Pelvic inflammatory disease is a long lasting (chronic) infection affecting the womb (uterus), the tubes which deliver eggs to the womb (fallopian tubes) and the nearby structures in the lower abdomen.

There is pain in the lower part of the tummy (abdomen) most often affecting both sides. Very occasionally there may be pain in the upper abdomen, and low back pain may occur too.

The monthly periods may be altered. Some women will suffer from vaginal discharge, pain on passing urine and on making love and also from pain in the back passage (rectum). Sometimes there is a raised temperature (fever).

A small percentage of sufferers will develop scarred fallopian tubes, which can cause difficulties with falling pregnant (conceiving) in the future.

Pelvic inflammatory disease (PID) is most likely to occur between the ages of 15 and 25, in sexually active women. In many cases the cause is a germ (microbe) which is transmitted sexually. Sometimes, however, it comes as a result of spread of an infection in the blood stream, from other parts of the body. Sometimes it is caused by spread of a germ from a nearby structure (as in appendicitis).

The most common germ to cause PID is Chlamydia trachomatis. Gonorrhoea (Neisseria gonorrhoeae) is also a fairly common cause, and both may occur together. Various other bacteria are sometimes involved, but in at least 20% of patients with PID no definite cause is found.

If you suspect you have this you should seek medical advice. Your doctor is likely to examine your abdomen and examine you internally. A specimen of the mucus inside the vagina and also just inside the neck of the womb (cervix) may be taken, using a thing rather like a cotton bud (a swab) and this will be sent to the laboratory to look for microbes.

The doctor may also ask for an ultrasound scan (rather like sonar on a submarine, and the same thing used to show up babies during a pregnancy) which will show up the womb and egg-producing organs (ovaries) and other organs in the pelvis in detail.

The doctor is likely to prescribe antibiotics for at least two weeks. This will usually take the form of two different antibiotics at the same time, as the infection is often difficult to eradicate.

You will need extra rest and may need to take painkillers as well as the antibiotics. You should avoid sex until both you and your partner have been checked by the doctor and treated if necessary. Your doctor may want to refer you to a specialist for further advice.

• Avoiding multiple sexual partners helps.
• Anyway, barrier methods of contraception help reduce the risk.
• In the event of gonorrhoea or one of the sexually transmitted diseases being involved your doctor is likely to want to put you in touch with a contact tracer. Tracing sexual contacts is done professionally, very sensitively and with great discretion. It is necessary to prevent further unnecessary spread.

• Health Protection Agency Chlamydia information
• Health Protection Agency Gonorrhoea information

Books

The New Harvard Guide to Women's Health, by Karen Carlson MD, Stephanie Eisenstat MD, Terra Ziporyn PhD

A book written by women doctors for women.