What Antibiotics Treat Pelvic Inflammatory Disease?

Medically reviewed on May 17, 2023 by Jillian Foglesong Stabile, MD, FAAFP. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

• What Is Pelvic Inflammatory Disease?
• What Are the Signs of Pelvic Inflammatory Disease?
• What Are the Effects of Pelvic Inflammatory Disease?
• How Is PID Diagnosed?
• What Antibiotics Are Used to Treat Pelvic Inflammatory Disease?
• Monitor Your Sexual Health with Everlywell
• Related Content

When the uterus, fallopian tubes, or ovaries become infected with sexually transmitted bacteria, women and people assigned female at birth (AFAB) can experience mild to severe symptoms that can lead to short and long-term health consequences until the condition is treated. [1]

Also called pelvic inflammatory disease (PID), this bacterial infection of the female reproductive organs is believed to affect 2.5 million women and people AFAB aged 18 to 44 years in the United States. [2] Typically, it’s most prevalent in individuals who have previously self-reported a sexually-transmitted infection (STI). Black people with female reproductive organs are also over two times more likely to have PID, compared to those who are white. [2]

Fortunately, PID is treatable with antibiotics, which provide broad-spectrum coverage of the related pathogens. [2] So, what antibiotics treat pelvic inflammatory disease? We explore the facts below.

What Is Pelvic Inflammatory Disease?

Before we dive into the types of treatment for PID, what is pelvic inflammatory disease? While pelvic inflammatory disease does affect the female reproductive organs, it’s not considered an STI. (However, STIs can often cause PID.) Rather, PID refers to various inflammatory disorders that occur within the upper female genital tract, affecting the uterus, fallopian tubes, ovaries, and adjacent pelvic structures. [5] Such conditions include:

• Endometriosis – Uterine cells begin to grow outside the uterus and cannot be expelled during menstruation. The cells may also envelop the ovaries and fallopian tubes. Those with endometriosis can experience pain during their periods, sex, bowel movements, and urination. [11]
• Salpingitis – Acute inflammation of the fallopian tubes, most often caused by sexually transmitted microorganisms. Signs of salpingitis include abnormal vaginal discharge, spotting, and pain in the abdomen and lower back. [10]
• Tubo-ovarian abscess– An infectious mass of cells can develop as a result of PID. While symptoms vary, those with a tubo-ovarian abscess may have lower abdominal-pelvic pain, unusual vaginal discharge, fever, and elevated white blood cell counts. If the abscess ruptures, it can lead to life-threatening sepsis. [12]
• Pelvic peritonitis – This condition is characterized by inflamed abdominal tissue. In the case of PID, pelvic peritonitis is caused by bacteria. However, it may also arise as a result of an organ rupture. Symptoms include stomach pain, bloating, vomiting, loss of appetite, fever, diarrhea, reduced urine, increased thirst, constipation, lethargy, and confusion. [13]

Inflammation occurs when sexually transmitted bacteria ascends from the lower female genital tract (vagina and uterus) to the upper tract and occurs most frequently in women and people AFAB aged 15 to 25 years old. [4] In 85% of PID cases, the condition is caused by sexually transmitted bacteria. [4] More specifically, Neisseria gonorrhoeae or Chlamydia trachomatis: [4]

• Gonococcal PID – Gonnorheal PID is often more severe than other types of pathogens. Signs of gonorrhea in women include increased vaginal discharge, painful urination, vaginal bleeding, and abdominal/pelvic pain. [6]
• Chlamydial PID – PID caused by a chlamydial infection is less likely to cause symptoms, since the STI is largely asymptomatic, with 70% of diagnosed women and people AFAB experiencing no noticeable symptoms.7 Because of this, chlamydial PID can often progress for a long period of time and may lead to subclinical PID, which means it's not associated with acute PID symptoms. This type of PID can lead to long-term complications in the reproductive system since it’s often left untreated. [4]

What Are the Signs of Pelvic Inflammatory Disease?

Women and people AFAB with PID can experience a range of symptoms, depending on the severity of the inflammation. While some people will not experience any symptoms, others may encounter: [1]

• Fever
• Chills
• Pain during sex
• Pain when urinating
• Pain in the pelvis or low abdomen
• Heavy vaginal discharge with an unpleasant odor
• Vaginal bleeding after sex or between periods

It’s advised to seek the help of a healthcare provider if you experience severe abdominal pain, nausea, vomiting, and/or a fever higher than 101 degrees Fahrenheit. [1]

Risk factors of PID can include: [4]

• Intercourse with multiple partners
• Being sexually active and aged 25 or younger
• Previous history of PID
• Intrauterine device (IUD) implantation
• Tubal ligation

While abstinence from vaginal, anal, and oral sex is the best way to prevent PID, those who are sexually active can lower their chances of contracting PID by limiting their number of sexual partners, regularly testing for STIs, and using latex condoms during sex. [8]

What Are the Effects of Pelvic Inflammatory Disease?

If left undiagnosed or untreated, PID can result in long-term inflammatory damage, which may lead to: [4]

• Scarring
• Adhesions
• Partial or total obstruction of the fallopian tubes

Consequently, these types of inflammatory damage can cause infertility, chronic pelvic pain, and ectopic pregnancy, which occurs when a fertilized egg grows outside of the uterus, usually in the fallopian tube. [4]

How Is PID Diagnosed?

Due to the irregularity of symptoms, PID is often difficult to diagnose in women and people AFAB. Signs are often subtle and can be entirely asymptomatic. [9] Accordingly, most women will not visit a healthcare provider until their inflammatory symptoms have become severe. [9] Patients may have extreme tenderness of their cervix on exam.

Healthcare providers use several diagnostic tools, including an ultrasound, endometrial biopsy, or laparoscopy, to determine a diagnosis. A laparoscopy is most often used for salpingitis. [9] This surgical procedure, also called a keyhole surgery, is minimally invasive. This involves general anesthesia and a few small incisions in the abdomen, where they’ll insert the laparoscope to take a closer look at any inflammation that may be occurring. [14]

Most healthcare providers will implement a clinical diagnosis strategy, in which they’ll identify the patient’s presenting symptoms to make a diagnosis. They may also perform a pelvic exam and screen for STIs. Most often, healthcare providers are instructed to assume a PID diagnosis in individuals who are: [9]

• Sexually active
• Young
• Living in areas with high rates of gonorrhea or chlamydia

Healthcare providers are advised to assume the presence of PID in women and people AFAB who are at high risk of the inflammatory disorder to avoid potential long-term health consequences, such as infertility. [9]

For those who are diagnosed with tubo-ovarian abscess, inpatient observation is recommended. Patients may also be hospitalized if they’re: [9]

• Pregnant
• Experiencing severe illness, such as vomiting or nausea
• Unable to tolerate an oral outpatient treatment plan
• At high risk of a surgical emergency, such as appendicitis

What Antibiotics Are Used to Treat Pelvic Inflammatory Disease?

Even in cases where chlamydia and gonorrhea are identified, PID is typically caused by a variety of different bacteria. As such, a healthcare provider will likely prescribe a combination of antibiotics once PID is diagnosed. [15]

Healthcare providers will typically prescribe both oral and parenteral treatments, which are injected, rather than administered orally. Parenteral treatment plans include: [9]

• Combination of Ceftriaxone, Doxycycline, and Metronidazole
• Combination of Cefotetan and Doxycycline
• Combination of Cefoxitin and Doxycycline
• Combination of Ampicillin-sulbactam and Doxycycline
• Combination of Clindamycin and Gentamicin

Oral treatment plans for PID are recommended for patients with mild-to-moderate symptoms. However, those that do not respond to oral treatments within 72 hours may be administered parenteral treatments instead. Oral antibiotic pills include:

• Combination of Ceftriaxone, Doxycycline, and Metronidazole
• Combination of Cefoxitin, Probenecid, Doxycycline, and Metronidazole
• Combination of Cephalosporin, Doxycycline, and Metronidazole

Oral tablets are typically taken for two weeks. [15] Even if symptoms subside, it’s important to finish the entire antibiotic treatment plan to ensure the bacterial infection is eradicated completely. [15]

All PID patients diagnosed with chlamydial or gonococcal PID should also undergo an additional STI screening three months after treatment. Additionally, each sexual partner should be tested and treated for any STIs to avoid reinfection.

As you take your antibiotic treatments, it’s also advised that you take care of yourself by: [17]

• Drinking water
• Eating healthy foods
• Avoiding a douche or tampons
• Resting in bed
• Avoiding sex until you have confirmation that the infection is gone

Side Effects of Pelvic Inflammatory Disease Antibiotics

Antibiotics for PID may cause various side effects, including: [18]

• Nausea
• Diarrhea
• Stomach pain
• Rash or itching
• Vaginal yeast infection

When taken, antibiotics kill all bacteria in the body—both good and bad—which is why diarrhea and yeast infections may occur. As such, it’s recommended to consume probiotics while taking antibiotics to help bacteria regrow in your gut and digestive system. Probiotics are found in supplements, as well as a range of foods, including: [16]

• Yogurt with active ingredients
• Kefir
• Sauerkraut
• Kimchi
• Tempeh
• Miso
• Kombucha
• Pickles

If you do begin to experience adverse or severe symptoms, speak to your healthcare provider about how you can amend your treatment plan.

Monitor Your Sexual Health with Everlywell

Pelvic inflammatory disease is most often caused by sexually transmitted bacteria that travel upward through the female reproductive system. While some individuals may experience symptoms like pelvic pain, unusual discharge, and vaginal bleeding, others may be entirely asymptomatic.

Because untreated PID can lead to long-term health issues, such as infertility and ectopic pregnancy, it’s crucial to test yourself regularly for the most common causes of PID—chlamydia and gonorrhea.

At Everlywell, we care about women’s health. If you think you have any symptoms of an infection of PID, get in touch with one of our clinicians for online STI treatment.

Your provider will discuss your symptoms and concerns with you to develop the best treatment plan. Take control of your health and well-being with Everlywell.

Related Content

Is Bacterial Vaginosis an STD?

Can a Urinary Tract Infection (UTI) Go Away On Its Own?

Common Causes of Vaginal Burning and Treatments

What Is Pelvic Inflammatory Disease?

References

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3. Pelvic inflammatory disease (pid) treatment and care. CDC. URL. Published July 22, 2021. Accessed May 10, 2023.
4. Jennings L, Krywko D. Pelvic inflammatory disease. StatPearls. URL. Published March 13, 2023. Accessed May 10, 2023.
5. Desapri K. Pelvic inflammatory disease. Medscape. URL. Published August 16, 2021. Accessed May 10, 2023.
6. Gonorrhea. Mayo Clinic. URL. Accessed May 10, 2023.
7. Chlamydia. NHS. URL. Published September 1, 2021. Accessed May 10, 2023.
8. Pelvic inflammatory disease (PID) – CDC basic fact sheet. CDC. URL. Published April 18, 2022. Accessed May 10, 2023.
9. Sexually transmitted infections treatment guidelines, 2021. CDC. URL. Published September 21, 2022. Accessed May 10, 2023.
10. Putten M, Engel M, Well G. Salpingitis. A rare cause of acute abdomen in a sexually inactive girl: a case report. Cases Journal. URL. Accessed May 10, 2023.
11. Endometriosis. Mayo Clinic. URL. Accessed May 10, 2023.
12. Kairys N, Roepke C. Tubo-ovarian abscess. StatPearls. URL. Published June 21, 2022. Accessed May 10, 2023.
13. Peritonitis. Mayo Clinic. URL. Accessed May 10, 2023.
14. Laparoscopy (keyhole surgery). NHS. URL. Published August 1, 2021. Accessed May 10, 2023.
15. Treatment - pelvic inflammatory disease. NHS. URL. Published January 27, 2022. Accessed May 10, 2023.
16. How to get more probiotics. Harvard Health Publishing. URL. Published August 24, 2022. Accessed May 10, 2023.
17. How do I get tested or treated for PID?. Planned Parenthood. URL. Accessed May 10, 2023.
18. Pelvic inflammatory disease (PID) - aftercare: Medlineplus medical encyclopedia. MedlinePlus. URL. Accessed May 11, 2023.