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 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