Pelvic Pain With Unusual Discharge: Could It Be Pelvic Inflammatory Disease?

Pelvic pain with unusual discharge can be a sign of pelvic inflammatory disease (PID), an infection of the uterus, fallopian tubes or ovaries that is often linked to sexually transmitted bacteria such as chlamydia and gonorrhea. Other conditions can look similar, so a clinician needs to examine you. Severe pain, high fever, fainting or vomiting that will not stop needs emergency care. This article covers symptoms, evaluation, treatment, complications and when to get help.

Pelvic pain with unusual discharge: what pelvic inflammatory disease is

Pelvic inflammatory disease is an infection of the female reproductive organs. According to MedlinePlus, it often occurs when bacteria spread upward from the vagina and cervix into the uterus, fallopian tubes or ovaries. Sexually transmitted infections such as chlamydia and gonorrhea are common causes, but other bacteria can be involved, and the exact mix differs from person to person.

PID can be mild enough to be missed or severe enough to need hospital care. Because symptoms vary, a single symptom does not establish the diagnosis, and a clinician combines your history, an exam and testing to decide.

Symptoms that can point toward PID

Some people have few symptoms. When symptoms occur, they may include:

• Pain or tenderness in the lower abdomen or pelvis, which can be dull or sharp
• Vaginal discharge that is new or different, such as a change in amount, color or odor
• Pain during sex
• Pain with urination
• Bleeding between periods or after sex
• Heavier or longer periods than usual
• Fever or chills in more significant infections
• Nausea or vomiting in more severe cases

Mild symptoms can be mistaken for a urinary infection, a yeast infection or bacterial vaginosis. If you are trying to sort out discharge alone, our article on yeast infection or bacterial vaginosis covers that comparison. The combination of pelvic pain plus discharge is what raises the question of PID.

What may cause it and who is at higher risk

Several factors contribute. Untreated chlamydia or gonorrhea can spread from the cervix upward. MedlinePlus describes chlamydia and gonorrhea as infections that may cause no symptoms at all, which is one reason they can progress unnoticed.

Factors associated with a higher chance of PID include:

• A recent sexually transmitted infection, or a partner who has one
• Having new or multiple sexual partners
• A past episode of PID
• Age under 25 and sexually active
• Recent procedures that pass through the cervix, such as placement of an intrauterine device (IUD), where the risk is generally described as small and mostly around the time of insertion

Having one of these factors does not mean you have PID, and PID can occur without any of them.

How clinicians evaluate pelvic pain with discharge

There is no single test for PID. A clinician usually asks about symptoms, sexual history, periods, contraception and possible pregnancy. A pelvic exam can show cervical tenderness, uterine or ovarian tenderness, or discharge from the cervix.

Testing may include:

• A pregnancy test, because ectopic pregnancy can cause pelvic pain and must be considered
• Swabs or urine tests for chlamydia and gonorrhea
• Tests for other vaginal infections
• Blood tests, depending on how ill you appear
• Pelvic ultrasound if an abscess, ovarian problem or other cause is a concern

Because treatment is often started when PID is suspected, a negative swab does not always end the discussion. Your clinician weighs your symptoms and exam findings together.

Other causes of similar symptoms

Pelvic pain has a long list of possible causes. Discharge plus pain can also occur with:

• Ectopic pregnancy. A pregnancy outside the uterus can cause one-sided pain and bleeding and can become an emergency. See MedlinePlus on ectopic pregnancy.
• Miscarriage. Cramping and bleeding in early pregnancy are covered by MedlinePlus.
• Cervical problems. Inflammation of the cervix (cervicitis) can cause discharge and may be related to the same infections. See cervix disorders.
• Endometriosis or ovarian cysts. These can cause pelvic pain, though discharge is less typical. We cover them in separate articles linked below.
• Urinary tract infection or appendicitis. Both can cause lower abdominal pain and need their own evaluation.

Cancers of the cervix or uterus are much less common causes of discharge and pain than infection, and one symptom alone does not suggest them. Persistent abnormal bleeding or discharge that does not resolve is still worth discussing with a clinician. See cervical cancer and uterine cancer for background.

How PID is treated

PID is generally treated with antibiotics. Regimens differ based on severity, pregnancy status and local resistance patterns, so your clinician chooses the specific medicines. Some people are treated with oral antibiotics at home, and others need a hospital stay for intravenous antibiotics, for example if they are pregnant, very ill, unable to keep medicine down, or may have an abscess.

Points worth discussing with your clinician and pharmacist:

• Take the full course as prescribed, even if you feel better. Ask your prescriber before changing or stopping any medicine.
• Tell your clinician about allergies, other medicines and possible pregnancy so the right antibiotic can be chosen.
• Ask your clinician whether and when sex is appropriate again, and whether partners need testing and treatment so reinfection is less likely.
• Ask about follow-up. If symptoms are not improving after you start treatment, tell your clinician promptly, since a different treatment or imaging may be needed.
• If you have an IUD, ask your clinician whether it needs to be reviewed. This decision is individual.

Antibiotic labels carry their own cautions, and some can interact with other medicines, so read the label and ask your pharmacist if anything is unclear.

Why early treatment matters: possible complications

When PID is not treated, or treated late, scarring can develop in the fallopian tubes. MedlinePlus lists possible long-term effects including chronic pelvic pain, ectopic pregnancy and difficulty becoming pregnant. See MedlinePlus on infertility for how fertility concerns are evaluated.

A pocket of infection called a tubo-ovarian abscess can also form. It may cause severe pain and fever and sometimes needs drainage or surgery in addition to antibiotics. Rarely, infection can spread into the bloodstream and cause sepsis, a life-threatening reaction. Outcomes vary, and prompt care can reduce the chance of lasting problems.

Reducing your chance of PID

• Condoms used consistently can lower the chance of sexually transmitted infections.
• Ask your clinician about screening for chlamydia and gonorrhea and how often it is appropriate for you. Screening recommendations depend on age and risk.
• If you are diagnosed with an infection, partner treatment can lower the chance of passing it back and forth.
• Seek care early for new discharge, pain with sex or pelvic pain rather than waiting for it to pass.

See MedlinePlus on sexually transmitted infections for a broader overview.

What to expect at your visit

It can help to note when the pain began, whether it is constant or comes and goes, the date of your last period, any chance you could be pregnant, any new partners, and any medicines or birth control you use. Visits are confidential, and clinicians ask these questions because they change the diagnosis and the treatment. Tell them about all symptoms, including those that feel embarrassing.

When to Seek Medical Care