Pelvic inflammatory disease (PID) is the ascent of bacteria from the vagina or cervix resulting in infection of the reproductive organs eg uterus, fallopian tubes, ovaries. It may also be a complication of sexually transmitted infections.
The most common symptoms of PID are lower abdominal pain (crampy or dull) that usually starts a few days after the onset of the last menstrual period, dyspareunia, abnormal vaginal or cervical discharge, postcoital or irregular vaginal bleeding, dysuria, fever, nausea and vomiting, although some have minimal symptoms or silent pelvic inflammatory disease.


  • Empiric treatment for PID should be started in sexually active young women & other women at risk for STIs if they are experiencing pelvic or lower abdominal pain, if no cause for the illness other than PID can be identified, & if >1 of the following minimum criteria are present on pelvic exam: Cervical motion tenderness, uterine tenderness, or adnexal tenderness
  • A low threshold for diagnosis of PID must be maintained because of difficulty in diagnosis & great potential for damage

Additional Criteria Supporting Diagnosis of Pelvic Inflammatory Disease

  • Temp >38.3°C
  • Abnormal cervical or vaginal mucopurulent discharge
  • WBCs on saline microscopy of vaginal secretions
    • Absence of vaginal or endocervical pus cells may rule out PID but their presence is nonspecific
  • Elevated ESR, elevated C-reactive protein (CRP), & leukocytosis
    • Nonspecific & can be normal in mild cases
  • Lab documentation of cervical infection w/ Neisseria gonorrhoeae or Chlamydia trachomatis
    • Endocervical or vulvovaginal samples for nucleic acid amplification test or culture
    • Positive result supports the clinical diagnosis of PID & emphasizes the need to treat sex partners; negative result does not exclude PID

Most Specific Criteria for Diagnosing Pelvic Inflammatory Disease

  • Endometrial biopsy showing histopathologic evidence of endometritis
    • Not useful in making diagnosis in the acute setting because of the time required to make histopathologic diagnosis
  • Transvaginal sonography (TVS) or Magnetic Resonance Imaging (MRI) showing thickened, fluid-filled tubes w/ or w/o free pelvic fluid or tubo-ovarian complex, or doppler studies suggesting pelvic infection
  • Laparoscopic abnormalities consistent w/ PID
    • Considered by some authorities to be the gold standard in diagnosing PID
    • Make an accurate diagnosis possible, yield information on the severity of the condition, & provide access to material that may be sent for bacteriologic culture
    • Typical findings are erythematous & swollen fallopian tubes w/ purulent discharge from the fimbrial end
    • Currently, use is restricted by expense & limited availability

Criteria for Hospitalization

Patients who fulfill any of the following criteria need to be hospitalized:

  • Uncertain diagnosis
  • Surgical emergencies eg appendicitis & ectopic pregnancy cannot be excluded
  • Suspected pelvic/tubo-ovarian abscess
  • Severe illness (N/V or high fever) precluding outpatient management
  • Pregnancy
  • Inability to follow or tolerate an outpatient regimen
  • Concomitant HIV infection
  • Unresponsive to an outpatient regimen
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