Pelvic Inflammatory disease (PID)

PID is caused by infection of the upper female genital tract, including the womb, fallopian tubes, ovaries and nearby pelvic structures.

The importance of diagnosing and treating PID early is related to its complications which can have major detrimental effects on a woman’s fertility and health.

What causes PID?

PID is caused by infection that moves upward from the vagina and cervix into the upper genital tract. Commonly the infection is sexually transmitted and the woman may or may not have any symptoms suggestive of an infection. The most common sexually transmitted organisms associated with PID is chlamydia trachomatis and neisseria gonorrhoea.

Other organisms that is linked to PID include gardnerella vaginalis, mycoplasma hominis, ureaplasma urealyticum, herpes simplex virus 2, trichomonas vaginalis, haemophilus influenza, cytomegalovirus, etc.

PID can be caused by both sexually transmitted and non sexually transmitted infections.

Studies have shown that up to one third of PID cases is caused by >1 organism.

Approximately 20% of untreated chlamydia or gonorrhoea infection progresses to PID.

Risk factors:

  • Multiple sexual partners
  • History of sexually transmitted infections (STI)
  • Current untreated sexually transmitted infections (STI)
  • Previous history of PID
  • Previous gynaecological surgical procedures – eg: endometrial biopsy, curettage, etc
  • Recent abortion
  • Having an intrauterine device (IUD) – risk is highest during the first 6 months after insertion
  • Douching


With PID, the severity of symptoms may vary in each individual and may take weeks or months for symptoms to present after being infected. Symptoms include:

  • Fever
  • Nausea/vomiting
  • Pelvic/lower abdominal pain (ranges from mild to severe) –usually bilateral dull, aching or crampy pain. Pain is worse with movement, exercise or sex.
  • Abnormal vaginal discharge – up to 75% of cases
  • Abnormal vaginal bleeding – usually after sex or in between menstrual period – up to 40% of cases


PID can be treated with antibiotics if diagnosed early. However, treatment would not reverse any damage that has already occurred to your reproductive system. Hence, it is important to seek treatment early as the longer you wait, the more likely you will develop complications from PID.

While being treated for PID, it is advisable to abstain from sexual activity until your symptoms have fully resolved and you have completed your antibiotic regimen. It is important for your sexual partner to be tested and treated for STI if necessary so that you do not re-infect each other.

Even after treatment, you can still contract PID again if you get infected again.

If you have had PID before, the chances of getting it again increases.



Chronic pelvic pain

Affects up to 25% of patients with a history of PID. Could be linked to cyclic menstrual changes, pelvic adhesions (due to scarring causing internal organs to be stuck together) or fallopian tube blockage.


Approximately 1 in every 10 women with PID becomes infertile, with the highest risk in women who have had delayed treatment or repeated episodes of PID.

Infertility is due to infection and inflammation causing scarring and adhesions outside and within the fallopian tubes, which can lead to tube blockage.

Ectopic pregnancy (pregnancy outside the womb)

Risk of ectopic pregnancy is increased from 10% to up to 50% in women who has a history of PID.

Complications during pregnancy

In pregnant women with untreated PID, complications such as miscarriage, premature birth and stillbirth increases.

Other complications

Include abscess formation in the fallopian tubes, ovaries which can also extend and spread to the rest of the abdomen (peritonitis) including structures around the liver (Fitz-Hugh-Curtis syndrome).


If you think you have symptoms suggestive of PID or you could be at risk of having PID or a sexually transmitted infection (STI), please see your doctor early or visit our clinics as the earlier you diagnose and treat PID, the lower the chances of developing complications which can be detrimental to your health and fertility. You can also help reduce the risk of getting PID or STI by using condoms with a new sexual partner until they have had a sexual health screen.

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Other related links:

STD general info

Costs of STD/HIV screening at our clinics

Vaginal discharge

Abnormal Vaginal bleeding

Vaginal bleeding in early pregnancy




Bacteria vaginosis


  1. hi doctor,
    i would like to ask hsv 1 got any cure,it is hsv 1 will transfer to hiv???please i need you professional answer

  2. Hi Doctor,

    I’ve been diagnosed with chlamydia and gardnerella vaginosis in February 2012. After taking medication, the chlamydia was gone by the end of February 2012 but the gardnerella vaginosis didn’t go away till about May 2012. I also started bleeding during the ovulation period from March 2012, and have been bleeding during ovulation off and on since then. Sometimes it’s just spotting, but other times it’s a light flow of blood. The gynae then did a PAP smear, in which the results came back slightly abnormal, but after further testing for a couple of months, the gynae said that I was fine and to have regular checkups once a year.

    In June 2013, I had an yeast infection as I was on antibiotics for flu, but that cleared up shortly after. I took a full STD test in August 2013, and another pap smear in November 2013, and both tests came out fine. I have asked 3 gynaes about the irregular bleeding during ovulation, but they have told me that it is common for some women and not to worry about it.

    What I would like to ask is if I have to worry about the irregular bleeding being caused by PID, what kind of testing does your clinic do for PID, and how much would it cost? Also, would my boyfriend have contracted PID from me if we have had unprotected sex?

    • Hi Dr Tan,

      Thanks for your prompt response.

      As I have taken the tests for the abovementioned STDs and they have all came out negative, does this mean that I do not have to worry about PID? Sorry I’m being really paranoid :/

      • I really cannot determine if you have PID or not over the internet. You have to see a Doctor.

  3. Previously I was diagnosed with UTI and yeast infection. However, I just found out that I have ureaplasm too in a STD. Finished the antibiotics given by doctor but still have some yellow discharge. Is it normal to have some amount of yellow discharge? Also, I asked my doc if I have PID but he said that it’s unlikely cos I don’t have fever/unbearable pain, but just cramps sometimes. How can in know if I have PID? What test?

    • Having a persistent discharge after an infection has been treated could be normal as the body is ‘clearing’ itself. However, we must always bear in mind 2 possibilities: 1. The treatment may not have worked i.e. the infection is still there. 2. There is another infection that was either missed of covered by the first problem. So retesting may be necessary. The best test for PID is a pelvic ultrasound. Click here for details of our Women’s Health Clinic.

      • I did a pelvic ultrasound and found small amount of fluid in pod. Is that indicative of pid? Tested for urea plasm and found that it’s cleared. My doc said that since the urea plasm is gone, I don’t need any treatment now. Not sure if really so..

        • Dr Elaine Loh

          Small amount of free fluid in the POD can be present in the middle of the menstrual cycle during or soon after ovulation. This is because of the blood and fluid from the dominant follicular rupture in the ovary. However, if this free fluid in POD is accompanied by abdominal pain, or abnormal discharge, it may be caused by pelvic inflammatory disease. So, in my opinion, since you do not have any symptoms at all, and your previous ureaplasma infection was treated and also I presume the test for clearance was done, you should be okay. If you have any concerns at all, you are most welcome to visit our clinics to speak to us and we can decide if you need a repeat vaginal swab.

  4. Amanda

    Hi doctor,

    This is going to be long but please bear with me.

    I am a 24 years old female. I have been with my current boyfriend (M) for 4.5 years now. I have been on birth control for maybe around 6 years. We have been having unprotected sex since the beginning. I have never had any STI symptoms never any odd discharge/foul odors, itch, inflammation with my vaginal areas or fever or anything. But I had a history of UTIs since maybe when I was 18 like maybe once a year or two. I cant tell if I’ve always had an UTI because a lot of times when I just describe my symptoms to the doctor they automatically think it’s UTI and just give me the antibiotics.

    So I have notice that a lot of times when I go back to hong kong in the summer or during periods when I am not stressed doing school I can get this oncoming sensitivity to my clitoris. And this is happening to me now as well. It’s not like it’s painful or itching just this slight sensitivity or numbing that makes me think I need to urinate. I have no burning sensation when I urinate nor are there any signs of abnormalities with my clitoris by looking at it. When I was in hong kong I went to the doctor they gave me UTI antibiotics, the symptoms didn’t get any better and I find that the urgency to pee and sensitivity at night is the most intense. If I drink pure cranberry juice it seems to heighten that effect. This episode all started when my boyfriend who came with me to hong kong had left me to go back to toronto for work and I was left to do nothing but sit at home all day and night for the next month and half with my parents. As soon as the day came for me to get on the plane to come back to toronto the symptoms pretty much dissapeared but a week later when I checked the mail that I have gotten an abnormal pap smear test from my doctor and my friend told me she go chlamydia I started worrying about things and the sensitivity came back. I am just wondering if clitoris sensitivity or disturbances can be caused by psychological factors if no other other symptoms are present??? Or should I go to check for std since I went through the UTI antibiotic treatment already??

    Also I went through a bad past before my current long time relationship.

    I was dating this one guy (B) for 11 months and he cheated on me with this girl towards the end of our relationship and is still currently with that girl as of today. We had unprotected sex. But he was a nurse and was sure he had no STD or any health problems. I had no symptoms of anything while being with him.

    When I was trying to get over (B) I had unprotected sex with my ex boyfriend (E) that was before (B). My Ex boyfriend (E) I was with for a year and he was trying to get back into a relationship with me at that time and I was vulnerable so I slept with him a few times.

    I also had unprotected sex with this other guy from work(A) who has not had anything going on for him for over a year and half before me and had a long term relationship before me.

    And a fourth guy that I had sex with unprotected who just broke up with his gf of 4 years.

    I never had symptoms of anything that would make me suspect STD. But with this clitoris sensitivity. Should I be worried? It’s been so long since I’ve been with my boyfriend. He never expressed any symptoms of anything either. Please let me know what you would advise as my next step. Thank you for taking your time in reading my situation , I hope this all makes sense to you as I know it is a lot to take in.

    • Thank you for the detailed history. My initial impression is that your symptoms are due to your stress/anxiety. It is actually very common for stress/anxiety/worry to cause hyper-sensitivity of the clitoris and urinary urgency and frequency. The fact that your symptoms resolve completely when you flew back to Toronto really lends evidence to this diagnosis. However, I also agree with you that your should screen for STDs especially Chlamydia. Let me explain why. Chlamydia is a very common STD. 80% of women who get infected with Chlamydia do not show any symptoms. If left untreated, Chlamydia could affect your fertility. This is me playing devil’s advocate: 1. The UTIs you had in the past were not UTIs at all. They were symptoms of Chlamydia. Since you were never tested, you never knew. The antibiotics given to you suppressed the infection but did not kill it. 2. The abnormal PAP smear you have indicates inflammation which is any sign of infection. 3. You have had several partners. 4. Chlamydia also rarely causes symptoms on men so perhaps your partner has it and does not even know about it. In summary, although I still think your symptoms are due to stress/anxiety, it would be VERY prudent for you to exclude Chlamydia and other STDs. Most Universities offer free Chlamydia/sexual health screening for their students. You should check with your school health service.


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