Pelvic inflammatory disease

Also called PID

Infection spreading up from the cervix. Treating it late is what causes infertility, so treatment starts before the tests come back.

What it is

Infection of the upper female reproductive tract: the womb, fallopian tubes and ovaries. Most cases follow a sexually transmitted infection, usually chlamydia or gonorrhoea, spreading upwards from the cervix.

The reason it matters is scarring. Each episode damages the fallopian tubes, and the risk of infertility and ectopic pregnancy rises with each one. Around one in ten women with PID becomes infertile, and repeated episodes raise that sharply.

Because the damage happens early and the tests take days, **treatment is started on clinical suspicion rather than waiting for results.** That is deliberate, and it is worth understanding, because being given antibiotics before anything is confirmed can otherwise feel like guesswork.

It is under-diagnosed because the symptoms are often mild and non-specific, and because the diagnosis requires somebody to consider it and perform an examination.

Partners need testing and treating, or reinfection is close to inevitable.

Signs you might notice

Pain in the lower abdomen and pelvis, usually on both sides.

Deep pain during sex, and afterwards.

Unusual vaginal discharge, often yellow or green.

Bleeding between periods, after sex, or heavier periods.

Pain on passing urine.

Fever, feeling unwell.

Often mild, which is why it gets missed.

Same-day assessment: severe pain, high fever, vomiting, or feeling very unwell, which may mean an abscess.

Urgent: severe one-sided pain with a missed period or a positive pregnancy test, which may be an ectopic pregnancy.

How it can affect day-to-day life

Chronic pelvic pain follows in a significant proportion, and it is then managed as a pain condition long after the infection has gone.

The fertility consequences are usually explained badly or not at all, and women find out years later when trying to conceive.

Partner notification is essential and is where treatment most often breaks down. Clinics will do it anonymously.

The coil is often assumed to need removing; usually it does not, and that decision belongs with the clinic rather than being made by default.

The link to sexual health carries stigma that delays presentation, and PID also occurs after childbirth, miscarriage, termination and gynaecological procedures, which is worth saying.

Supporting someone well

Get pelvic pain with abnormal discharge or bleeding assessed rather than waiting.

Expect treatment to start before the test results, and complete the full 14-day course. Stopping early is the main cause of long-term damage.

Get tested for the full range of STIs, and make sure partners are tested and treated.

Avoid sex until both partners have completed treatment.

Ask about the coil rather than assuming it must come out.

Go back if symptoms are not improving within three days; that may mean an abscess.

Ask about fertility implications directly, and ask for it to be recorded, so a future fertility assessment starts from the right place.

Where to get help

A sexual health clinic, which is usually faster and better equipped than general practice for this.

A GP practice, and same-day assessment for severe pain or fever.

A and E for severe pain with fever or vomiting, or suspected ectopic pregnancy.

Terrence Higgins Trust and Brook for sexual health information.