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Pelvic inflammatory disease

Last reviewed: 4 Sep 2023
Last updated: 07 Jul 2023



History and exam

Key diagnostic factors

  • uterine tenderness
  • cervical motion tenderness
  • adnexal tenderness
More key diagnostic factors

Other diagnostic factors

  • lower abdominal pain
  • abnormal cervical or vaginal discharge
  • fever
Other diagnostic factors

Risk factors

  • prior infection with chlamydia or gonorrhea
  • young age at onset of sexual activity
  • unprotected sexual intercourse with multiple sexual partners
  • prior history of PID
  • IUD use
  • smoking
  • low socioeconomic status
  • current vaginal douching
  • intercourse during menstruation
More risk factors

Diagnostic investigations

1st investigations to order

  • white blood cell count
  • polymorphonuclear cells on wet mount of vaginal secretions
  • genetic probe or culture of vaginal secretions for Neisseria gonorrhoeae and Chlamydia trachomatis
  • nucleic acid amplification test for Mycoplasma genitalium
More 1st investigations to order

Investigations to consider

  • serum erythrocyte sedimentation rate (ESR)
  • transvaginal ultrasound
  • pelvic CT
  • pelvic MRI
  • laparoscopy
  • endometrial biopsy
More investigations to consider

Treatment algorithm


suspected or confirmed mild-to-moderate PID at initial presentation

severe PID, complications, or no response to intramuscular/oral therapy



Madhavi Manoharan, MD, FRCOG

Consultant Obstetrician and Gynecologist

Integra Healthcare Ltd

Grand Cayman

Cayman Islands


MM declares that she has no competing interests.


Dr Madhavi Manoharan would like to gratefully acknowledge Dr Dan Selo-Ojeme and Dr Susan Arjmand, previous contributors to this topic.


DSO and SA declare that they have no competing interests.

Peer reviewers

Bradford Fenton, MD


Department of Obstetrics and Gynecology

Summa Health System




BF declares that he has no competing interests.

Edmond Edi-Osagie, MBBS, MRCOG, MD

Consultant Gynaecologist

Central Manchester University Hospitals

St. Mary's Hospital




EEO declares that he has no competing interests.

  • Pelvic inflammatory disease images
  • Differentials

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    • Acute appendicitis
    • Ovarian cyst complications (ruptured ovarian cyst, ovarian cyst torsion, hemorrhagic ovarian cyst)
    More Differentials
  • Guidelines

    • European guideline on the management of Mycoplasma genitalium infections
    • ACR-SPR practice parameter for the performance of computed tomography (CT) of the abdomen and computed tomography (CT) of the pelvis
    More Guidelines
  • Patient leaflets

    Pelvic inflammatory disease

    Endometrial ablation (microwave method)

    More Patient leaflets
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