Last reviewed: 28 Jun 2021
Last updated: 02 Feb 2018

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • uterine tenderness
  • cervical motion tenderness
  • adnexal tenderness

Other diagnostic factors

  • lower abdominal pain
  • abnormal cervical or vaginal discharge
  • fever
  • nausea and vomiting

Risk factors

  • prior infection with chlamydia or gonorrhoea
  • young age at onset of sexual activity
  • unprotected sexual intercourse with multiple sexual partners
  • prior hx of PID
  • IUD use
  • smoking
  • low socio-economic status
  • current vaginal douching
  • intercourse during menstruation

Diagnostic investigations

1st investigations to order

  • White blood cell count
  • Polymorphonuclear cells on wet mount of vaginal secretions
  • serum erythrocyte sedimentation rate
  • genetic probe or culture of vaginal secretions for Neisseria gonorrhoeae and Chlamydia trachomatis

Investigations to consider

  • transvaginal ultrasound
  • pelvic CT
  • pelvic MRI
  • laparoscopy
  • endometrial biopsy

Treatment algorithm

Contributors

Authors

Madhavi Manoharan, MBBS, MD, MRCOG

Consultant Obstetrician and Gynaecologist

Barnet and Chase Hospitals NHS Trust

Enfield

Middlesex

UK

Disclosures

MM declares that she has no competing interests.

Acknowledgements

Dr Madhavi Manoharan would like to gratefully acknowledge Dr Dan Selo-Ojeme and Dr Susan Arjmand, previous contributors to this monograph. DSO and SA declare that they have no competing interests.

Peer reviewers

Bradford Fenton, MD

Physician

Department of Obstetrics and Gynecology

Summa Health System

Akron

OH

Disclosures

BF declares that he has no competing interests.

Edmond Edi-Osagie, MBBS, MRCOG, MD

Consultant Gynaecologist

Central Manchester University Hospitals

St. Mary's Hospital

Manchester

UK

Disclosures

EEO declares that he has no competing interests.

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