• being sexually active at a young age
• having multiple sexual partners
• not using a barrier form of contraception
• using a intrauterine device (IUD)
• termination of a pregnancy
• smoking.

Generally, signs for pelvic inflammatory disease (PID) are usually seen 7 to 21 days after contracting chlamydia, or 2 to 5 days after contracting gonorrhoea.

Early signs of pelvic inflammatory disease (PID) are usually irritation and an unusual discharge from the vagina and urethra. PID should be suspected if a patient is suffering from these symptoms, especially if they have recently had contact with a new sexual partner.

Other signs and symptoms of PID include:

• a constant, dragging pain in the lower abdomen, which is painful to touch
• pain following or during sexual intercourse
• abnormal vaginal bleeding – heavy periods, bleeding between periods, bleeding after intercourse
• fever
• abscesses on the lips of the vagina (if PID is associated with a bacterial infection).

Some women are asymptomatic and will not realise they have an infection.

Pelvic inflammatory disease (PID) due to bacterial infections, such as chlamydia and gonorrhoea, can usually be successfully treated with a course of antibiotics. An intensive course of a broad-spectrum antibiotic is recommended and this will usually clear any infection present. It will not treat any damage to the genital organs, and if severe, this may need to be treated surgically. In severe cases, hospital admission may be necessary for the administration of intravenous antibiotics.

Further guidance on the management of PID includes:

• Pelvic inflammatory disease PRODIGY guidance
• Management of acute pelvic inflammatory disease by the Royal College of Obstetricians and Gynaecologists
• United Kingdom national guideline on the management of pelvic inflammatory disease by the British Association of Sexual Health and HIV.

Sexual contact with others should be avoided until the cause of the infection has been identified and successfully treated.

Not a notifiable disease. Consult your local policy document for further information.

If left untreated the infection spreads through the genital tract, causing inflammation of the cervix and fallopian tubes. This in turn causes the lining of the tubes to become red and swollen, and the narrow tubes become even narrower. This makes it very difficult for the fertilised egg to travel along the fallopian tubes, and may lead to infertility or ectopic pregnancy. The risk of becoming infertile is related to the number and severity of the PID episodes.

If the woman is successful in falling pregnant, PID can lead to complications in the pregnancy, such as an increased risk of early delivery and a greater risk of morbidity in the mother and baby. If the PID is a result of chlamydia or gonorrhoea infection, there is a risk that these infections will be passed on to the newborn baby. Click here for further information on chlamydia or gonorrhoea in the pregnant woman.

If the infection is allowed to develop further, the whole wall of the fallopian tubes will eventually become affected, leading to pus seeping out of the tubes from the open ends on to the ovaries. The outer walls of the tubes may then stick to other nearby organs such as the bladder or rectum.

Other complications of PID include:

• perihepatitis – a rare disorder which may complicate the PID
• tubo-ovarian abscess
• reactive arthritis.

Using a condom carefully and regularly when having sexual intercourse can help prevent contracting diseases which may lead to pelvic inflammatory disease (PID). Reducing the number of sexual partners can also help.

None.

Pelvic inflammatory disease (PID) is treated with antibiotics and there are different types recommended for those who may be sensitive to certain drugs. As with all antibiotics, certain side-effects can be experienced.

PRODIGY guidance
www.prodigy.nhs.uk

British Association for Sexual Health and HIV
www.bashh.org

NHS Direct
www.nhsdirect.nhs.uk

NHS Direct Wales
www.nhsdirect.wales.nhs.uk

BBC Health
www.bbc.co.uk

NetDoctor
www.netdoctor.co.uk

National Library for Health
www.library.nhs.uk

The Royal College of Obstetricians and Gynaecologists
www.rcog.org.uk

Clinical evidence from the BMJ publishing group
www.clinicalevidence.com

Young People’s Sexual Health website run by Central Suffolk NHS Trust
www.ypsh.net

Sexual Health InfoCenter
www.sexhealth.org

World Health Organization
www.who.int

NHS Wales
www.wales.nhs.uk

Avert – an international AIDS charity
www.avert.org

NHS DIRECT (2003) Pelvic inflammatory disease [on-line].
Available at: www.nhsdirect.nhs.uk/en.asp? [Accessed 12 May 2005].

PRODIGY (2003) PRODIGY guidance – Pelvic inflammatory disease [on-line]. London: Department of Health.
Available at: www.prodigy.nhs.uk/guidance.asp? [Accessed 12 May 2005].