Hesperian Health Guides

Complications of STIs

Pelvic Inflammatory Disease (PID)

Pelvic Inflammatory Disease or PID is the name for an infection of any of the reproductive parts in a woman’s lower abdomen. It is often called a ‘pelvic infection’.

Pelvic infection can happen if you have had an STI that was not cured, especially gonorrhea or chlamydia. It can also happen if you recently gave birth, had a miscarriage or abortion, or had an IUD inserted.

The germs that cause pelvic infection travel up from the vagina through the cervix and then into the womb, tubes, and ovaries. If the infection is not treated in time, it can cause chronic pain, serious illness, or death. An infection in the tubes can leave scars that make you infertile or at risk for a pregnancy outside the womb (tubal or ectopic pregnancy).

illustration of the above: infection in the tube caused by bacteria entering the vagina


PID does not always cause pain.

Signs (you may have one or more of these):
  • pain in the lower belly
  • high fever
  • you feel very ill and weak
  • green or yellow bad-smelling discharge from the vagina
  • pain or bleeding during sex

a woman in a bed, looking ill and weak

Treat pelvic infection
right away.
Start taking the medicines below right away. If you do not feel better after 2 days and 2 nights (48 hours), or if you are very ill with a high fever or vomiting, or if you are pregnant, recently had an abortion or gave birth, go to a health center or hospital immediately. You may need strong medicines in the vein (IV).

To prevent PID, always treat STIs correctly. Be sure to:

  • take all the medicine.
  • make sure your partner gets treated.
  • stop having sex until you and your partner have finished all the medicine and your signs have gone away.

Medicines for Pelvic Infection (PID)
This infection is usually caused by a mix of germs, so more than one medicine must be used to
cure it.
Medicine How much to take When and how to take
ceftriaxone 250 mg inject into muscle as a single dose
or spectinomycin 2 grams (2000 mg) inject into muscle as a
single dose
(do not use doxycycline if pregnant and avoid using it if you are breastfeeding)
100 mg by mouth, 2 times a day
for 14 days
or azithromycin
(take azithromycin with food, safe during pregnancy)
1 gram (1000 mg) by mouth as a single dose, and a second dose 1 week (7 days) later
or erythromycin
(safe during pregnancy)
500 mg by mouth, 4 times a day
for 14 days
or amoxicillin
(amoxicillin can be used if you are pregnant and azithromycin and erythromycin are not available)
500 mg by mouth, 3 times a day
for 14 days
(avoid metronidazole in the first
3 months of pregnancy)
400 to 500 mg by mouth, 3 times a day
for 14 days
Also treat the woman’s partner with the medicines in the box for ‘AT RISK for an STI’.
IMPORTANT! Do not drink alcohol during the time you are taking metronidazole.

My husband taught school in a town far away from our village and returned home to visit me only a few times a year. After one of his visits, I became very ill with fever and a terrible pain in my abdomen. I did not know what was causing my sickness.... I tried remedies from the local healer, but they did not work. I did not want to leave my village to look for help because I did not want to leave my children, and I did not have much money. I got so sick that my neighbors thought I was going to die. So they took me in a truck to the nearest hospital, 90 miles away.
a woman in a hospital bed

The doctor at the hospital said I had gonorrhea, and that this had caused a bad infection inside my abdomen. He said I would need expensive surgery and many days of medicines to cure me. He also said I would probably not be able to have more children. Now, I only wish I had taken the right medicines when I first became sick.

—Central African Republic

In addition to PID, STIs can cause other problems for a woman. A woman with an STI that is not cured is more likely to have problems with infertility and tubal pregnancies. STIs can also cause:

Early treatment of STIs can prevent complications.

Swollen vagina (Bartholin gland infection)

Just inside the vagina there are 2 small pockets of skin called ‘glands’. They make a liquid that helps to keep the vagina wet. Sometimes germs get inside, and one or both glands become infected.

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  • Swollen, hot, painful vaginal fold that is darker in color. Usually it happens on one side only.
  • Sometimes there is swelling with no pain.

Although not always caused by an STI, this infection often happens when a woman has gonorrhea or chlamydia.

  1. Soak a cloth in clean, hot water and place it on the swelling. Do not make it so hot that you burn yourself. Do this as often as you can until the swelling opens and pus comes out, or until the swelling goes down.
  2. Also, you and your partner both need to take medicines for gonorrhea and chlamydia. See the
    medicine chart for 'AT RISK for an STI'.
  3. If the area is painful and stays swollen, see a trained health worker who can cut it open and drain out the pus.

Problems in newborn babies

More Information
care of the eyes
a baby with swollen eyelids and liquid coming out of the eyes

If a woman has gonorrhea or chlamydia, she may pass it to her baby during birth. The infection can get into the baby’s eyes and cause blindness. To prevent infection and blindness, put antibiotic ointment in the baby’s eyes right after birth. Chlamydia can also cause pneumonia in newborn babies.