Last edited 07/2021 and last reviewed 08/2021

Pelvic inflammatory disease describes a spectrum of inflammatory disorders of the upper genital tract and surrounding structures caused by ascending infection from the lower genital tract

  • bacteria spread directly from the cervix to the endometrium and on to the upper genital tract (1,2,3,4)

Clinical features of PID are not specific and may range from asymptomatic to serious illness (5)

  • PID can cause endometritis, parametritis (infection of the structures near the uterus), salpingitis (infection of the fallopian tubes), oophoritis (infection of the ovary), and tubo-ovarian abscess
  • peritonitis and perihepatitiscan also occur.
    • peritonitis, tubo-ovarian abscess, and severe systemic illness (e.g. fever and malaise) are considered severe forms of PID

PID is an important cause of chronic pelvic pain, infertility and ectopic pregnancy

  • among women with PID, 10% to 20% may become infertile, 40% will develop chronic pelvic pain, and 10% of those who conceive will have an ectopic pregnancy (5)

PID is almost always caused by sexually transmitted organisms (2).

PID has a prevalence of between 2% and 12% (5)

PID does not have a diagnostic gold standard.

  • the most commonly used diagnostic criteria are based on those from the Centers for Disease Control and Prevention (CDC) (4), namely sexually active young women and
    other women at risk for sexually transmitted disease (STD) who are experiencing recent pelvic or lower abdominal pain where no cause other than PID can be identified, and one or more of the following minimum criteria are present on pelvic examination:
    • cervical motion tenderness,
    • uterine tenderness,
    • or adnexal tenderness
  • the requirement for all three minimum criteria to be present increases the specificity of the diagnosis but reduces sensitivity (5)

Key points (6):

  • refer women and sexual contacts to GUM

  • raised CRP supports diagnosis, absent pus cells in HVS smear good negative predictive value

  • exclude:
    • ectopic pregnancy, appendicitis, endometriosis, UTI, irritable bowel, complicated ovarian cyst, functional pain

  • moxifloxacin has greater activity against likely pathogens, but always test for gonorrhoea, chlamydia, and M. genitalium

  • If M. genitalium tests positive use moxifloxacin