Last reviewed: 10 Nov 2024
Last updated: 31 May 2024
Summary
Definition
History and exam
Key diagnostic factors
- uterine tenderness
- cervical motion tenderness
- adnexal tenderness
Full details
Other diagnostic factors
- lower abdominal pain
- abnormal cervical or vaginal discharge
- fever
Full details
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
Full details
Diagnostic tests
1st tests 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
Full details
Tests to consider
- serum erythrocyte sedimentation rate (ESR)
- transvaginal ultrasound
- pelvic CT
- pelvic MRI
- laparoscopy
- endometrial biopsy
Full details
Treatment algorithm
ACUTE
suspected or confirmed mild-to-moderate PID at initial presentation
severe PID, complications, or no response to intramuscular/oral therapy
Contributors
Authors
Madhavi Manoharan, MD, FRCOG
Consultant Obstetrician and Gynecologist
Integra Healthcare Ltd
Grand Cayman
Cayman Islands
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.
Differentials
- Ectopic pregnancy
- Acute appendicitis
- Ovarian cyst complications (ruptured ovarian cyst, ovarian cyst torsion, hemorrhagic ovarian cyst)
More DifferentialsGuidelines
- ACR appropriateness criteria: acute pelvic pain in the reproductive age group
- European guideline on the management of Mycoplasma genitalium infections
More GuidelinesPatient information
Pelvic inflammatory disease
Endometrial ablation (microwave method)
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