Skip to Main Content

Chapter 64: Pelvic Inflammatory Disease

Abigail D. Hankin

INTRODUCTION

Pelvic inflammatory disease (PID) comprises a spectrum of infections of the female upper reproductive tract, including endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis. Neisseria gonorrhoeae and Chlamydiatrachomatis are frequently isolated pathogens; however, many other microorganisms have been associated with PID, including vaginal flora, gram-negative rods, streptococci, and mycoplasmas. Risk factors for PID include age (teenagers are at greatest risk), multiple sexual partners, a new sexual partner within the past 30 days, presence of other sexually transmitted diseases, and intrauterine device insertion within the prior 3 weeks. PID occurs less commonly in pregnancy, but is associated with increased maternal morbidity and preterm labor. Complications of PID include significantly increased risk for ectopic pregnancy, infertility, and chronic pain, even after only a single episode of PID.

CLINICAL FEATURES

Clinical diagnosis of PID is complicated due to the wide variation in symptoms and clinical findings. Common presenting complaints include lower abdominal pain (seen in >90%), vaginal discharge (75%), vaginal bleeding, urinary discomfort, fever, nausea, and vomiting. Many women with PID may have nonspecific or very subtle symptoms. Physical exam may show lower abdominal tenderness, cervical motion tenderness, or uterine/adnexal tenderness. Mucopurulent cervicitis is a common finding, and its absence should prompt consideration of alternative causes of the patient's symptoms.

DIAGNOSIS AND DIFFERENTIAL

Given the clinical variability in the diagnosis of PID and the potential sequelae of delayed treatment, the United States Centers for Disease Control and Prevention recommends empiric treatment for PID based on the minimal criteria listed in Table 64-1. No single laboratory test is highly sensitive or specific for PID. Laboratory evaluation should include a pregnancy test, wet preparation of vaginal secretions, and DNA probe or culture for N. gonorroheae and Chlamydia trachomatis. Treatment, when indicated, should not be delayed pending test results.

Table 64-1

Diagnostic Criteria for Pelvic Inflammatory Disease

View Table||Download (.pdf)
Table 64-1

Diagnostic Criteria for Pelvic Inflammatory Disease

  • Group 1: Minimum criteria. Empiric treatment if no other cause to explain findings.

  • Uterine or adnexal tenderness

  • Cervical motion tenderness

  • Group 2: Additional criteria improving diagnostic specificity.

  • Oral temperature >101°F (38.3°C)

  • Abnormal cervical or vaginal mucopurulent secretions

  • Elevated erythrocyte sedimentation rate

  • Elevated C-reactive protein level

  • Laboratory evidence of cervical infection with Neisseria gonorrhoeae or Chlamydia trachomatis (i.e., culture or DNA probe techniques)

  • Group 3: Specific criteria for PID based on procedures that may be appropriate for some patients.

  • Laparoscopic confirmation

  • Transvaginal US (or MRI) showing thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex

  • Endometrial biopsy results showing endometritis

Source: Reproduced with permission from Centers for Disease Control and Prevention; Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recommend Rep. 2010;59(RR-12):12.

The differential diagnosis includes gastroenteritis, diverticulitis, ectopic pregnancy, spontaneous or septic abortion, ovarian cyst, pyelonephritis, and renal colic.

EMERGENCY ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close