How did I get PID despite testing negative?

Question

Hello doctor,

I am currently being treated for pelvic inflammatory disease (PID) and wanted some clarity.

A few months ago, I had a medical abortion with no complications. Shortly after that, I had a copper IUD inserted. Before the insertion, I was tested for STIs, and everything came back negative.

Soon after the IUD was fitted, I developed symptoms of bacterial vaginosis (BV). Testing suggested BV with reduced healthy bacteria, and I completed a one-week course of antibiotics.

Recently, I began experiencing unusual discharge, mild pelvic pain, and light spotting. I returned to the clinic, was examined and tested again for BV, and was told it was likely PID. I have started a two-week course of antibiotics and plan to have my copper IUD removed in the next few days. I have only had one sexual partner during this time. I have been retested for STIs and am awaiting results, and my partner has also been advised to test.

I am feeling confused about how this may have developed.

Could the copper IUD have contributed to this?
Is it possible my previous STI tests were falsely negative? (I also tested negative about six months before the IUD insertion.)
Once I complete the antibiotics, is it likely that the infection will fully resolve?
Why might this have happened, and how can I reduce the risk of it recurring in the future?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query.

I can really understand why this feels unsettling.

You did the right things; you tested, you were careful, and now you are dealing with something that feels scary and confusing. That is a lot to sit with.

First, PID (pelvic inflammatory disease, a serious, often sexually transmitted, bacterial infection of the upper female reproductive organs) does not always mean an STI (sexually transmitted infection). While infections like chlamydia (a very common, curable sexually transmitted infection caused by the bacterium Chlamydia trachomatis) or gonorrhea (a common, curable sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae) are common causes, PID can also happen when normal vaginal bacteria travel upward into the uterus. That can occur after things like:

A medical abortion.
An IUD (intrauterine device) insertion.
A disruption in vaginal balance, like BV (bacterial vaginosis, a common, treatable vaginal infection caused by an imbalance of natural flora).

You mentioned that soon after your copper IUD was placed, you developed BV-type symptoms and were told your healthy bacteria were low. That loss of protective lactobacillus can make it easier for bacteria to move upward. When you later developed discharge, mild pelvic pain, and spotting, that fits with how a flora imbalance can sometimes progress.

About the IUD (intrauterine device), copper IUDs slightly increase PID risk, but mainly in the first few weeks after insertion. After that, the risk goes back to normal. So yes, the timing suggests the insertion and the shift in vaginal bacteria could have played a role. It does not mean the IUD is bad, but in your case, it may have contributed.

Regarding STI testing, if proper PCR (polymerase chain reaction) testing was done, false negatives are uncommon. The main time results can miss something if testing is done very soon after a new exposure. Since you have had one partner and tested negative before, the chances of a missed infection are lower, though having your partner tested now is still the right step.

Importantly, this situation does not automatically mean:

Maybe your partner was unfaithful.
Your earlier test was wrong.
You did something careless.

Sometimes this is just biology reacting in an unfortunate way.

The reassuring part is this: when PID is treated early, as yours was, most women recover fully without long-term problems. Finishing the full antibiotic course is key. Removing the IUD as planned is reasonable, especially if it gives you peace of mind. As for now, you can:

Complete your antibiotics.
Avoid sex until treatment is done.
Make sure your partner is tested (and treated if needed).
Follow up if pain does not improve.

Going forward, if you ever choose another IUD, screening right before insertion and treating any BV symptoms quickly can help reduce risk.

The most important thing now is how your body is responding.

Are you starting to feel even a little improvement on the antibiotics, or are things staying the same?

That will tell us a lot about how this is progressing.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.