Pelvic inflammatory disease (PID) is an infection of the upper female reproductive organs: the womb (uterus), fallopian tubes and ovaries. It is most often caused by sexually transmitted infections such as chlamydia and gonorrhoea, which frequently cause no symptoms at first. Untreated or repeated PID can cause long-term pelvic pain, ectopic pregnancy and infertility.
This guide explains the symptoms, causes, testing and treatment of PID, why partners must be treated too, and practical ways to protect your fertility.
Imagine a 24-year-old woman with dull lower abdominal pain for two weeks. She assumes it is period pain and takes painkillers. She also notices a change in discharge and pain during sex but feels too embarrassed to mention it. When she finally visits a clinic, a nurse takes a sensitive history, examines her, takes swabs and starts treatment the same day. Months later she learns that early treatment may have saved her fertility. Many women are not so lucky, because they wait.
What causes PID?
PID happens when bacteria travel up from the vagina and cervix into the womb, tubes and ovaries. Common causes include:
- Chlamydia and gonorrhoea (the most important preventable causes);
- Mycoplasma genitalium;
- bacteria normally found in the vagina (as in bacterial vaginosis);
- less commonly, infection after childbirth, miscarriage, abortion or insertion of an intrauterine device (mainly in the first few weeks).
Symptoms
- Pain or tenderness in the lower abdomen or pelvis.
- Pain during sex (deep dyspareunia).
- Abnormal vaginal discharge.
- Bleeding between periods or after sex.
- Painful or heavier periods.
- Pain when passing urine.
- Fever, feeling unwell, nausea or vomiting (in more severe cases).
Some women have mild or no symptoms, which is why routine STI testing matters.
When to seek urgent care
Go to an emergency department or urgent clinic if you have severe abdominal pain, high fever, vomiting, fainting, or if you could be pregnant, because ectopic pregnancy and other emergencies must be ruled out.
Diagnosis
There is no single perfect test. A nurse or healthcare provider will usually:
- take a sexual and medical history;
- perform an abdominal and pelvic examination;
- take swabs to test for chlamydia, gonorrhoea and other infections;
- do a pregnancy test;
- sometimes order blood tests or an ultrasound scan.
Because delays increase the risk of complications, treatment is often started on clinical suspicion before test results return.
Treatment
- Antibiotics: usually a combination covering the likely bacteria, for about two weeks, following national guidelines. Complete the full course.
- Pain relief.
- Rest and avoiding sex until both you and your partner(s) have completed treatment.
- Hospital admission if severely ill, pregnant, unable to take oral medicines, or if an abscess is suspected.
- Follow-up to check symptoms have improved.
Gonorrhoea resistance to antibiotics is a growing global concern; see our guide to gonorrhoea.
Partners must be treated
Recent sexual partners should be tested and treated, even if they have no symptoms. Otherwise, reinfection is likely, and each episode of PID increases the risk of infertility. Clinics can help notify partners confidentially.
Complications
| Complication | What it means |
|---|---|
| Infertility | Scarring blocks the fallopian tubes |
| Ectopic pregnancy | A pregnancy grows outside the womb, usually in a damaged tube; can be life-threatening |
| Chronic pelvic pain | Long-lasting pain from scarring and adhesions |
| Tubo-ovarian abscess | A collection of pus needing hospital treatment |
| Recurrent PID | Each episode increases risks further |
How to prevent PID
- Use condoms with new or casual partners.
- Get tested regularly for STIs, especially with new partners.
- Seek treatment early for unusual discharge or pelvic pain.
- Make sure partners are treated.
- Attend follow-up after treatment.
The role of nurses
Sexual health nurses, midwives and primary care nurses are often the first professionals women see. Non-judgemental questions, same-day testing and treatment, and partner notification are key. Learn more about the role of a sexual health nurse.
Frequently asked questions
Can PID go away on its own?
Sometimes symptoms settle, but the infection can still damage the tubes. Always get assessed and treated.
Can I get pregnant after PID?
Many women can, especially with early treatment, but the risk of infertility and ectopic pregnancy rises with each episode.
Is PID a sexually transmitted infection?
PID itself is not, but it is most often caused by STIs such as chlamydia and gonorrhoea.
Does my partner need treatment?
Yes, recent partners should be tested and treated to prevent reinfection.
But I have no symptoms, so I am fine?
Not necessarily. Chlamydia and gonorrhoea often cause no symptoms but can still damage the fallopian tubes. Regular testing is the only way to know.
Your next step: If you have had a new partner since your last test, book a confidential STI test at a sexual health or family planning clinic this month.
Related: Sexual health nurse · Gonorrhoea · Vaginal discharge
Sources: World Health Organization guidelines for the management of symptomatic sexually transmitted infections (2021); national sexual health guidelines (e.g. BASHH UK guideline for PID, CDC STI Treatment Guidelines 2021). Treatment must follow local guidance.
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