Causes, Treatments, and Concerns- K Health

It’s normal for women to experience vaginal discharge, or fluid secretions from the glands of the cervix. And though vaginal discharge often changes throughout a person’s menstrual cycle, some changes may indicate a health problem.

For example, yellow malodorous vaginal discharge can be a sign of a bacterial infection or a sexually transmitted infection (STI). If you’re concerned about your vaginal discharge, contact your healthcare provider.

In the meantime, read on to learn about yellow vaginal discharge. I’ll start with the causes and explain what normal vaginal discharge is like. Then I’ll share how to prevent yellow discharge and when to see a doctor. 

Yellow Vaginal Discharge Causes

Vaginal discharge can have textures and colors. Yellow or green vaginal discharge most commonly occurs with infections, including sexually transmitted infections. 

Vaginal discharge accompanied by  other symptoms may help you or your healthcare provider determine your current diagnosis.

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Common causes of yellow discharge

• Bacterial vaginosis: One of the most common causes of yellow vaginal discharge is an infection called bacterial vaginosis (BV), which is thought to be caused by a disruption of vaginal flora. BV usually causes excessive, fishy-smelling discharge and rarely itching. If left untreated when pregnant, it can result in pregnancy complications.
• Trichomoniasis: Long for “trich,” trichomoniasis is an STI that spreads by unprotected sex with an infected person. It commonly causes greenish-yellow discharge that smells musty and appears frothy. Trichomoniasis can also cause pregnancy complications if untreated in pregnancy.
• Gonorrhea: Another sexually transmitted infection, gonorrhea can cause yellow or greenish discharge. People with gonorrhea typically experience increased discharge, painful urination, vaginal bleeding between periods, and pelvic or abdominal pain. Gonorrhea discharge may smell foul.
• Chlamydia: This STI can also result in smelly, yellow discharge accompanied by painful urination, painful sex, and bleeding between periods. 

More serious concerns

Bacterial infections, including STIs, are often treatable. However, they can result in serious complications, so seek prompt medical treatment if you think you may have an infection.

For example, infections that cause yellow discharge can increase your risk of pelvic inflammatory disease. Left untreated, PID can lead to fertility complications, and in some cases may be life threatening requiring hospitalization and IV antibiotics.

If  you’re pregnant, if left untreated, bacterial vaginosis or STIs can result in pregnancy complications such as preterm labor. 

What Is Normal Discharge Like?

Vaginal  discharge can change consistency throughout the menstrual cycle. Typically, healthy vaginal discharge is clear or white.

Close to your period, discharge may have a pink or reddish hue. Normal discharge that appears in your underwear and is exposed to air can also turn yellow, which isn’t necessarily cause for concern.

Darker yellow or greenish vaginal discharge, on the other hand, is more likely a sign of an infection that should be addressed by a medical provider. 

Different Possible Colors and Their Meanings

Certain times or conditions can cause different colored vaginal discharge. Below are some of the most common colors of vaginal discharge and what they may mean. 

• Clear: Clear discharge is typically healthy. You may have clear discharge if you’re pregnant or ovulating. Sexual arousal can also cause clear discharge.
• White: White discharge can be normal. But if it’s thick, like cottage cheese, and accompanied by itching or burning, white discharge may indicate a yeast infection.
• Gray: Gray vaginal discharge is often associated with infection, sometimes an STI and more commonly bacterial vaginosis.
• Pink or red: Pink or reddish discharge may occur in the days leading up to a person’s period. It can also occur with implantation bleeding, or bleeding that occurs when a fertilized egg attaches to the uterus leading to early pregnancy. Another cause is an irritated or inflamed cervix. In rare cases, red discharge can be a sign of cervical infection or cancer.
• Brown: Vaginal discharge may turn brown in the presence of blood, so it can occur during or before your period. Brown vaginal discharge could also be a  sign of a vaginal infection or, in rare cases, a retained foreign object such as a tampon. 
• Yellow: Yellow discharge is most commonly associated with bacterial vaginosis or a sexually transmitted infection such as chlamydia. .
• Green: As with yellow, green-colored discharge usually happens with an infection, including sexually transmitted infections.  

How to Prevent Yellow Discharge

To prevent sexually transmitted infections associated with yellow vaginal discharge, always use condoms when you have sex of any kind, especially with a new partner.

Latex or polyurethane condoms can reduce the risk of infection but not completely prevent it. If possible, limit your number of sex partners to reduce your risk of sexually transmitted infection.

Regular STI screening can also help prevent the risk of more serious medical problems. It may not be possible to completely prevent bacterial vaginosis as this is the overgrowth of your natural vaginal flora that sometimes causes symptoms.

Some people experience it due to a natural lack of healthy bacteria in their vagina. Douching is associated with a higher risk of bacterial vaginosis, so avoid using scented wipes, washes or products in the vaginal area.

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When to See a Doctor

See a healthcare provider anytime you’re concerned about the color or texture of your vaginal discharge, particularly if you are pregnant or suspect a vaginal or sexually transmitted infection.

Also contact your doctor if you have an infection or suspect an infection and experience: 

• Fever
• Chills
• Fatigue
• Weakness
• Nausea and vomiting

These could indicate a worsening or spreading infection, which requires immediate medical treatment.

Infections that cause yellow vaginal discharge are usually bacterial, so they may be treated with antibiotics. Your doctor can determine the best course of treatment for you, depending on your medical history, symptoms, and diagnosis.

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Frequently Asked Questions

What does it mean when you have a yellowish discharge?

Yellow discharge is commonly associated with a vaginal infection called bacterial vaginosis. Sexually transmitted infections, or STIs, can also cause yellow or green discharge. If you’re concerned about a change in your vaginal discharge, see a medical provider.

Is a light yellow discharge normal?

Vaginal discharge varies from person to person, and not all changes indicate a medical problem. Clear, white, or even light yellow discharge can be healthy and normal. If you have yellow, green, or gray discharge, consult a healthcare provider. It’s possible you have an infection or another health condition that should be treated.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions,
and medical associations. We avoid using tertiary references.

• Abnormal Vaginal Discharge. (n.d.).
  https://www.chop.edu/conditions-diseases/vaginitis

• Vaginal Discharge. (1990).
  https://www.ncbi.nlm.nih.gov/books/NBK281/

• Vaginal Discharge. (2007).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2099568/

• Vaginal Itching and Discharge: Adult and Adolescent. (2021).
  https://medlineplus.gov/ency/article/003158.htm

Common Sexually Transmitted Infections – (STIs)

Sexually transmitted infections (STIs) are infections spread by sexual contact. These infections are usually passed from person to person through vaginal intercourse. However, they also can be passed through anal sex, oral sex, or skin-to-skin contact. STIs can be caused by viruses, bacteria, or parasites. Many people get STIs but don’t know it because they don’t have symptoms. Other people have symptoms that can be mild or more bothersome.

Path to improved health

There are many different kinds of STIs. Here is information on some of the most common ones, their symptoms, and their treatments.

Chlamydia

What it is: Chlamydia is a bacterial infection that is easily cured. Left untreated it can cause infertility in women.

Symptoms: Women may have pain when urinating, itching around the vagina, yellow fluid (discharge) from the vagina, bleeding between periods, or pain in the lower abdomen. Men may have a burning sensation when urinating and a milky colored discharge from the penis. It can also cause painful swelling of the scrotum in men.

Treatment: Antibiotics. Both partners should be treated.

Gonorrhea

What it is: Gonorrhea is a bacterial infection. Left untreated, it can cause serious health problems. But it’s easily cured.

Symptoms: Women may have white, green, yellow, or bloody discharge from the vagina, pain when urinating, bleeding between periods, heavy bleeding during a period, or a fever. Both women and men can get sore throats if they’ve had oral contact with an infected person. Men may have thick, yellow discharge from the penis and pain when urinating. The opening of the penis may be sore. Gonorrhea can cause serious complications if it’s not treated.

Treatment: Antibiotics. Both partners should be treated.

Herpes

What it is: Herpes is a viral infection that causes painful sores in the genital area. It’s spread through skin-to-skin contact. Once you’re infected, you have the virus for the rest of your life.

Symptoms: Women and men may have tingling, pain, or itching around the vagina or penis. They also may develop oral lesions (blisters) through sexual contact. These may look like fever blisters because they are caused by a similar virus. Small blisters can form on the penis, vaginal area, around the anus, or on the mouth depending on the exposure. When the blisters break open, they can be very infectious. This means you could easily transmit herpes to another person. When the blisters break, they also can cause a burning feeling. It may hurt to urinate. Some people have swollen glands, fever, and body aches. The sores and other symptoms go away, but this doesn’t mean the virus is gone. The sores and blisters can come back periodically. This is called an “outbreak.”

Treatment: Medicine can treat symptoms but can’t cure herpes. If one partner is infected, the other should by checked by a doctor.

HIV/AIDS

What it is: HIV (human immunodeficiency virus) is the virus that causes AIDS (acquired immunodeficiency syndrome). HIV attacks the body’s immune system, making you more likely to get sick from other viruses or bacteria.

Symptoms: HIV makes the body’s immune system weak so it can’t fight disease. Symptoms may take years to develop. When symptoms do appear, they can include swollen lymph nodes, diarrhea, fever, cough, shortness of breath, or unexplained weight loss. Symptoms are often similar to those of other illnesses, such as the flu.

Treatment: Medicines can treat symptoms but can’t cure HIV or AIDS. If one partner is infected, the other should be checked by a doctor.

HPV/Genital Warts

What it is: HPV (human papillomavirus) is a family of more than 100 types of viruses. Some don’t cause any symptoms. Some types cause genital warts. More aggressive types can cause cancer.

Symptoms: HPV can cause warts in or around the vagina, penis, or rectum. In women, the warts can be on the cervix or in the vagina where you can’t see them. Or they may be on the outside of the body, but may be too small to see. The warts can be small or large, flat or raised. They can appear alone or in groups. They usually don’t hurt. Most types of HPV, including those that cause cancer, don’t have symptoms.

Treatment: No medicine cures HPV. A doctor can remove external warts. Warts on the cervix or in the vagina can cause changes that may lead to cervical cancer. Doctors will watch for these changes. If one partner is infected with HPV, the other should be checked by a doctor.

Some types of HPV can be prevented, including those that cause cancer. There is a vaccine that can prevent some types of HPV in young men and women. The Centers for Disease Control and Prevention (CDC) recommends that girls and boys between the ages of 11 and 12 receive the vaccine, before they become sexually active. The vaccine is approved for men and women between the ages of 9 years and 45 years.

Pubic lice (crabs)

What it is: Pubic lice (also called crabs) are tiny insects that live in pubic hair and lay eggs. They spread through direct contact but don’t cause many problems.

Symptoms: Women and men may have redness and itching around the genitals. You may be able to see the lice or their eggs on the shaft of the pubic hair.

Treatment: Medicine, such as over-the-counter lotions or shampoos (some brand names: Nix, Rid), can kill the lice. Prescription shampoos, lotions, or pills are also available if over-the-counter medicine doesn’t work. Clothes, sheets, and towels must be washed in hot water to kill remaining bugs, or your lice can come back. Usually both partners need to be treated. Removal of the nits (lice eggs) is important to reduce the chance of another outbreak after treatment.

Syphilis

What it is: Syphilis is a serious bacterial infection that causes sores in the genital area. It’s passed by touching the blood or sores of an infected person.

Symptoms: An early symptom is a red, painless sore, called a chancre. The sore can be on the penis, vagina, rectum, tongue, or throat. The glands near the sore may be swollen. Without treatment, the infection can spread into your blood. Then you may experience a fever, sore throat, headache, or pain in your joints. Another symptom is a scaly rash on the palms of the hands or the bottom of the feet. The sores and other symptoms go away, but this doesn’t mean the infection is gone. It could come back many years later and cause problems in the brain and spinal cord, heart, or other organs.

Treatment: Syphilis can cause serious health problems if it’s not treated. Antibiotics should be taken as early as possible after infection. If one partner is infected, the other should be tested.

Trichomoniasis

What it is: Trichomoniasis is an infection caused by a parasite. The parasite spreads through skin-to-skin contact.

Symptoms: Women can have a heavy, greenish-yellow frothy discharge and pain when urinating or while having sex. It also can cause redness, itching, and a burning feeling in the genital area. Men may have burning with urination or ejaculation, itching, or irritation inside the penis, or discharge from the penis. Left untreated, the infection can last for months or years.

Treatment: Antibiotics. Usually both partners need to be treated.

Things to consider

It’s common to feel guilty or ashamed when you are diagnosed with an STI. You may feel that someone you thought you could trust has hurt you. You may feel sad or upset. Talk to your doctor about how you’re feeling.

Remember you can take steps to prevent getting an STI. The only sure way to prevent them is by not having sex. But if you do have sex, you can lower your risk if you do the following things.

• Limit your number of sex partners.
• Avoid sex with people who have had many sex partners.
• Use condoms consistently and correctly.
• Ask your partner if he or she has, or has had, an STI. Tell your partner if you have had one. Talk about whether you’ve both been tested for STIs and whether you should be tested.
• Look for signs of an STI in your sex partner. But remember that STIs don’t always cause symptoms. Don’t have sex if you or your partner are being treated for an STI.
• Wash your genitals with soap and water and urinate soon after you have sex. This may help clean away some germs before they have a chance to infect you.

Questions to ask your doctor

• Do I have an STI? Can it be cured?
• What kind of treatment will I need?
• Can I have sex with my partner without passing on my STI?
• Can I spread an STI if I don’t have symptoms and don’t even know I have it?
• How do I prevent getting an STI?
• What long-term problems might I have if I have an STI?
• If I’m pregnant, can I pass my STI onto my baby?
• Are there any STI support groups in my area?

Resources

Centers for Disease Control and Prevention: Sexually Transmitted Diseases

National Institutes of Health, MedlinePlus: Sexually Transmitted Diseases

Yellow vaginal discharge in women | Discharges with odor and without yellowish color

Medical expert – Lysenko Oksana Borisovna.

Editor and medical expert – Harutyunyan Mariam Harutyunovna.

Number of views: 1,144,138

Date last updated: 03/25/2022

Average read time: 3 minutes

90 002 Types of yellow discharge
Possible causes of heavy yellow discharge
What to do if yellow discharge appears in urination time, redness of the mucosa). Beli cleanse the genital tract from dead epithelium and microorganisms, maintain normal microbiocenosis of the vagina. But a change in the color of natural secretions can indicate various disorders in the body, including infectious and inflammatory processes and sexually transmitted diseases.

Types of yellow discharge

Slightly odorless or with it . Moderate slightly yellow discharge in women, not accompanied by redness of the vulva, itching and burning, can be considered normal. The intermenstrual leucorrhea is actually light, but on a panty liner it has a slightly yellowish tinge. Slight, yellow, odorless discharge in women increases slightly in the middle of the cycle (during ovulation) and a few days before menstruation. During this period, it is necessary to carefully monitor the quality of personal hygiene, use thin daily.

Abundant with or without bad odor . Such secretions indicate the development of an inflammatory process in the organs of the reproductive system. A woman may complain of burning, itching in the vulva and other unpleasant symptoms. The discharge may have a strong odor and a yellowish-green tint.

Possible causes of heavy yellow discharge

Vaginosis . The disease usually occurs in women of reproductive age. The disease is based on a non-inflammatory process, in which the number of representatives of the lactoflora decreases and the number of anaerobic microorganisms increases. Vaginosis can occur with little or no symptoms. A characteristic symptom is an unpleasant yellow discharge from the vagina with a fishy odor.

Colpitis . The disease is based on inflammation of the vaginal walls with the appearance of itching, burning, signs of an acute inflammatory process that can spread to the uterus and appendages, causing reproductive disorders. A symptom of colpitis is white or yellow discharge from the vagina with a rather unpleasant odor.

Inflammation of the ovaries and fallopian tubes . The inflammatory process in the appendages can occur as a result of urogenital infections, hypothermia. Inflammation of the tubes and ovaries is accompanied by intense pain in the lumbar region and lower abdomen, the appearance of yellow vaginal discharge. Breakthrough uterine bleeding is possible.

Venereal diseases . Sexually transmitted diseases pose a serious threat to women’s health. They often lead to inflammation of the appendages, the formation of adhesions and the development of infertility. Venereal diseases are accompanied by pathological yellow discharge with a smell, severe swelling of the vulva, painful urination, itching and burning in the perineum and genitals.

What to do if yellow discharge appears

Abundant white-yellow and yellow discharge with or without odor is a reason to visit a gynecologist or venereologist. Regardless of the diagnosis (thrush, inflammation of the ovaries, etc.) and the prescribed treatment, a woman should pay special attention to intimate hygiene. To make daily care easier, you can use CAREFREE® Thin Daily to keep laundry clean and feeling fresh. Gentle dailies are securely attached to the underwear, quickly absorb discharge, leaving no feeling of discomfort in the intimate area.

Yellow or green vaginal discharge in women

Yellow or green vaginal discharge, especially if it is abundant and accompanied by an unpleasant odor, is a sign of the development of a pathological process and a serious reason to consult a gynecologist.

Any change in the discharge, which is normally clear to milky white in color and practically odorless, should alert the woman. Discoloration of normal discharge to yellow, yellow-green or green, sometimes frothy, accompanied by an unpleasant (for example, fishy) odor, itching and burning in the vagina and vulva, pain in the pelvic area, dysuria, pain during intercourse – signs of infection or inflammation that requires treatment.

Discoloration, consistency or smell of discharge may be caused by infections, many of which are sexually transmitted (chlamydia, gonorrhea, trichomoniasis). In some cases, a woman may have several types of such infections.

Bacterial vaginosis

This disease is characterized by signs such as a change in the smell of discharge to fish (especially after intercourse or during menstruation), a change in the color of the discharge to gray, yellow or greenish, itching and burning in the vagina and vulva (rare) . Often, bacterial vaginosis is asymptomatic, so it is very important to undergo regular preventive examinations by a gynecologist. The disease occurs due to a violation of the natural balance of lactobacilli in the vagina, this is the most common cause of pathological discharge in women of reproductive age (before menopause). The risk is higher in women who are sexually active, who have multiple sexual partners (the disease is not sexually transmitted, the risk increases due to a violation of the microflora of the vagina and an increased likelihood of bacterial reproduction), who do not use contraceptives such as condoms, who use douching, and also in pregnant women against the background of hormonal changes. In some cases, bacterial vaginosis resolves without treatment, but more often requires the use of antibiotic therapy. In most cases, a course of antibiotics is sufficient to achieve treatment success, but sometimes a second course of drugs is required. Treatment does not guarantee the absence of the disease in the future, according to statistics, more than 70% of women experience bacterial vaginosis again.

Pregnant women with bacterial vaginosis (whether symptomatic or not) are given drugs that are safe to use during pregnancy. Refusal of treatment can cause complications of pregnancy: premature birth or the birth of a child with a weight below the average.

Timely referral to a gynecologist for diagnosis and treatment of this condition is very important, as BV is associated with negative obstetric and gynecological outcomes, including increased susceptibility to STIs (especially HIV), complications after operations such as hysterectomy. In addition, the symptoms of bacterial vaginosis are similar to those of other vaginal infections, so you need to see a doctor for differential diagnosis and treatment.

The disease is not fully understood, so there is no reliable way to avoid BV. Risk reduction is facilitated by: avoiding douching, limiting the number of sexual partners, using condoms, good personal hygiene, wearing cotton underwear.

Chlamydia

Chlamydia is one of the most common sexually transmitted infections caused by the bacterium Chlamydia trachomatis. You can become infected with it, including during anal or oral sex, the use of common devices to satisfy sexual needs. The risk group includes people under 25 years of age, women with multiple sexual partners, women who previously had chlamydia, pregnant women. Often the infection does not show any symptoms, so people with chlamydia, not knowing that they are infected, do not take action and pass the infection on. The spread of the disease can only be reduced by regular examinations by a gynecologist, which, unfortunately, many women neglect. Meanwhile, in women, the complications of chlamydia are much more severe than in men – inflammatory diseases of the pelvic organs, complications of pregnancy (premature birth, transmission of infection to the newborn), reactive arthritis, increased risk of HIV infection.

Symptoms of chlamydia (if present) are similar to those of cervicitis (inflammation in the cervix) and urinary tract infections: white, yellow or gray vaginal discharge, sometimes with an unpleasant odor, frequent urination, dysuria, pus in the urine, itching and burning in the vagina and vulva, intermenstrual bleeding, painful menstruation, discomfort and pain during intercourse, pain in the lower abdomen. Chlamydia can affect not only the reproductive organs, so along with the above symptoms, you need to pay attention to pain in the anus, mucus, bleeding from the anus, sore throat, conjunctivitis.

Chlamydia is diagnosed using the Nucleic Acid Amplification Technique (NAAT), and a gynecologist may take a vaginal swab, cervical swab, or urine sample to test for Chlamydia trachomatis bacteria in the laboratory. Treatment of chlamydia is carried out with antibiotics (the duration of the course is determined by the doctor), which should never be stopped. During this time, you should abstain from sexual activity, try to tell all sexual partners that you have the infection, and get tested for other STIs, including HIV/AIDS, syphilis, herpes, and gonorrhea.

To reduce your risk of chlamydia, use condoms, have sex with a partner you know you have, and generally practice safer sex.

Trichomoniasis

Trichomoniasis is a parasitic disease caused by the vaginal Trichomonas Trichomonas vaginalis, also belongs to STIs, is highly contagious. Like chlamydia, trichomoniasis is often asymptomatic and therefore difficult to detect and treat (unless a woman has regular pelvic exams). Women are more prone to trichomoniasis than men, the risk increases if the rules of safe sex are ignored (refusal to use condoms) and if there are several sexual partners.

Symptoms of trichomoniasis include watery (sometimes frothy), profuse white, yellow or green discharge with an unpleasant odor, irritation and itching of the genitals, pain and burning during urination, pain during intimacy.

Diagnosis of the disease includes an examination by a gynecologist and a laboratory examination of a sample of discharge. Treatment is carried out with drugs with antiprotozoal and antimicrobial action for 5-7 days (infected and his partner / s). At this time, it is necessary to give up alcohol, since the interaction of drugs with it can cause side effects (nausea, vomiting, heart palpitations). After completing the course of treatment, you should refrain from intimacy for a week to avoid re-infection.

In pregnant women, treatment of trichomoniasis is carried out according to the same principle, failure to treat it can lead to complications such as premature birth (before 37 weeks of pregnancy) and low birth weight of the newborn.

Prevention of trichomoniasis includes the use of condoms, regular check-ups for sexually transmitted diseases, adherence to doctor’s recommendations for treating an identified infection, choosing a relationship with one sexual partner.

Gonorrhea

Gonorrhea is a sexually transmitted infection caused by gonococci (Neisseria gonorrhoeae). People who often change sexual partners and ignore the rules of safe sex are at high risk of the disease. The disease can be asymptomatic, so those infected do not immediately seek help and continue to infect their partners, unaware that they are sick.

If symptoms of gonorrhea are present, you may notice white or yellow vaginal discharge, pain in the lower abdomen and pelvis, pain and burning when urinating, intermenstrual bleeding, sore throat (if you practice oral sex).

Diagnosis of gonorrhea includes questioning the patient about symptoms, intimacy and sexual preferences, gynecological examination, urinalysis and a sample of secretions from the cervix, bacteriological culture from the throat or anus. Antibacterial therapy is prescribed for treatment (including the partner). After completing the course of treatment, you should refrain from intimacy for a week, as well as be tested for other sexually transmitted diseases, including HIV / AIDS, syphilis, herpes and chlamydia. Prevention of the disease is similar to the prevention of any STD.

Pelvic inflammatory disease (PID)

Occurs when an infection (including STIs) enters the upper reproductive system (uterus, fallopian tubes, and ovaries) or the small pelvis (pelvioperitonitis). The risk of PID is higher in women with STIs (gonorrhea or chlamydia), who have had PID before, in sexually active women under 25 years of age, with multiple sexual partners, as well as after an abortion, complicated childbirth, insertion of an intrauterine device, gynecological operations. Without treatment, PID can lead to complications such as chronic pelvic pain syndrome, infertility, and ectopic pregnancy.

Symptoms of the disease can be either mild or appear abruptly and suddenly. These include pain in the lower abdomen, yellow or green discharge with an unpleasant odor, nausea or vomiting, fever, pain during intimacy and urination, irregular periods, intermenstrual bleeding.

The diagnosis of PID is established on the basis of anamnesis, gynecological examination, determination of signs of infection and inflammation, and ultrasound results. Antibacterial therapy is prescribed for treatment. The earlier PID is treated, the less likely it is to develop complications.