Pelvic Inflammatory Disease (PID): Symptoms and Prevention

What Is Pelvic Inflammatory Disease?

Pelvic Inflammatory Disease (PID) is an infection of the female reproductive organs. It often starts in the lower genital tract—typically the vagina or cervix—and moves upward into the uterus, fallopian tubes, and ovaries. The condition results from the spread of bacteria, most commonly those associated with untreated sexually transmitted infections (STIs), though other types of bacteria can also cause PID.

When detected early, PID can often be treated without long-term issues. However, if left untreated, it can lead to serious complications such as chronic pelvic pain, infertility, or ectopic pregnancy. The longer the infection is present without treatment, the higher the risk of permanent damage to reproductive organs.

What Causes PID?

The most common cause of PID is a bacterial infection that spreads from the cervix to the upper reproductive tract. This often happens when harmful bacteria ascend through the cervix and into the uterus and fallopian tubes.

PID is most frequently associated with:

• Sexually transmitted infections, especially chlamydia and gonorrhea
• Vaginal infections where natural protective bacteria are disrupted
• Post-surgical exposure or instrumentation of the uterus (such as during a dilation and curettage procedure)
• Childbirth, miscarriage, or abortion if bacteria enter the uterus during or after the process

Although STIs are a leading cause, it’s important to recognize that PID can also develop in the absence of a known STI.

What Are the Symptoms of PID?

Symptoms of PID can vary significantly between individuals. In some cases, symptoms are severe and unmistakable. In others, they may be mild or even absent. This variation can delay diagnosis and treatment.

Common symptoms include:

• Lower abdominal or pelvic pain
• Abnormal vaginal discharge, often with an unusual color or odor
• Pain during intercourse
• Irregular menstrual bleeding or spotting between periods
• Burning sensation during urination
• Fever or chills
• Fatigue or general malaise

Some individuals may only discover they’ve had PID when experiencing fertility issues or undergoing evaluation for chronic pelvic pain. That’s why recognizing even mild or vague symptoms is important.

How Is PID Diagnosed?

There is no single test that definitively diagnoses PID. Diagnosis is usually based on a combination of the following:

• Medical history: A detailed discussion about symptoms, sexual history, and any recent infections or procedures.
• Pelvic exam: Your provider may check for tenderness in the uterus, cervix, or adnexa (the area of the ovaries and fallopian tubes).
• Laboratory testing: Cervical or vaginal swabs are often collected to test for STIs. Blood tests may be used to evaluate inflammation.
• Imaging: If needed, a pelvic ultrasound or other imaging studies may be used to look for signs of abscesses or other abnormalities.
• Laparoscopy: In rare cases, a minimally invasive surgical procedure may be used to visually examine the pelvic organs directly.

Diagnosis can sometimes be challenging because symptoms overlap with other conditions, such as appendicitis, ovarian cysts, or urinary tract infections.

What Is the Treatment for PID?

Treatment for PID typically involves a course of broad-spectrum antibiotics to target the most likely bacteria. It’s crucial to complete the full course of medication even if symptoms improve quickly.

Standard treatment includes:

• Oral antibiotics, sometimes in combination, to cover various types of bacteria
• Intravenous antibiotics in more severe cases or if oral medications are not effective
• Pain management, including over-the-counter medications
• Follow-up within a few days to ensure symptoms are improving
• Treating sexual partners to prevent reinfection

If an abscess is present or symptoms worsen despite antibiotics, surgery may be required to drain infected tissue.

What Happens If PID Is Left Untreated?

When PID isn’t treated promptly, the consequences can be significant and long-lasting. The infection can cause scarring and blockages in the fallopian tubes, leading to complications that include:

• Infertility: Scarring in the fallopian tubes can prevent sperm from reaching an egg or block the fertilized egg from reaching the uterus.
• Ectopic pregnancy: A fertilized egg may implant in a fallopian tube instead of the uterus, a potentially life-threatening condition.
• Chronic pelvic pain: Ongoing inflammation or scarring may lead to persistent lower abdominal pain.
• Tubo-ovarian abscess: In some cases, infected fluid can collect around the ovary and fallopian tube, requiring surgical drainage.

Even one episode of PID can have lasting effects, which is why early detection and treatment are essential.

Can PID Be Prevented?

While PID isn’t always preventable, certain steps can significantly lower the risk. Most preventive measures focus on reducing the chance of infection reaching the upper reproductive tract.

Ways to reduce risk include:

• Routine STI screening and early treatment when needed
• Consistent use of barrier protection, such as condoms, during intercourse
• Limiting the number of sexual partners and discussing STI status openly
• Avoiding douching, which can disrupt the vaginal microbiome and push bacteria upward
• Seeking prompt care for abnormal symptoms such as unusual discharge or pelvic pain
• Waiting until post-surgical or postpartum healing is complete before resuming sexual activity

For those with a history of PID, prevention also includes staying alert for early signs of recurrence and attending regular follow-ups.

Is PID Always Caused by an STI?

No. While STIs are a leading cause, PID can occur without an active STI. Normal vaginal bacteria can become problematic if they move into the upper reproductive tract under certain conditions.

PID can also result from:

• Insertion of intrauterine devices (IUDs), especially if placed during an active infection
• Gynecologic procedures that introduce bacteria to the uterus
• Postpartum infections following childbirth
• Natural imbalances in vaginal flora that allow harmful bacteria to proliferate

That’s why even individuals without a history of STIs should be aware of PID symptoms and risk factors.

Can PID Come Back After Treatment?

Yes, PID can recur, especially if the underlying causes are not fully addressed. Recurrent PID increases the risk of long-term complications and often results in more severe damage than the initial episode.

Reasons for recurrence include:

• Re-exposure to untreated partners
• Incomplete antibiotic treatment
• Delayed treatment after initial symptoms
• Structural damage from previous infections making reinfection more likely

To reduce the risk of recurrence, it’s important to complete all prescribed medications, abstain from sex until treatment is finished, and ensure partners are also treated.

What If I Don’t Have Symptoms—Can I Still Have PID?

Yes, it’s possible to have what’s sometimes called “silent PID.” This form presents with few or no symptoms and may go undetected until complications arise. It’s more common than many realize and can be just as damaging.

Individuals with silent PID may only discover it when they:

• Experience difficulty getting pregnant
• Undergo evaluation for chronic pelvic pain
• Have imaging that shows evidence of scarring or inflammation

Because symptoms aren’t always obvious, regular reproductive health screenings are essential—even in the absence of discomfort.

How Can I Tell If It’s PID or Something Else?

Several other pelvic or abdominal conditions can mimic PID. These include urinary tract infections, ovarian cysts, endometriosis, appendicitis, and gastrointestinal disorders. The key is not to self-diagnose.

A full medical evaluation—including pelvic exam, testing, and imaging when needed—is the best way to determine the cause of symptoms. Timely attention is especially important when symptoms are persistent, worsen over time, or interfere with daily life.

Can You Get PID More Than Once?

Yes — Pelvic Inflammatory Disease can recur, and in some cases, individuals experience it multiple times. Once someone has had PID, the risk of getting it again increases, particularly if the underlying causes were not fully addressed during the first episode.

Why is PID more likely to return?

There are several reasons why PID might recur:

• Reinfection from an untreated or new partner
• Incomplete treatment from the previous infection
• Persistent damage in the reproductive tract that makes it more vulnerable to future infections
• Delayed or missed diagnosis of early symptoms during a second or third episode

The scarring and inflammation caused by previous infections may impair the body’s ability to fight off bacteria effectively, creating a setting where future infections spread more easily. Even when symptoms seem to improve quickly, it’s crucial to complete the full course of antibiotics, attend follow-up appointments, and ensure that sexual partners receive appropriate treatment.

What are the consequences of repeated PID episodes?

Recurrent PID increases the risk of:

• Tubal blockage or distortion that interferes with fertility
• Ectopic pregnancy, where a fertilized egg implants outside the uterus
• Chronic pelvic pain that may last for months or years
• Formation of abscesses, particularly around the ovaries or fallopian tubes

Each recurrence tends to worsen the likelihood of lasting complications, so proactive follow-up and prevention are especially important for those who’ve had PID in the past.

Does PID Affect Fertility?

Pelvic Inflammatory Disease is one of the leading preventable causes of infertility in individuals with ovaries. The impact on fertility depends on how early the condition is diagnosed and treated, how many episodes have occurred, and how much damage has been done to the fallopian tubes or surrounding tissue.

How does PID impair fertility?

When PID causes inflammation in the fallopian tubes, it can lead to scarring, narrowing, or even complete blockage. These changes interfere with the ability of an egg to travel from the ovary to the uterus. In some cases, sperm may be unable to reach the egg, or a fertilized egg may become trapped, resulting in an ectopic pregnancy.

Even mild or “silent” PID can result in this kind of damage if left untreated. Sometimes individuals only discover a history of PID when undergoing evaluation for infertility.

Can fertility be preserved after PID?

Yes, many individuals with a history of PID go on to have healthy pregnancies. Early diagnosis and effective treatment are key factors in protecting reproductive health. If scarring is present, options like assisted reproductive technology (ART) may help overcome blockages or tubal issues.

In some cases, imaging studies such as hysterosalpingography (HSG) can assess the condition of the fallopian tubes. When blockages are found, a fertility specialist may recommend specific next steps, including surgery or IVF, depending on the extent of the damage.

Regular gynecologic care and attention to symptoms can help minimize long-term impact on fertility after PID.

How Can I Reduce My Risk of Getting PID?

While not every case of PID is preventable, certain steps can significantly reduce the risk. Because PID is most often triggered by bacterial infections, many prevention strategies focus on reducing exposure to harmful bacteria and identifying infections early.

Key ways to lower the risk of PID include:

• Consistent use of barrier protection
  Using condoms or other barrier methods during intercourse can reduce the transmission of bacteria that lead to PID. Even in long-term relationships, protection may be recommended if partners have not been screened recently.
• Routine STI testing
  Regular screening for common sexually transmitted infections, especially chlamydia and gonorrhea, is one of the most effective ways to catch infections before they can spread. Early detection makes treatment easier and prevents progression to PID.
• Avoiding douching
  Douching disrupts the natural balance of bacteria in the vagina and can push harmful organisms further up into the uterus and fallopian tubes. Avoiding this practice helps maintain a healthy microbiome and reduces the risk of ascending infections.
• Prompt treatment of symptoms
  Seeking care as soon as unusual symptoms arise—such as pelvic pain, abnormal discharge, or irregular bleeding—can prevent infections from worsening. Delaying evaluation may allow bacteria to spread further into the upper reproductive tract.
• Partner communication and treatment
  If one partner is diagnosed with an STI, both individuals should be treated, even if the other has no symptoms. Reinfection is a common cause of recurrent PID and can be prevented with clear communication and medical follow-through.
• Post-procedure awareness
  After gynecologic procedures like IUD insertion, dilation and curettage (D&C), or surgical abortions, following post-care guidelines closely helps prevent infection. Symptoms that appear after these procedures—such as pain, fever, or unusual bleeding—should be evaluated quickly.
• Limiting number of sexual partners
  While everyone’s relationship preferences are different, having fewer partners and establishing mutual monogamy after STI screening can reduce the likelihood of exposure to infectious bacteria.

Prevention isn’t about eliminating risk entirely but about being aware of how infections happen and taking small, proactive steps to reduce exposure. Whether or not someone has had PID before, staying informed and practicing consistent sexual health habits plays a powerful role in protecting reproductive wellness.

By Dr. Varkey — Published August 22, 2025