Why You Could Have PID Despite a Lack of Symptoms

Pelvic inflammatory disease (PID) is a condition caused by bacteria, which spreads through the reproductive tract.

Many sexually transmitted infections (STIs) show no symptoms, so treatment may be delayed. When an STI is left untreated, it can create lifelong complications. One such complication from an untreated STI is PID. Pelvic inflammatory disease can cause infertility, chronic pelvic pain and other health issues, such as increasing the chance of an ectopic pregnancy or an abscess in the reproductive tract, which could lead to a life-threatening infection.

PID is a common cause of infertility. According to the American College of Obstetricians and Gynecologists (ACOG), 1 in 10 women with PID become infertile. The risk of ectopic pregnancy increases when a fertilized egg implants outside the uterus due to scarring in the fallopian tubes caused by PID, which can obstruct a fertilized egg from moving to the uterus.

"Pelvic inflammatory disease is an infection of the female reproductive organs. It occurs when bacteria from the vagina move to the uterus, fallopian tubes or ovaries. It is essentially contracted sexually," explained Anna Cabeca, D.O., an OB-GYN in Dallas.

While PID is contracted sexually, it is not considered an STI. It is treatable, but prompt treatment is essential to prevent future complications.

How common is PID?

Cabeca said PID is quite common, with more than 1 million people receiving the diagnosis each year in the United States, where it affects about 5 percent of women. A 2013 study reported that at one point, PID was the most common gynecological reason for hospital admission in the U.S.

The condition is also extremely prevalent among younger women, though women of varying ages can get it.

"PID occurs most frequently in sexually active women in their childbearing years, usually of the age group of 15 to 25," Cabeca said.

PID is common and can exist without symptoms, so it's easy to contract without noticing. STIs are also most common among young adults, accounting for half of all new infections in 2020, according to the Centers for Disease Control and Prevention (CDC) surveillance data. Young adults with STIs may be less likely to receive testing, potentially adding to why PID may be more common in this age range.

But there's also another potential explanation, Cabeca said.

"This is, in part, because the cervix in teenage girls and young women is not fully matured, and it increases the risk of STI in general," Cabeca said.

Risk factors for PID

PID can be treated and it is possible to get rid of the infection. However, long-term PID can create scarring in the reproductive organs, which treatment may not reverse. The longer PID is untreated, the harder it can be to treat its effects. It's possible to have PID and not develop symptoms for a time; it's common for people to think PID symptoms might be related to another condition. PID can take up to a year to develop, and symptoms often depend on the severity of the infection.

An untreated STI, primarily gonorrhea and chlamydia, is the most common cause of PID. These STIs are largely asymptomatic, too. About 70 percent of women and 50 percent of men with chlamydia have no symptoms. With gonorrhea, about 50 percent of women and 10 percent of men have no symptoms.

The onset of PID from an untreated STI can take days or weeks to develop. Regardless of whether or not symptoms present, PID can still spread and create future complications.

While the most common cause of PID is an STI, other causes, such as untreated bacterial vaginosis (BV), can lead to PID. Douching and unprotected intercourse can increase the risk of developing BV.

"While rare, PID can occur without any sexual interaction. Sometimes it can come from normal vaginal bacteria traveling to your reproductive organ," Cabeca said.

According to ACOG, the more sex partners someone has, the greater risk they have of getting PID.

"It is always safest to use a condom," Cabeca said. "Chlamydia, mycoplasma genitalium and gonorrhea are the most common STIs that can cause PID. It is important to note that men can be silent carriers of the bacteria, so even in the event of an exclusive, long-term partner, a woman could be infected."

It's possible for women who have sex with women to get PID. Both internal and external condoms, and additional barriers such as dental dams, can help to prevent the transmission of bacteria or an STI; using them correctly every time is essential.

The risk of getting PID increases if you've had the condition in the past. Taking care of your sexual health is crucial for prevention. Receiving frequent STI testing can help alleviate risk factors, especially if you have more than one sexual partner.

Although untreated chlamydia and gonorrhea are the most common causes of PID, women with newer intrauterine devices (IUDs) may have higher susceptibility due to bacterial contamination. However, the risk of developing PID from an IUD is very low. The risk is also less when someone has had their IUD for more than five years. Copper IUDs may carry less risk than hormonal IUDs.

Cabeca said taking stress into account is also crucial to sexual health.

"Stress impacts our behavior and ability to practice self-care and can impact our biology and lead to inflammation, which in turn can lead to an infection," Cabeca explained.

To lower the risk of PID, avoiding behavior that might affect the bacteria in the vagina can be helpful. Practices such as douching are not recommended; douching can alter the vaginal pH and alter healthy bacteria.

Left untreated, PID can create a variety of symptoms, such as fever, abdominal pain, vaginal discharge, abnormal menstruation, painful urination and painful intercourse. Receiving treatment is essential to cure the infection.

Barrier contraception is crucial to reducing PID risk. Often, the bacteria that cause PID also cause STIs. If you have any symptoms, a provider can perform an STI test and screen for PID.