• Reference Number: HEY-320/2016
• Departments: Gynaecology

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Pelvic Inflammatory Disease – the basics

PID is the name given to inflammation of a woman’s reproductive organs: the womb (or uterus) fallopian tubes, ovaries and surrounding tissues. It is usually caused by a bacterial infection that spreads from the cervix (neck of the womb) up into the womb, fallopian tubes and ovaries. In about a quarter of women it is caused by a sexually transmitted infection (STI) such as chlamydia or gonorrhoea.

Symptoms of PID can vary from very mild to severe – sometimes requiring treatment in hospital. Early signs of PID include bleeding in-between periods or after sex and lower abdominal pain – particularly during and sometimes after sex.

PID is easily treated with antibiotics but if not treated promptly can lead to scarring of the fallopian tubes and serious problems such as infertility, ectopic pregnancy (a baby growing in an abnormal place outside the womb) abscess formation and persistent pain in the lower abdomen.  If you have PID we recommend that you should have a full set of tests for sexually transmitted infections (STIs) including an HIV test.

     
PID is an infection of the uterus (womb) and/or the fallopian tubes.

How common is PID?

It is most frequent in young sexually active women. Those under 25 years are most at risk as the cervix is immature and more likely to be infected with chlamydia or gonorrhoea.

Current estimates suggest that 10% of women with untreated chlamydia infection may develop PID within a year.

How do you catch PID?

• From an untreated STI (usually chlamydia or gonorrhoea) that spreads from the cervix to inside the womb and tubes.
• From a bacterial infection that spreads from elsewhere in the abdomen e.g. acute appendicitis.
• Occasionally after a surgical abortion (or other surgery where an instrument is passed into the womb). Most women in the UK are treated with antibiotics at the time of surgery to prevent this.
• Rarely after fitting a intrauterine device (IUD or coil) – but the risk is greatly reduced by testing and treating for any infection or STI beforehand.

What would I notice if I had PID?

In the early stages you may not notice anything wrong. Most women have mild symptoms that may include one or more of the following:

• Lower abdominal pain or aching – a bit like a period pain.
• Pain deep inside during sex.
• Bleeding in-between periods or after sex.
• Unusual vaginal discharge.

A few women become very ill with severe lower abdominal pain, a high temperature and nausea and vomiting. In this situation you need to seek urgent medical attention – either attend a GUM clinic or A&E.

How do I get tested for PID?

PID is diagnosed by a medical assessment/examination and STI screening. There is no one simple test. You can still have PID even if your STI screen is negative.

If your doctor suspects PID you will be advised to have a course of antibiotics. This is because the consequences of leaving PID untreated or not treating promptly (see below) can be serious.

We also need to make sure you are not pregnant – please tell your doctor if you think you could be pregnant.

How is PID treated?

It is important to get treated quickly to reduce the risk of complications. PID is treated with a mixture of antibiotics to cover the most likely infections. The treatment course is usually for 2 weeks. The treatment is free and issued to you directly in the clinic.

Important information about your treatment

Completing the full two week course of treatment will minimise your risk of developing the serious complications of PID. Make sure you also rest and take pain killers such as ibuprofen (do not take if you are allergic to aspirin) or paracetamol if required.

If your symptoms (pain/fever/sickness) get worse or do not get better within 2-3 days then you should come back to the clinic, see your GP or attend A&E. The treatment does not interfere with your contraception.

What about my partner?

As PID can be caused by a sexually transmitted infection it is important that all current partners are tested for STIs and are treated with antibiotics too (even if their STI tests are negative). Sometimes ex partners will need to be tested too – you will be advised about this.

When can I have sex again?

It’s best you don’t have sex at all (not even with a condom and not even any oral sex) until you and your partner have finished your antibiotics.

What happens if my PID is left untreated?

Untreated PID can cause serious problems:

• Persistent or recurrent bouts of pelvic pain.
• Infertility.
• An ectopic pregnancy (this is a serious condition requiring urgent surgery).
• Pelvic abscess.
• Persistent or recurrent bouts of pelvic or abdominal pain.

However, prompt treatment of PID can minimise these risks and most women with PID can go on to get pregnant in the future if they wish.

More information

www.bashh.org/guidelines.

www.nhs.uk/Conditions/Pelvic-inflammatory-disease/Pages/Introduction.aspx.

www.patient.co.uk/health/Pelvic-Inflammatory-Disease.htm.

March 2011 Leaflet produced by the Clinical Effectiveness Group of the British Association for Sexual Health & HIV.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the Data Protection Act (1998) we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.