What is pelvic inflammatory disease?

Pelvic inflammatory disease (PID) is an infection of the upper (internal) female reproductive organs. It usually begins as an infection of the cervix, which then spreads to the uterus and fallopian tubes. The infection can spread beyond the reproductive organs into the tissues surrounding them. Chlamydia and gonorrhea are sexually transmitted infections (STIs) that commonly cause PID. Other infections that are not sexually transmitted can also cause PID.

To find out if you have PID, you must be examined by a health care provider and have lab tests done.

How is it spread?

PID is most often caused by STIs. Factors that make getting PID more likely include having:

• Unprotected sex with someone with an STI such as chlamydia or gonorrhea
• A previous PID infection
• Sexual contact
• Medical procedures that open your cervix such as abortion, dilation & curettage (D&C), or having an intrauterine device (IUD) inserted
• Leaving tampons or items such as contraceptive sponges or diaphragms in the vagina too long. Bacteria can thrive and then spread from the vagina to the uterus

What are the symptoms?

Women who have PID often do not have any symptoms, and do not know they have it. However, when present, the most common symptoms are:

• Pain in the lower abdomen (usually both sides)
• Fever (greater than 38℃ /100.4℉)
• Pain deep inside during vaginal sex
• Abnormal vaginal bleeding or spotting between periods
• Change in the amount, colour and/or odour of fluid from the vagina
• Having to urinate more often
• Pain or burning feeling when urinating
• Lower back pain
• Nausea or vomiting

What are the potential complications?

If you are treated early in the infection, you are less likely to have complications. The potential complications from PID can include:

• Long lasting pelvic pain
• Trouble getting pregnant (infertility)
• Increased chance of an ectopic or tubal pregnancy - where a fertilized egg attaches to the fallopian tube or any other area outside of the uterus
• Getting PID again
• Toxic shock syndrome (TSS)
• Fitz-Hugh-Curtis syndrome – a rare complication of the liver

The likelihood of having the complications from PID increases each time a person has a pelvic infection.

What is the treatment for PID?

The usual treatment for PID is antibiotics. In some cases, PID may be severe enough that you need to be admitted to the hospital for intravenous (IV) antibiotic treatment.

You should return to your health care provider 3 to 7 days after starting treatment if symptoms continue. If symptoms worsen, seek urgent medical care (e.g., to a hospital emergency).

Sexual partners from the last 2 months need to be tested and treated. If you have not had a sexual partner in the last 2 months, then your last sexual partner will need to be tested and treated. It takes time for the infection to clear from the body, so it is important that you do not have any oral, vaginal or anal sex until after you and your partner(s) complete the antibiotic treatment. If you or your partners do not finish the treatment, miss pills or have unprotected sex before you have finished the medication, there is a chance that the infection will stay in your body or pass back to you or your partner(s), and may cause health problems later on. If that happens, talk with your health care provider to see if you or your partners need more treatment.

How can I reduce my chance of getting a sexually transmitted infection (STI)?

Practice safer sex by using a condom

When used correctly, external (“male”) and internal (“female”) condoms help prevent the spread of many STIs during vaginal, anal and oral sex. Condoms are less effective at protecting against STIs transmitted by skin-to-skin contact, such as herpes simplex virus, genital warts (human papillomavirus (HPV)) and syphilis (when sores are present).

Important things to remember when using condoms:

• Check the condom package for damage. Do not use a damaged condom
• Check the expiry date. Do not use a condom after its expiry date
• Carefully open the package so that the condom does not tear. Do not use a torn condom
• Keep condoms away from sharp objects such as rings, studs or piercings
• Store condoms at room temperature
• Use a new condom every time you have sex. Do not reuse condoms
• Do not use 2 condoms at once. Using 2 condoms together may result in a condom breaking
• Use only water-based lubricants with external (“male”) latex condoms. Oil-based lubricants, such as petroleum jelly, lotion or baby oil, can weaken and destroy latex
• Water or oil-based lubricant may be used with polyurethane/nitrile condoms
• Use only condoms made of latex or polyurethane/nitrile/polyisoprene rubbers. Latex and polyurethane condoms are the best types of condoms to use to help prevent pregnancy and STIs. (Lambskin and sheepskin condoms can help prevent pregnancy but don’t work as well as latex or polyurethane condoms to prevent STIs)
• Avoid using condoms with spermicides containing nonoxynol-9 (N-9) as it can irritate tissue and may increase the chance of getting an STI

Get vaccinated

Some STIs, such as hepatitis A, B and human papillomavirus (HPV) can be prevented with vaccines. Talk to your health care provider about how to get these vaccinations.

Know your sexual health status

If you have recently changed sexual partners, or have multiple sex partners, getting regularly tested for STIs will tell you if you have an infection. Some people can have an STI and not have any symptoms. Finding and treating an STI reduces the chances of passing infections on to your partner(s).

The more partners you have, the higher your chances of getting exposed to STIs.

Talk about prevention

Talk to your partner(s) about STIs and how you would like to prevent them before having sex. If you are having trouble discussing safer sex with your partner(s), talk about it with your health care provider or a counsellor.

For tips on how to talk to your partner(s), visit the BC Centre for Disease Control (BCCDC) Smart Sex Resource https://smartsexresource.com/sex-talk/talk-about-it.

Informing partners

If you have a sexually transmitted infection and are sexually active, it is important to tell your sexual partner(s). This will enable them to make decisions about their health and getting tested.

For more information

For more information on how you can reduce your chance of getting an STI, see HealthLinkBC File #08o Preventing sexually transmitted infections (STIs).