Pelvic Inflammatory Disease in Africa: Causes and Symptoms


Image depicting structures affected in Pelvic Inflammatory Disease in a woman

Image showing structures affected in Pelvic Inflammatory Disease.



Although the incidence of PID has decreased in high income countries, it is still relatively high in most African countries. So is the incidence of infertility, due to the fact that the majority of cases are subclinical. Acute PID should be diagnosed and treated early to avoid serious complications.



Although men may have inflammatory diseases affecting different pelvic organs; e.g., prostate, urethra, epididymis, etc., the term Pelvic Inflammatory Disease (PID) is commonly discussed in the context of women.

In this article, you will learn about Pelvic Inflammatory Disease in Africa from the following viewpoints :

  • What is PID?
  • What causes PID?
  • How common is PID?
  • Risk factors for PID
  • Complications of PID
  • How do I know I may have PID?
  • What other conditions may mimic PID?
  • How is PID diagnosed?
    • Testing for PID
  • How do I get treated for PID
  • Prevention of PID
  • Takeaways



What is Pelvic Inflammatory Disease?


Pelvic inflammatory disease (PID) is defined as the inflammation of the upper genital tract in women that includes the uterus, fallopian tubes, the ovaries and the pelvic peritoneum.

PID can present as an acute (or sudden onset), subacute or chronic condition and can have significant reproductive consequences.

Most often the presentation is subclinical and asymptomatic (i.e. without symptoms) but still with serious consequences.

Due to multiple factors, the incidence of acute PID has decreased in many developed countries, but not so in much of sub-Sahara Africa.

Variable incidence between 0.28% and 1.67% has been reported worldwide.

In sub-Sahara Africa, rates as high as 5.2 - 11% have been reported in hospital populations across different countries.

In Nigeria rates varying considerably from 11 - 70% have been reported in several small hospital samples across the country.

These rates may still be underestimates of community incidence of PID in Africa as many cases of PID are subclinical or self-treated anyway.



What causes PID?


PID results mostly from bacterial infection. Typical sexually transmitted micro-organisms responsible for PID include:

  • Chlamydia trachomatis
  • Neisseria gonorrhea


Photomicrograph of Chlamydia trachomatis                                                                                        Photomicrograph showing Neisseria gonorrheae organism in cells obtained from vaginal swab          

Photomicrograph of Chlamydia trachomatis.                                    Photomicrograph of Neisseria gonorrheae in cells obtained from vaginal swab

Note the presence of a cluster of spore like, C. trachomatis

elementary bodies located intracellularly (at arrow)

inside one of the larger epithelial cells. Credit: US CDC.



About 10% of women infected by Chlamydia trachomatis subsequently develop PID


Non-sexually transmitted micro-organisms responsible for PID include:

  • Streptococcus specie
  • Enterococcus faecalis
  • Escherichia coli
  • Klebsiella
  • Bcateroides fragilis
  • Staphylococcus sp.

More recent micro-organisms implicated in the causation of PID include:

  • Mycoplasma genitalium

Photomicrograph of Mycoplasma organisms from vaginal swab

Photomicrograph of Mycoplama genitalum obtained from vaginal swab in a woman.



In most cases of PID, many microorganisms are simultaneously involved. The other organisms invade the tissues when the most virulent ones have either begun to destroy tissues or shift vaginal flora to an aerobic state as is the case for bacterial vaginosis.



What are the risk factors for PID?


The risk factors for PID include:

  • Prior history of sexually transmitted infection.
  • Multiple sexual partners.
  • Frequent intercourse.
  • Single status.
  • Student.
  • Lower socioeconomic status.
  • Young age (< 30 years).
  • Intrauterine contraceptive device use.
  • Insertion of unregulated herbal products into the vagina.
  • Unsafe abortion.
  • Previous intrauterine procedures;
    • Endometrial biopsy,
    • Curettage / Aspiration,
    • Hysteroscopy,
    • Hysterosalpingography - an X-ray procedure carried out to examine the structure and health of the female uterus, fallopian tubes and ovaries.



Complications of PID

The complications of acute PID can be consequential and sometime life-threatening. They include:

  • Tubal damage with resulting tubal infertility.
  • Ectopic pregnancy.
  • Chronic pelvic pain.
  • Ruptured tubo-ovarian abscess with severe peritonitis.


Although the incidence of PID has decreased in high income countries, it is still relatively high in many African countries. So is the incidence of infertility, due to the fact that the majority of cases are subclinical. Acute PID should be diagnosed and treated early to avoid serious complications.


Knowing the sociodemographic profile of women as well as the common microorganisms involved in acute PID might help in identifying the group that should be targeted, in order to reduce the complications associated with this disease.



How do I know that I may have PID?


Whereas some women with PID may have acute, serious illness, most patients exhibit few or no symptoms. The most common presenting complaint is lower abdominal pain. In addition, many women report an abnormal vaginal discharge.


You most likely have PID if you have one or more of the following signs and symptoms:

  • Fever ≥38.3°C
  • Lower pelvic pain and tenderness
  • Pain on passing urine
  • Frequent urination
  • Abnormal vaginal discharge (may be foul smelling, frothy, greenish, etc.)
  • Pain during intercourse (Dyspareunia)
  • Uterine cervix motion tenderness on examination
  • Adnexial tenderness (i.e. tenderness on either or both sides of the lower abdomen).


Talk early to your doctor or other healthcare providers if you notice any of the above conditions.



What other conditions may mimic PID?

Conditions that may mimic or be confused with PID include:

  • Ectopic pregnancy.
  • Appendicitis.
  • Cervicitis.
  • Urinary tract infection.
  • Endometriosis.
  • Torsion of the ovary.
  • Interstitial cystitis, and
  • Pelvic adnexal tumors.





1. Elie Nkwabong and Madye A.N. Dingom (2015): Acute Pelvic Inflammatory Disease in Cameroon: A Cross Sectional Descriptive Study African Journal of Reproductive Health December 2015; 19(4):90.

2. Oseni, T.I.A.: Occurrence of pelvic inflammatory disease and associated factors among undergraduates attending Irrua Specialist Teaching Hospital, Irrua, Edo state, Nigeria. A dissertation submitted to the National Postgraduate Medical College of Nigeria. May 2016. Retrieved Online as a PDF download, March 9, 2023.

3. Lindsey K. Jennings; Diann M. Krywko. Pelvic Inflammatory Disease. National Library of Medicine. NIH.  June 5, 2022.

4. Tough DeSapri, K. A. Pelvic Inflammatory Disease. Medscape. Updated August 2021. (Subscription and log in is required to access material).

5. CDC: Pelvic Inflammatory Disease: Treatment Guidelines. 2021. Retrieved March 10, 2023.






  Female doctor in consultation with female patient in doctor's office                          Doctor holding a vaginal speculum                                                                      

Endometriosis: What you need to know                Pelvic examination: What is it and why you may need one?            What you need to know when you do not have a period?



Published: February 21, 2023

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