Hesperian Health Guides

Pelvic Inflammatory Disease

In this chapter:

Pelvic Inflammatory Disease or PID is the name for an infection of any of the reproductive parts near and including the womb in the lower abdomen. PID is most often caused by a STI infection— usually gonorrhea, chlamydia, or both—that was not treated or was treated but not cured.

The germs that cause PID 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 that can be mild or severe
  • pain or bleeding during sex
  • tenderness when you press on the lower belly
  • fever over 38°C (100.4°F)
  • feeling very ill and weak
  • unusual bleeding or bad-smelling discharge from the vagina
a woman in a bed, looking ill and weak
Treat PID right away

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

Medicines to treat Pelvic Inflammatory Disease (PID)
This infection is usually caused by a mix of germs, so 3 medicines are used. Choose one medicine from each of the first two sections below and also give metronidazole (third section). Where more than one medicine is listed, the best choice in each section is shown first.
Medicine How much How to use
ceftriaxone 250 mg inject into muscle 1 time only
In some places, 500 mg may be recommended.
or cefixime 400 mg by mouth 1 time only
Only use cefixime if ceftriaxone is not available.
doxycycline 100 mg by mouth, 2 times a day for 14 days
Do not use doxycycline if you are pregnant and avoid using it if you are breastfeeding.
or azithromycin 1 gram (1000 mg) by mouth 1 time only
or erythromycin 500 mg by mouth, 4 times a day for 14 days
metronidazole 400 to 500 mg by mouth, 3 times a day for 14 days
IMPORTANT! Do not drink alcohol if you are taking metronidazole.

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My husband taught school in a town far away from our village and returned home to visit me only a few times each 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, and the remedies from the local healer did not work. I could not leave my children to travel for help, 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.

The doctor at the hospital said I had gonorrhea that 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 probably will 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

This page was updated:22 Jan 2024