- Clinical science
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.
- Multiple sexual partners, unprotected sex
- A history of prior STIs and/or adnexitis
- Infrequently: IUD , menstruation, former abortions, douching
- Dysbiosis supports the development of PID.
- Risk is lower during pregnancy but if occurs PID increases the risk of maternal morbidity and preterm births. 
- Possible sites of infection
- Diagnosis is primarily based on clinical findings. Further diagnostic tests help confirm the diagnosis, especially in ambiguous cases.
- Important diagnostic criteria
- Blood tests: elevated ESR, leukocytosis
- Pregnancy test: to rule out an (ectopic) pregnancy.
- Cervical and urethral swab: gonococcal and chlamydial DNA (PCR) and cultures (see and )
Culdocentesis: aspiration of intraperitoneal fluid from the pouch of Douglas
- Reveals nature of the fluid (e.g., serous, purulent, bloody)
- Culdocentesis is no longer a routine procedure and it has been largely replaced by ultrasound.
PID should be suspected in young, sexually active women who present with lower abdominal pain and adnexal/cervical motion tenderness!
|Clinical features||Diagnostic clues||Therapy|
|Ectopic pregnancy|| || |
|Kidney stones|| |
|Ovarian cyst rupture|| || |
- Definition: inflammation of the uterine cervix
- Infectious (most common): C. trachomatis, N. gonorrhea, herpes simplex virus, T. vaginalis
- Noninfectious : localized trauma (e.g., cervical caps, diaphragms, tampons), chemical irritation (e.g., contraceptive creams, latex exposure), malignancy
- Risk factors: multiple partners, young age, new sexual partner within the last 6 months, unprotected intercourse
- Often asymptomatic
- Usually no fever
- Vaginal discharge: may be purulent, blood-tinged, and/or malodorous
- Postcoital or intermenstrual bleeding
- Lower abdominal or pelvic pain
- Symptoms of the underlying condition (e.g., genital lesions in HSV infections)
- Physical examination
- Diagnosis mainly clinical
- Further tests for identification of a pathogen
- Assess vaginal secretions for appearance, pH , leukocyte count, and visible pathogens (e.g., protozoa in T. vaginalis infections)
- Swab samples for bacterial culture
- Complications: PID
The differential diagnoses listed here are not exhaustive.
Empirical antibiotic therapy (also consider coinfections!)
- Outpatient regimen
- Inpatient regimen (parental antibiotics)
- It is better to overtreat rather than delay treatment if PID is suspected!
- Short-term complications
- Long-term complications
We list the most important complications. The selection is not exhaustive.