• Clinical science

Pelvic inflammatory disease

Summary

Pelvic inflammatory disease (PID) is caused by a bacterial infection that spreads beyond the cervix to infect the upper female reproductive tract, including the uterus, fallopian tubes, ovaries, and surrounding tissue. The most common pathogens that cause PID are Chlamydia and Gonococci. Symptoms may vary considerably; while some women are asymptomatic, others may complain of mild pressure pain and discharge or present with signs of systemic inflammation such as fever and severe abdominal pain. Diagnosis is based on clinical findings and may be supported by ultrasound, PCR, and/or cultures of cervical and urethral discharge. Calculated parenteral antibiotic therapy is indicated in women with suspected PID. Complications include sterility due to impairment of the fallopian tubes.

Epidemiology

  • Lifetime prevalence in the US (women aged 15–44): ∼ 6%
  • > 1 million women experience an episode of PID/year.
  • PID is one of the most common causes of infertility.

References:[1][2][3]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References:[6][7][4]

Clinical features

References:[8]

Diagnostics

PID may present with symptoms of appendicitis due to periappendicitis or perihepatitis. Symptoms may also resemble those of an ectopic pregnancy!

PID should be suspected in young, sexually active women who present with lower abdominal pain and adnexal/cervical motion tenderness!

References:[9][2][10]

Differential diagnoses

Clinical features Diagnostic clues Therapy
Ectopic pregnancy
  • Lower unilateral abdominal pain and guarding
  • Vaginal bleeding
  • Amenorrhea
PID
Appendicitis
  • Initially diffuse epigastric pain
  • Later localized right lower quadrant pain
  • Nausea and vomiting
  • Fever
Kidney stones
  • Unilateral colicky flank pain
  • Pain may radiate to the lower abdomen and genital area
  • Destruction or removal of stone
Ovarian cyst rupture
  • Unilateral abdominal pain
  • Sudden onset during physical activity (exercise, sexual intercourse)
  • Continued surveillance or surgery

Cervicitis

References:[11][12][13][9][14]

The differential diagnoses listed here are not exhaustive.

Treatment

References:[4]

Complications

References:[9][2][3]

We list the most important complications. The selection is not exhaustive.