Clinical features

The clinical picture of PID is variable and clinical symptoms and signs lack specificity and sensitivity (1). Many women are asymptomatic with PID diagnosed retrospectively during investigation for infertility.

• Gonococcal disease tends to be more abrupt in onset and produce more dramatic symptoms of fever and peritoneal irritation than nongonococcal disease.
• Chlamydial PID is most likely to be asymptomatic and recognition of the infection is delayed most of the time leading to more long-term sequelae when compared to PID caused by other organisms. (2)

Lower abdominal pain, usually bilateral, is the most common presenting symptom. Sometimes the pain may radiate to the legs as well (1). Other symptoms may include:

• fever (>38 C)
• deep dyspareunia
• abnormal vaginal or cervical discharge
• nausea, vomiting
• dysuria
• abnormal bleeding - menstrual irregularities can occur in 25% of women with PID (1), and can be post-coital as well

Examination may reveal: (1, 2)

• bilateral lower abdominal tenderness - in 90% of PID
• bilateral adnexal tenderness - confirmed by bimanual vaginal examination
• cervical excitation
• pain on manipulation of the cervix } laparoscope
• adnexal mass(es)
• rebound, guarding
• vaginal discharge - cervical mucopurulent discharge
• pyrexia

Reference:

1. British Association for Sexual Health and HIV. UK national guideline for the management of pelvic inflammatory disease. Jan 2019 [internet publication].

2. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.