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Chlamydia trachomatis and Neisseria gonorrhoea account for the majority of cases. (1)

  • Chlamydia is thought to be the most common cause of PID and is associated with 14% to 35% of cases (1)
  • Neisseria gonorrhoea and chlamydia trachomatis co-infection can occur

Less commonly, PID may result from: (2)

  • Mycoplasma hominis
  • Mycoplasma genitalium
  • anaerobes such as Bacteroides
  • G. vaginalis
  • Haemophilus influenzae
  • Cytomegalovirus
  • U. urealyticum
  • Actinomyces israelii - especially with long term IUCD; may cause unilateral infection
  • Herpes simplex virus type II - very rarely

No microbiological cause can be found in 20%.

Routes of infection include:

  • ascending from the vagina - endogenous infection, for example, Bacteroides; or sexually transmitted infection, especially Chlamydia and Neiserria

  • direct inoculation - for example, during dilatation and curettage, termination of pregnancy, insertion of a intrauterine contraceptive device

  • transperitoneal - for example, following appendicitis or diverticulitis

  • haematogenous - classically tuberculosis, usually at the time of puberty, but theoretically, any bacteraemia may produce pelvic foci of infection


1. Goller JL et al. Population attributable fraction of pelvic inflammatory disease associated with chlamydia and gonorrhoea: a cross-sectional analysis of Australian sexual health clinic data. Sex Transm Infect. 2016 Nov;92(7):525-31.

2. Curry A, Williams T, Penny ML. Pelvic Inflammatory Disease. Diagnosis, Management, and Prevention. Am Fam Physician. 2019 Sep 15;100(6):357-364.


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