Pelvic inflammatory disease
Risk factors include age younger than 25, new or multiple sexual partners, and not using barrier contraception. PID is uncommon in sexually inactive adolescents and children but has been reported.
Patient complaints may be vague or nonspecific, and some patients may be asymptomatic. Symptoms may begin suddenly or may progress over many days to a few weeks. Many patients will have lower abdominal pain that worsens with intercourse. Abnormal vaginal discharge and abnormal uterine bleeding may be present. Fever may or may not be present. Purulent endocervical discharge may be noted on pelvic examination. Cervical motion tenderness is frequently present. Patients may develop perihepatitis with right upper quadrant pain on examination. A subset of patients (4%-14%) develop Fitz-Hugh-Curtis syndrome (liver capsule inflammation).
PID increases the risk of ectopic pregnancy and infertility due to adhesions made in the Fallopian tubes. Because of the difficulty of diagnosis and the potential for damage to the reproductive health of patients, health care providers should maintain a low threshold for the clinical diagnosis of PID.
Related topic: salpingitis
N73.9 – Female pelvic inflammatory disease, unspecified
198130006 – Female pelvic inflammatory disease
Differential Diagnosis & Pitfalls
- Ectopic pregnancy – A pregnancy test should be performed.
- Appendicitis – Ultrasound or other imaging of the appendix may be helpful.
- Endometriosis – Pelvic ultrasound may be helpful; the pain of endometriosis is usually chronic or cyclical and usually not acute.
- Rupture or torsion of an ovarian cyst – Ultrasound of the ovaries may be helpful.
- Irritable bowel syndrome – Abdominal pain may be more generalized, and constipation and/or diarrhea is a more prominent feature.
- Acute cystitis – Check urinalysis / urine culture, as this may also cause pain with bimanual examination.