Tell-tale signs of pelvic inflammatory disease and how it's diagnosed

• Pelvic inflammatory disease (PID) is usually caused by bacteria from an untreated STI.
• It can trigger symptoms like pelvic pain, fever, frequent urination, abnormal bleeding, and more.
• PID can cause complications like infertility, so it's important to get antibiotics right away.

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs often caused by an untreated sexually transmitted infection (STI), like gonorrhea or chlamydia.

The infection affects about 5% of women in the United States and is most common in women ages 15 to 24.

PID can be painful and may even cause fertility issues. But there are ways to treat the condition and steps you can take to reduce your risk of developing PID in the first place.

Symptoms of pelvic inflammatory disease

Signs and symptoms of PID can vary from mild to severe. Some people may not notice symptoms at all. If you do experience symptoms, they may include:

• Pain in your lower abdomen or pelvis
• Unusual vaginal discharge that may have a foul or sour odor
• Pain during intercourse
• Abnormal bleeding between periods or during and after sex
• Painful, frequent urination
• Fever
• Nausea and vomiting

If you are experiencing these symptoms, even if they are mild, consult with a doctor as soon as possible.

Untreated PID can lead to complications like scar tissue that can block the fallopian tubes, infertility, and chronic abdominal pain, says Donna Gin Baick, MD, an OB-GYN with UCI Health and an associate clinical professor at the UCI School of Medicine.

Risk factors for PID

Any person with female reproductive organs can develop PID, but certain factors may increase your risk, including:

• Having multiple sexual partners
• Not using a condom during sex
• A history of PID or sexually transmitted infections
• Untreated gonorrhea or chlamydia
• Being younger than 25 years old and sexually active
• Douching regularly

Causes of pelvic inflammatory disease

PID is caused by bacteria moving upward from the vagina or cervix into the uterus, fallopian tubes, and ovaries, Baick says.

Many different types of bacteria can cause PID, but the most common include bacteria acquired through unprotected vaginal intercourse, like Neisseria gonorrhoeae, which causes gonorrhea, and Chlamydia trachomatis, which causes chlamydia.

In fact, about 85% of PID cases are caused by sexually transmitted bacteria, and 10% to 15% of women who get chlamydia or gonorrhea go on to develop PID.

While less common, it is possible to develop PID without having an STI, Baick says. Other ways bacteria can enter the reproductive organs and potentially cause PID include:

• Douching, which can push bacteria up toward the cervix and into the reproductive tract.
• Recent insertion of an IUD. The risk of developing PID after getting an IUD is highest in the first three weeks after insertion. Getting tested for an STI before getting an IUD can reduce your risk of developing PID.
• Childbirth, miscarriage, or abortion, which opens the cervix and may allow bacteria to enter the reproductive system.
• Certain pelvic procedures, like taking a small sample from the uterus for laboratory testing.

Complications of PID

If left untreated, PID can cause long-term complications, including:

• Infertility, or difficulty getting pregnant, which affects 1 in 8 people with a history of PID.
• Ongoing pelvic or abdominal pain

• Formation of scar tissue on the fallopian tubes, which can cause tubal blockage and increase your risk of ectopic pregnancy. An ectopic pregnancy is a pregnancy that occurs outside the womb and can be life-threatening.
• Abscesses or collections of pus in the ovaries, fallopian tubes, or uterus. If left untreated, an abscess can turn into a fatal infection.

How is PID diagnosed?

In most cases, PID is diagnosed by clinical symptoms, Baick says. Sometimes a doctor will also do a physical exam to look for signs of infection, like tenderness on the cervix, ovaries, or uterus.

Other tests a provider might use to diagnose PID include:

• A vaginal culture or sample of bacteria
• A urine test to check for a urinary tract infection, which may present with similar symptoms, like painful urination
• An ultrasound to get a more in-depth look at your reproductive organs

Treatment and prevention of PID

PID is treated with antibiotics, says Kimberly Langdon, MD, an OB-GYN with Medzino, a telehealth provider.

However, taking antibiotics won't undo any damage PID may have caused to your reproductive organs before beginning treatment. So, the sooner you get treated for PID, the lower your risk of developing long-term complications.

You can also take steps to lower your risk of developing PID by:

• Using a condom every time you have sex
• Regularly getting tested for STIs
• Seeking treatment if you do get an STI, like gonorrhea or chlamydia
• Talking to your partner about their sexual history and asking them to also get tested for STIs
• Avoid douching

Insider's takeaway

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. Many kinds of bacteria can cause PID, but the most common causes include sexually transmitted infections (STIs).

If left untreated, PID can lead to long-term complications, like chronic pelvic pain and infertility.

You can reduce your risk of developing PID by practicing safe sex and always using a condom. Since symptoms of PID are not always noticeable, it's especially important to regularly get tested for STIs that can cause PID, like chlamydia and gonorrhea.