⚠️ Key exam pearl: Lower abdominal pain and cervical/adnexal tenderness are the most consistent findings. Always consider PID in sexually active women with pelvic pain, abnormal vaginal discharge, or fever.

📖 Overview

Definition: Infectious and inflammatory disorder of the upper female genital tract — uterus, fallopian tubes, ovaries ± peritoneum.
Etiology: Most commonly ascending sexually transmitted infections (STIs).
Significance: Untreated PID can lead to infertility, ectopic pregnancy, chronic pelvic pain, and tubo-ovarian abscess.

🧬 Aetiology & Risk Factors

PID is usually polymicrobial, often triggered by STIs and complicated by anaerobic organisms.

STIs: Chlamydia trachomatis, Neisseria gonorrhoeae
Other bacteria: anaerobes, Gardnerella vaginalis, streptococci, staphylococci, E. coli
Risk factors: multiple sexual partners, prior STIs, IUCD insertion (esp. first 3 weeks), young age, previous PID

🤒 Clinical Presentation

Systemic: Fever >38°C, malaise, nausea, vomiting.
Pelvic: Bilateral lower abdominal pain, deep dyspareunia, abnormal bleeding, offensive vaginal discharge.
Exam: Cervical motion tenderness (Chandelier sign), adnexal tenderness ± masses, uterine tenderness.

🧾 Differential Diagnosis

Acute appendicitis
Ectopic pregnancy
Ovarian torsion or cyst rupture
Urinary tract infection or pyelonephritis
IBD flare (Crohn’s/UC)

⚡ Complications

Infertility (tubal scarring, 15–20%)
Ectopic pregnancy (5–10× increased risk)
Chronic pelvic pain
Tubo-ovarian abscess → sepsis, rupture
Fitz-Hugh–Curtis syndrome (perihepatitis with “violin-string” adhesions)

🔬 Investigations

Bedside: Pregnancy test (exclude ectopic), speculum exam, cervical swabs for NAAT (chlamydia/gonorrhoea)
Bloods: FBC, CRP/ESR, LFTs, U&E
Imaging: Pelvic US for abscess, hydrosalpinx; MRI if US inconclusive
Laparoscopy: Gold standard for diagnosis and microbiological sampling

💊 Management

Empirical antibiotics: Start immediately — do not wait for swab results
- IM Ceftriaxone 1 g stat + Doxycycline 100 mg PO BD 14 days ± Metronidazole 400 mg PO BD 14 days (covers anaerobes)
Admission indications: Severe illness, pregnancy, abscess, failed outpatient therapy, diagnostic uncertainty
Pain relief: NSAIDs, rest, adequate hydration
Partner notification & treatment: Essential to prevent reinfection
Surgical: Drainage of tubo-ovarian abscess if no improvement after 72 hours or if ruptured

📉 Prognosis

✅ Early treatment: Complete resolution in most women
⚠️ Delayed treatment: Tubal damage, infertility, ectopic pregnancy, chronic pelvic pain
🔄 Recurrence risk: ~25% within 1 year if reinfected

✅ Key Takeaways

PID is a preventable cause of infertility and ectopic pregnancy. Maintain a high index of suspicion in sexually active women with pelvic pain. Prompt antibiotics, partner treatment, and structured follow-up are crucial to reducing long-term complications.

📚 References

CDC – Pelvic Inflammatory Disease
NICE NG43: STIs & PID
Wilson TJ, et al. BMJ 2018;361:k2135

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

Pelvic Inflammatory Disease