Pelvic Inflammatory Disease (PID)

What Is Pelvic Inflammatory Disease (PID)?

Pelvic inflammatory disease is a condition where there is inflammation of a woman’s uterus, fallopian tubes and ovaries, usually caused by an infection that spreads upwards from the vagina and cervix. It is more common in young, sexually active women, or in women who have endometriosis. In some cases, PID can be caused by sexually transmitted infections (STIs) like chlamydia or gonorrhoea; in other cases, it can be caused after procedures such as intrauterine contraceptive device (IUCD) insertion, termination of pregnancy, hysterosalpingogram (HSG).

How do I know if I’ve got pelvic inflammatory disease? 

Symptoms of PID Include:

• Fever
• Smelly vaginal discharge
• Lower abdominal pain
• Pain during sexual intercourse
• Unusual bleeding in between periods or after sex

Do see your doctor for further checks as these symptoms can also be caused by other conditions.

Who is at risk of PID?

Your risk for PID is higher if you: 

• Have had PID before 
• Have had an STI
• Are sexually active and below the age of 25
• Have multiple sex partners 
• Douche 
• Had an IUD inserted recently. The risk of getting PID is higher the first few weeks after inserting an IUD. To lower your risk, get tested for an STI before the IUD insertion.

How do you test for pelvic inflammatory disease in Singapore? 

Your doctor will take a detailed medical/sexual history and perform a pelvic examination. Swabs will be taken from the vagina and cervix to test for infections. It is still possible to have PID even if the swabs return negative as they may not be able to pick up the infections all the time. Blood tests may help to determine the level of inflammation in your body, especially if you have a fever. 

A urine pregnancy test may be done if you have any chance of being pregnant. An ultrasound scan will also be performed to check for any formation of abscess (pus collection) in the pelvis.

If your swab test comes back positive, you and/or your partner will be advised for additional tests.

How is PID treated in Singapore?

Most women can be successfully treated with 2 weeks of oral antibiotics, although severe cases may need hospitalisation for intravenous antibiotics. You will need painkillers and rest, and must continue follow-up with your doctor to ensure that your PID has resolved.

Contact your doctor earlier if you experience:

• Increasing abdominal pain
• Worsening/persistent fever
• Feeling very unwell

What happens if PID is left untreated? 

Prompt and complete treatment is important as there can be serious health consequences if PID goes untreated, as it can cause pelvic organ scarring and result in you being at risk of:

• Ectopic pregnancy (pregnancy outside of the womb)
• Pelvic abscesses
• Chronic lower abdominal pain
• Recurrent PID
• Infertility

Do I need an operation?

Some women with severe PID and large pelvic abscesses who do not improve with intravenous antibiotics may require an operation for pus drainage. This may be done via gynae laparoscopy surgery (keyhole surgery) or by the X-ray department – your doctor will discuss the appropriate options with you.

Will PID affect my partner?

PID can be caused by STIs and your partner may have no symptoms even if they carry the infection. It is important for all partners to be tested and treated appropriately, to avoid reinfection and long-term health problems. Avoid sexual contact for a week after you and your partner have completed treatment. Use a condom to protect against STIs and to prevent PID reinfection.

Can you have a pelvic infection without having a STD?

Although PID is usually caused by an STI, you can get it without having an STI too. This happens when normal bacteria in the vagina travels up to your reproductive organs, causing a PID. Douching can cause the upward movement of bacteria, so do not douche. 

Can I get pregnant if I have PID?

Your chances of getting pregnant are lower if you’ve had PID more than once. 

When you have PID, bacteria can cause inflammation of the fallopian tubes, causing tissue scarring. Scar tissue can prevent an egg from your ovary from travelling down to the uterus through your fallopian tubes, preventing fertilisation from happening. Without fertility treatment, getting pregnant with PID may be difficult. 

Scar tissue from PID can also cause an ectopic pregnancy. Women with PID are 6 times more likely to have ectopic pregnancies.