Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection of the female upper reproductive organs — the uterus, fallopian tubes, and ovaries — usually resulting from an untreated sexually transmitted infection. It can cause long-term complications, including infertility and chronic pelvic pain, if not treated promptly.

• Lower abdominal or pelvic pain
• Abnormal vaginal discharge
• Pain during sex
• Fever
• Irregular vaginal bleeding
• Symptoms can range from mild to severe, and some infections cause few noticeable symptoms despite ongoing tubal damage

• Most commonly results from an ascending infection from the lower genital tract, often caused by chlamydia or gonorrhoea that was not treated.
• Risk is increased by multiple sexual partners, inconsistent condom use, a prior episode of PID, and certain gynaecological procedures.
• Untreated or repeated episodes increase the risk of long-term complications, including infertility, ectopic pregnancy, and chronic pelvic pain.

• Diagnosed clinically based on pelvic pain together with tenderness on pelvic examination, in the context of risk factors for sexually transmitted infection.
• Testing for chlamydia and gonorrhoea, where available, helps identify the underlying cause, though treatment is often started based on clinical suspicion without waiting for results.
• Pregnancy testing is important to exclude ectopic pregnancy, which can present similarly and is a more urgent emergency.

Treatment involves a combination of antibiotics covering the range of likely organisms, typically including coverage for gonorrhoea and chlamydia, started promptly once PID is suspected clinically, without waiting for test confirmation.

Sexual partners should be tested and treated to prevent reinfection.

Women with severe illness, pregnancy, inability to tolerate oral medicine, or lack of improvement on outpatient treatment require hospital admission for intravenous antibiotics and closer monitoring.

Any woman of reproductive age with pelvic pain and a positive pregnancy test should have ectopic pregnancy excluded before PID is assumed to be the cause.

• Consistent and correct condom use.
• Prompt testing and treatment of sexually transmitted infections, including chlamydia and gonorrhoea, to prevent progression to PID.
• Ensure sexual partners are tested and treated when an STI is diagnosed.
• Seek prompt medical assessment for pelvic pain or abnormal discharge rather than waiting, since early treatment reduces the risk of long-term complications.