Infection of the womb, tubes and ovaries. The single thing that protects fertility is treating it quickly.
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Pelvic inflammatory disease is infection of the upper female reproductive tract — the womb, the fallopian tubes and the ovaries. Bacteria travel up from the vagina and cervix, and the inflammation they cause can scar the tubes permanently.
The single most important thing on this page is about timing. PID is treated on suspicion, before any test results come back. Guidance is explicit that treatment should not be delayed waiting for swabs, because the damage to the tubes accumulates day by day, and a few days of waiting can be the difference between a full recovery and a fertility problem years later.
The second thing, and it catches people out constantly: a negative chlamydia and gonorrhoea test does not rule out PID. Only a minority of cases are caused by those two organisms. Plenty of women are told their swabs were clear, sent away without treatment, and come back months later with chronic pain.
Each episode of PID roughly doubles the risk of infertility, and it raises the risk of ectopic pregnancy several times over. Treated promptly, most women recover completely. That gap between the two outcomes is almost entirely about how fast treatment starts.
Some women are acutely unwell with a high fever. Others have nothing more than a niggling ache and a change in discharge. Mild PID does exactly as much damage to the tubes as severe PID — the symptoms simply do not track the harm being done, and this is why the threshold for treating is deliberately low.
Around one in ten women with PID develop inflammation around the liver, causing sharp right-sided pain under the ribs that can be worse on breathing. It is called Fitz-Hugh-Curtis syndrome, and it gets mistaken for gallbladder disease. Mention pelvic symptoms if you present with this pain.
Pain and fever in the weeks after a coil fitting, a termination, a miscarriage or childbirth should raise the possibility immediately.
This is the reason a clear STI screen does not exclude PID. Most cases are not caused by the two infections that get tested for.
PID is a clinical diagnosis, made on symptoms and examination. There is no single test that confirms it, and guidance accepts that some women will be treated who turn out not to have had it. That trade-off is intentional, because the harm from missing it is far greater than the harm from a course of antibiotics.
Ectopic pregnancy, appendicitis, an ovarian cyst that has twisted or burst, endometriosis, a urinary tract infection, irritable bowel syndrome, or a kidney stone.
Endometriosis is worth naming — it causes very similar symptoms and is frequently mistaken for recurrent PID for years, with repeated antibiotic courses that never quite work.
Diagnosing PID depends on a pelvic examination — specifically, tenderness on moving the cervix and tenderness over the tubes and ovaries. Those findings cannot be assessed remotely, and they are the core of the diagnosis.
Treatment is a 14-day course that usually begins with an injection, alongside two oral antibiotics. And it needs a pregnancy test first, because an ectopic pregnancy presents very similarly and is a surgical emergency.
Go to a sexual health clinic, your GP, or A&E if you are unwell. Sexual health clinics are free, need no referral, and are particularly good at this.
You should be noticeably better within 72 hours. If you are not, or you are getting worse, you need reassessing — an abscess may have formed, or the diagnosis may be something else.
If you have symptoms suggestive of PID, ask to be treated rather than to wait for swabs. That is what the guidance says should happen, and it is the single decision that most affects your future fertility.
It can usually stay in. Guidance is to start treatment and review at 48 to 72 hours; removal is considered only if there is no improvement. Removing it immediately is generally unnecessary, though it may be discussed if you have had unprotected sex in the preceding week.
Most women who are treated promptly go on to conceive normally. Risk rises with each further episode, which is why preventing a second one matters more than anything else you can do.
If you struggle to conceive afterwards, say that you have had PID. It changes which investigations are appropriate and how soon.
Do not spend time deciding between options. With PID, whoever can see you soonest is the right answer, and speed matters more than choosing well.
This page follows BASHH — the British Association for Sexual Health and HIV — UK national guideline for the management of pelvic inflammatory disease, alongside NICE Clinical Knowledge Summaries and RCOG guidance.
Guidance notes that repeated episodes of PID are associated with a progressive increase in the risk of tubal factor infertility, and that ectopic pregnancy risk is substantially raised following infection. Early treatment is the principal modifiable factor.
Reviewed against BASHH, RCOG and NICE CKS guidance current at the date shown above.
No — and this is the most important answer here. Only a minority of PID is caused by chlamydia or gonorrhoea, so clear swabs do not rule it out.
If your symptoms and examination fit PID, you should be treated regardless of the swab result. Being sent away untreated on a negative swab is a recognised route to lasting harm.
Because the tubes scar while you wait. Guidance is explicit that treatment should not be delayed for results.
Some women will be treated who did not have it — that is an accepted trade-off, and a fair one against the alternative.
Treated promptly, most women conceive normally.
The risk of infertility roughly doubles with each episode, so getting treated fast and preventing a second episode is where all the leverage lies.
Not exactly. Some PID follows an STI, but a large share is caused by bacteria already present in the vagina travelling upwards.
Having PID does not necessarily mean anyone has been unfaithful, and that is worth saying plainly.
Yes, and this matters. Untreated partners cause reinfection, and each further episode adds to the risk to your fertility.
Clinics will contact partners anonymously if you would rather not.
Usually not. Guidance is to start treatment and review at 48 to 72 hours, removing it only if you are not improving.
Immediate removal is generally unnecessary, though it may be discussed if you have had unprotected sex in the previous week.
You should be clearly improving within 72 hours. If you are not, go back — that may mean an abscess, or a different diagnosis.
Finish the full 14 days regardless, because stopping early is linked to chronic pelvic pain.
Around one in ten women with PID develop inflammation around the liver, called Fitz-Hugh-Curtis syndrome.
It is regularly mistaken for a gallbladder problem, so mention your pelvic symptoms if you are being assessed for that pain.
It may not be recurrent PID. Endometriosis causes very similar symptoms and is frequently mistaken for it for years.
Repeated antibiotic courses that never quite work should prompt a rethink rather than another prescription.
No — it needs a pelvic examination and a pregnancy test, and the treatment usually starts with an injection.
We can tell you within minutes whether this needs seeing today, and make sure you are not sent away without treatment.
August 30, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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