end (called an endoscope) is inserted into your belly button to see your reproductive organs.

Pelvic inflammatory disease (PID) treatment

Persistent pelvic pain can occur if PID is not treated. This is usually due to extensive scarring.

Early treatment of PID may minimise the risk of complications.

Treatment usually involves:

• a combination of antibiotics that act against a range of organisms (usually taken for 2 weeks)
• avoiding sexual contact until you have finished your treatment and you have no symptoms
• testing your partners and treating them
• if an IUD is the cause, your doctor may organise to have it removed and suggest other forms of treatment
• in rare cases, a stay in hospital. This can happen for various reasons including – severe symptoms, uncertain diagnosis, abscesses, or you are unresponsive to recommended treatments.

Preventing pelvic inflammatory disease (PID)

To help reduce your risk of PID and transmitting the bacteria that causes it:

• Practise safe sex – use condoms (external and internal) during any form of sexual contact (including vaginal, oral or anal sex) with your partner/s.
• If you are sexually active, get tested at least every 12 months for STIs.
• Get tested for STIs – more regularly if you have multiple sexual partners (including casual partners) over a short period.
• See your GP or health clinic if you notice any symptoms or suspect you may have PID.
• If you are planning to start a family or are pregnant, get tested for STIs.
• If you have an STI, let your sexual partners know. If you feel uncomfortable, your GP or sexual health centre can help. You can also notify partners anonymously through the Let Them Know website.

Where to get help

• Your GP (doctor)
• A gynaecologist or obstetrician
• Your local community health service
• Women’s Health Information Centre, The Royal Women’s Hospital, Melbourne Tel. (03) 8345 3045, regional or rural callers Tel. 1800 442 007
• Nurse-on-Call Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
• Jean Hailes Persistent Pelvic Pain Service Tel. (03) 9562 7555
• Your pharmacist
• 1800 My Options – Victoria’s sexual and reproductive health information and phone line service Tel. 1800 My Options (1800 696 784)
• Sexual Health Victoria (SHV) – book an appointment online or call Melbourne CBD Clinic: (03) 9660 4700, Box Hill Clinic: (03) 9257 0100 or (free call): 1800 013 952 (Monday to Friday 9 am – 5 pm). These services are youth friendly.
• Melbourne Sexual Health Centre (Monday to Friday 8:30 am – 5 pm) Tel. (03) 9341 6200 or 1800 032 017 or National Relay Service (for people with a hearing impairment) (03) 9341 6200
• Victorian Sexual Health Network – where to get tested – visit Melbourne Sexual Health Centre's GP partner clinics for STI check-ups and treatment
• Partner Notification Officers can help you anonymously notify your sexual partners. Tel. 03) 9096 3367
• Let Them Know – free and anonymous service
• Thorne Harbour Health (formerly Victorian AIDS Council) Tel. (03) 9865 6700 or 1800 134 840 (toll free)
• The Centre Clinic, St Kilda Tel. (03) 9525 5866
• Equinox Gender Diverse Health Centre (Monday to Friday 9 am – 5 pm) Tel. (03) 9416 2889 or email: equinoxadmin@thorneharbour.org
• PRONTO! Clinic for men who have sex with men. Book online or Tel. Tel. (03) 9416 2889
• Ballarat Community Health Sexual Health Clinic – book online or Tel. (03) 5338 4541
• Bendigo Community Health Services Sexual and Reproductive Health Hub – book online Tel. (03) 5406 1200 or (03) 5448 1600
• Gateway Health Sexual and Reproductive Health  – Clinic 35, Wodonga (Monday to Friday 9 am – 5 pm) Tel. (02) 6022 8888 and Wangaratta Tel. (03) 5723 2000 or email: info@gatewayhealth.org.au
• Sunraysia Community Health Services, Mildura (Monday to Friday 8:30 am – 5 pm) Tel. (03) 5022 5444 or email to: schs@schs.com.au
• Barwon Health Sexual Health Clinic (no GP referral, walk-in service Tuesdays 2 pm – 6:30 pm) Tel. (03) 5226 7489
• Victorian Aboriginal Health Service Fitzroy: Tel. (03) 9419 3000 and Preston Tel. (03) 9403 3300 (Monday to Friday 10 am – 4 pm) and after-hours locum service Tel. 132 660 or Epping: Tel. (03) 8592 3920 (Monday to Thursday 9 am-5 pm, Friday 9 am-4 pm)