Pelvic Inflammatory Disease (PID)

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Pelvic inflammatory disease (PID) is an STI-related condition and is usually the result of infection with bacterial STI such as chlamydia and gonorrhoea. PID occurs when an infection spreads from the vagina to the cervix, the lining of the uterus (endometrium) and/or the fallopian tubes. This inflammation can result in a range of pelvic and reproductive complications. 

PID is easily treated when diagnosed early, and most people make a full recovery. PID is common among sexually active people with vaginas, but it’s often undiagnosed because it does not always cause symptoms. 

Signs and Symptoms

There is no defined length of time during which PID symptoms may occur, and you can be asymptomatic for a very long time. The symptoms of PID might be mild, moderate or severe. They may develop gradually or come on suddenly.  

If left untreated, PID can result in complications such as lower fertility, chronic abdominal pain, ectopic pregnancy (foetus development outside of the uterus), miscarriage, premature birth and stillbirth. 

The recent onset of pelvic pain is a key symptom of PID.

PID may cause any of the following symptoms:

  • Lower abdominal pain or cramps
  • Pain that goes from the pelvic area down to the top of the legs
  • Pain during vaginal sex
  • Vaginal discharge, usually heavier than normal and with an unpleasant odour
  • Abnormal menstrual periods
  • Bleeding or spotting between periods
  • Urinary frequency and urgency
  • Abdominal pain when making bowel movements
  • Rectal discomfort or a sense of fullness in the bowels
  • Feeling bloated in the abdomen
  • Fever, chills, nausea and vomiting
  • Weakness, fatigue, and lethargy

Common Causes

The most common causes of PID are chlamydia and gonorrhoea infections. Mycoplasma genitalium has recently been recognised as another sexually transmissible infection associated with PID. The risk of fallopian tube blockage is slightly higher for PID caused by gonorrhoea.

There is a low-level risk of developing PID following an abortion, insertion of an intrauterine contraceptive device (IUD), or childbirth.

Prevention

Because PID is a complication of certain STI, your best methods of prevention are STI-related. You can prevent PID by: 

  • Reducing your STI risk, particularly for chlamydia and gonorrhoea
  • Getting regular sexual health screening to detect any STI which may cause PID
  • Treating known STI infections quickly and thoroughly

It is recommended that you always change condoms when going from anal to vaginal or oral sex.

Testing 

Here’s some information about testing for PID. You can view a list of sex worker-friendly sexual health clinics at our Where To Test page.

Testing Method

  • Vaginal examination (the doctor/nurse will insert to fingers into the vagina to feel the cervix and other internal structures for tenderness)
  • Vaginal and cervical swabs
  • Other testing options might include a blood test, a urine test and an ultrasound, as recommended by your doctor.
  • Laparoscopy (using a camera to look inside your abdomen) is sometimes required in more severe cases.

When to Test

You should see your doctor as soon as possible if you are experiencing PID symptoms. Be sure to describe your symptoms, rather than just requesting a routine sexual health check, as PID diagnosis is done differently to STI diagnosis. 

Other Info

  • PID is not included in standard sexual health screening, but it is usually diagnosed as a result of other STIs
  • Sexual health clinic testing is often bulk billed, even if you don’t have Medicare, so the test will most likely be free
  • If you see a GP, you may pay a fee or be bulk billed 

Treatment

PID is treatable, especially if detected early. Here’s what you need to know about treating it.   

Treatment Method/s

  • Combination of antibiotics, usually taken for two weeks
  • Treament of any related STI would also occur at this time
  • People with severe episodes of PID may be hospitalised for treatment

Costs and Other Information 

  • Treatment cost will depend on which antibiotic you are prescribed.
  • Sexual health clinic treatments are often bulk billed, even if you don’t have Medicare, so the treatment may be free. 
  • If you see a GP, you may pay a fee or be bulk billed. 
  • PID can return if the initial STI infection is not entirely cured, often because the antibiotic course was not completed or a sexual partner was not tested and treated.

How might this impact my work? 

Practical Considerations

  • It is recommended that you do not have sex for a week during treatment, and until symptoms are gone. 
  • If you can’t avoid having sex, then using a condom will help lower the chance of transmitting infections that cause PID, but there is no guarantee.
  • Some antibiotics can reduce the effectiveness of oral contraception (‘the pill’). 
  • If you often get thrush when you take antibiotics, you may want to take probiotics during and after your treatment to help prevent this.

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