Last reviewed: 28 Sep 2021
Last updated: 28 Jul 2021

Summary

Definition

History and exam

Key diagnostic factors

  • uterine tenderness
  • cervical motion tenderness
  • adnexal tenderness

Other diagnostic factors

  • lower abdominal pain
  • abnormal cervical or vaginal discharge
  • fever

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

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

Investigations to consider

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

Treatment algorithm

Contributors

Authors

Madhavi Manoharan, MD, FRCOG

Senior Attending Physician

Sidra Medicine

Assistant Professor in Clinical Obstetrics and Gynaecology

Weill Cornell Medicine - Qatar

Doha

Qatar

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 topic.

Disclosures

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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