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Pelvic inflammatory disease
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Pelvic inflammatory disease

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Contributors: Neil Mendoza MD, Paritosh Prasad MD, Mitchell Linder MD
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Synopsis

Pelvic inflammatory disease (PID) is a clinical syndrome characterized by inflammation of the upper genital tract in women. It is caused by infection by microorganisms that spread from the endocervix. Many cases are due to infection with Neisseria gonorrhoeae or Chlamydia trachomatis; 10%-20% of women with untreated gonorrhea or chlamydia will go on to have PID. Infection with Mycoplasma genitalium may also play a role. Other organisms that have been implicated in this infection are usual vaginal flora including anaerobic organisms, gram-negative bacilli, and Streptococcus species.

Risk factors include age younger than 25, new or multiple sexual partners, and not using barrier contraception. PID is uncommon in nonsexually active female 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 a number of 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.

Related topic: Salpingitis

Codes

ICD10CM:
N73.9 – Female pelvic inflammatory disease, unspecified

SNOMEDCT:
198130006 – Female pelvic inflammatory disease

Look For

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Diagnostic Pearls

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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 exam.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 06/20/2017
Last Updated: 07/15/2019
Copyright © 2019 VisualDx®. All rights reserved.
Pelvic inflammatory disease
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Pelvic inflammatory disease : Fever, Lower abdominal pain, Rebound tenderness, Dyspareunia, Dysuria, Purulent cervical discharge
Copyright © 2019 VisualDx®. All rights reserved.