Pelvic Inflammatory Disease (PID) vs Urinary Tract Infection (UTI)

What is Pelvic Inflammatory Disease (PID)?

Pelvic Inflammatory Disease (PID) is an infection of the female reproductive organs. PID occurs when bacteria develop in the vagina or cervix and upwards to the uterus, fallopian tubes, or ovaries. The bacteria can cause an abscess in the ovary or fallopian tube. If PID is not treated promptly, long-term complications may arise.

What are the symptoms of PID?

Some individuals may have mild symptoms of PID. However, most individuals may not have symptoms of PID. Common symptoms include:

Lower abdominal pain (around the pelvis)
Pain during sexual intercourse
Pain during urination
Bleeding between periods or after sexual intercourse
Irregular menstruation
Abnormal vaginal discharge
Fever
Nausea or vomiting

What causes PID?

The main cause of PID is sexually transmitted infections (STIs), particularly gonorrhoea and chlamydia. It can also be caused by infections that are not sexually transmitted, such as bacterial vaginosis. Other bacteria, such as mycoplasma genitalium, can also cause PID.

What are the risk factors of PID?

PID can affect anyone with female reproductive organs, but you are more likely to develop PID if you:

Have more than one sexual partner
Have a new sexual partner
Have a history of STIs
Had PID in the past
Are under the age of 25
Began sexual activity at a young age

How is PID diagnosed?

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

Pelvic exam
- To check for tenderness and abnormal vaginal discharge.
- Your doctor may take swabs from the inside of your vagina and cervix, which are then sent to the lab to look for signs of infection.
Ultrasonography
- To assess the severity of the infection and rule out other possible causes of pelvic pain.
Laparoscopy
- It is a minor keyhole surgery in which two small incisions are made in the abdomen.
- The doctor then inserts a thin camera to examine your internal organs and, if necessary, extract tissue samples.

How is PID treated?

PID is treatable. The longer the infection remains untreated, the greater the likelihood of long-term complications, such as infertility.

Depending on the severity of the infection and the type of bacteria causing it, treatment typically involves antibiotics to clear the infection. Even if you feel better, it is crucial to finish the entire course of antibiotics to ensure that the infection is eliminated.

In severe PID cases, hospitalisation may be necessary to administer intravenous antibiotics through an arm drip.

Surgical intervention may be necessary in specific circumstances, such as the detection of an abscess.

The sex partners need to be treated as well.

What are the complications of PID?

Complications of PID include:

Repeated episodes of PID
Abscess
Infertility
Chronic pelvic pain
Pregnancy outside the uterus (womb) - ectopic pregnancy

How to prevent PID?

Since PID is typically caused by STIs, it is important to practice safe sex and limit active sexual partners to reduce the risk of developing STIs that may cause PID. Also, seek medical attention promptly if you suspect you may have contracted STI.

What is Urinary Tract Infection (UTI)?

A urinary tract infection (UTI) is a common infection that occurs when bacteria, typically from the skin or rectum, infect the urinary tract via the urethra. The most common bacteria that cause UTIs are Escherichia coli (E. coli), Enterococcus, Pseudomonas, Klebsiella, and Proteus.

UTIs can affect any part of the urinary tract, which includes the bladder (cystitis), urethra (urethritis), and kidneys (pyelonephritis). However, bladder infections are the most common type.

Women are more likely to have a urinary tract infection compared to men as their urethra is shorter and closer to the rectum.

When confined to the bladder, an infection can be unpleasant and painful. However, if a UTI spreads to the kidneys, it may cause severe health complications.

What are the symptoms of UTI?

Lower UTIs (bladder and urethra):
- Increased frequency of urination
- Strong urge to urinate despite having an empty bladder
- Foul-smelling urine
- Burning sensation or pain during urination
- Cloudy appearance of urine
- Blood in the urine
- Lethargy and tiredness
- Lower abdomen pain
Upper UTI (kidneys and ureters):
- Symptoms mentioned
- Fever (38^oC or above)
- Chills and rigor
- Nausea and vomiting
- Lower back pain or pain in the sides of your back
- Restlessness

What causes UTIs?

Bacteria that cause UTIs do not usually live in the urinary tract as they live in the gastrointestinal tract. UTIs occur when these bacteria enter the genital area, travel up via the urethra and into the bladder.

The most common causative bacteria are Escherichia coli (E. coli), Enterococcus, Pseudomonas, Klebsiella, and Proteus.

Other causes of UTI may be due to the presence of calculi of the urinary tract or blocked urine flow because of the underlying anatomical abnormality or dysfunctional emptying of the bladder.

What are the risk factors of UTI?

Risk factors include:

Sexually active
Had a bladder or kidney infection in the last 12 months
Usage of spermicide for birth control
Menopause
Pregnancy
Kidney stones
Ureteral reflux
Poor hygiene
Weak immune system
Diabetes
Genetic predisposition

How is UTI diagnosed?

There is a high likelihood of UTI if a woman has typical symptoms of bladder infection but does not have vaginal discharge or irritation.

Urinalysis: To look for white blood cells in the urine.
Urine culture: To identify the type of bacteria causing infection and determine the suitable antibiotic for the treatment.
Imaging tests: X-rays, ultrasound, Computed Tomography (CT) scan, and Magnetic resonance imaging (MRI) are not usually needed unless suspected of severe kidney infection or blockage in the urinary tract.
Cystoscopy: To look inside the urethra and bladder.

How is UTI treated?

Doctors commonly treat this condition with a course of antibiotics. Patients are advised to undergo a full course of treatment to eliminate the infection.

You may also be prescribed pain relief medications such as phenazopyridine to reduce the burning pain in some UTIs.

How to prevent UTI?

UTI may be prevented by following these practices:

Keep the genital area clean
Wipe from front to back after using the toilet
Stay hydrated
Urinate after sexual intercourse
Avoid using vaginal douches and sprays in the genital area

Can PID be mistaken for UTI?

Yes, PID may sometimes be mistaken for a UTI because both conditions share similar symptoms, such as painful urination, lower abdominal pain, and pelvic pain.

Although both conditions are caused by bacterial infection, they affect different organs. PID affects the female reproductive organs, whereas UTI affects the urinary tract.

If you are unsure whether you have contracted UTI or PID, seek medical attention promptly to prevent complications. An accurate diagnosis and appropriate treatment plan will depend on findings from diagnostic tests, such as urine culture, pelvic exam, blood tests, or imaging studies, such as ultrasound or CT scans.

Book an appointment at Pantai Hospitals

If you are experiencing symptoms of PID or UTI, seek medical attention promptly to ensure early detection and effective treatment.

A dedicated and expert team of obstetricians and gynaecologists at Pantai Hospital is available for consultation to provide patients with the best care and assistance. Get in touch with us to book an appointment today if you have any concerns or questions about PID or UTI.

Pantai Hospital has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.