Pelvic Inflammatory Disease (PID) Diagnosis and Treatment

Pelvic Inflammatory Disease (PID)

Pelvic Inflammatory Disease (PID) is an infection which occurs when bacteria enter the uterus, fallopian tubes and ovaries. There are a variety of bacteria which can cause PID, but most infections are caused by the same organisms that cause sexually transmitted diseases like Gonorrhea and Chlamydia. In most cases of PID bacteria enter the vagina during sex and ascend into the cervix, uterus, fallopian tubes and ovaries. Bacteria may also enter the body after an IUD insertion, childbirth, miscarriage, elective abortion or other invasive gynecological procedure. Without prompt treatment, the pelvic infection can cause scarring, abcesses, blockages, and infertility. Pelvic Inflammatory Disease is the leading cause of infertility in women.


Each year in the United States, more than 1 million women experience an episode of acute PID, with the rate of infection highest among teenagers. Between 100 and 200 of every 100,000 women have PID. An estimated 1 in 8 sexually active adolescent girls will develop PID before age 20. According to the National Institute of Allergies and Infectious Diseases, more than 100,000 women become infertile each year as a result of PID, and a large proportion of the 70,000 ectopic (tubal) pregnancies occurring every year are due to the consequences of PID. In 1997 alone, an estimated $7 billion was spent on PID and its complications.

Risk Factors:

Condoms and vaginal spermicides reduce the risk of PID. Oral Contraceptives may also reduce risk. However, safe sex, abstinence, and a reduction in the number of partners are the best protection.

Signs and Symptoms:

PID may be asymptomatic. Often, though, PID presents with a pattern of complaints including:


PID can be hard to diagnose. The physician must determine if the abdominal discomfort stems from PID or another gynecological or intestinal problem. Generally, a diagnosis of PID will be based on the presence of lower abdominal tenderness, elevated white blood cell count and elevated temperature. The physician will perform a pelvic exam and try to pinpoint the tenderness. PID is associated with tenderness of the cervix, uterus and ovaries. During a pelvic exam the practitioner will obtain several cultures to test for chlamydia, gonorrhea, or other bacteria. The cultures will only indicate that a woman has a lower tract infection, but the physician may treat aggressively since PID can be asymptomatic.

PID can be best diagnosed with a laparascopy. A laparascopy is a surgical procedure in which a woman is sedated and a surgeon makes a couple very small incisions in order to insert a special tube which allows the surgeon to see the ovaries, fallopian tubes and uterus. Laparascopies are generally done only if the physician suspects other problems. Without a laparscopy, the physician will treat PID from a total clinical picture since, in the absence of problems, there is no rationale for putting the mother through a surgical procedure.


In most cases, Pelvic Inflammatory Disease can be treated on an outpatient basis. A variety of antibiotics can be used. Close follow-up is required to ensure that the infection is gone. A woman should abstain from intercourse during treatment or have her partner use a condom. All sexual partners should be treated at the same time, too, or the woman is likely to be re-infected.

More complicated or advanced cases of Pelvic Inflammatory Disease may require hospitalization. During hospitalization, intravenous antibiotics are used and then the woman is transferred to oral antibiotics. The initial antibiotic therapy fails in 15% of cases. If initial therapy fails another antibiotic regimen will be used. In cases where the infection repeatedly fails to respond to antibiotic treatment, surgery may be necessary. Between 20% and 25% of women with PID have a recurrence of PID sometime during the reproductive years. A woman with PID should try to change her lifestyle to minimize the risk of repeat infection.

Impact on Fertility and Pregnancy:

Pelvic Inflammatory Disease is the leading cause of infertility. The infection damages the tissues of the fallopian tubes causing scar tissue, narrowing, and partial or complete obstruction of the tubes. Abscesses can form, too. If the tubes become blocked, sperm are unable to pass to fertilize the egg. Infertility risks are based upon the number of episodes of PID:

Additionally, a woman with a history of PID is 7-19 times more likely to have an ectopic pregnancy. Approximately 8% of women with a history of PID experience an ectopic pregnancy because the fertilized egg is unable to pass through a damaged tube to implant in the uterus. Instead, the egg usually attaches in the fallopian tube, which connects the ovary to the uterus. The fertilized egg cannot grow normally in the fallopian tube. This type of pregnancy is life-threatening to the mother, and almost always fatal to her fetus. It is the leading cause of pregnancy-related death in African-American women.

Women with damage from PID may require help in achieving pregnancy. A physician may be able to remove some damaged tissue during a laparoscopy. If the tubes remain blocked, in-vitro fertilization may be necessary.

Related Journal Articles:

Aral, S.O., Mosher, W.D., & Cates, W., Jr. (1991). Self- reported pelvic inflammatory disease in the United States, 1988. Journal of the American Medical Association, 266, 2570-2573.

Bell, T.A., Holmes, K.K. (1984) Age specific risks of syphilis, gonorrhea, and hospitalized pelvic inflammatory disease in sexually experienced US women. Sexually Transmitted Diseases, 11, 291-295.

Bowie, W.R., Jones, H. (1981). Acute pelvic inflammatory disease in outpatients: Association with C. trachomatis and N. gonorrhoea. Annals of Internal Medicine, 95, 685-688.

Buchan, H., Vessey, M., Goldacre, M., & Fairweather, J. (1992). Morbidity following pelvic inflammatory disease. British Journal of Obstetrics & Gynaecology, 100, 558-562,

Cates, W.Jr., Wasserheit, J.N., & Marchbanks, P.A. (1994). Pelvic inflammatory disease and tubal infertility: The preventable condition. Annals of the New York Academy of Sciences, 709, 179-195.

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