Pelvic Inflammatory Disease (PID): Symptoms, Causes & Treatment

Pelvic Inflammatory Disease (PID) is an infection of the upper female reproductive tract (uterus, fallopian tubes, ovaries). It is usually polymicrobial, ascending from the cervix.

Common Pathogens

• Sexually transmitted: Chlamydia trachomatis, Neisseria gonorrhoeae (most common).
• Endogenous: Mycoplasma genitalium, anaerobes, Gardnerella, enteric Gram-negatives.

Clinical Presentation

• Lower abdominal/pelvic pain (bilateral, dull/aching).
• Cervical motion tenderness, uterine/adnexal tenderness on exam.
• Fever, chills (may be absent in mild cases).
• Abnormal vaginal discharge (purulent, malodorous).
• Irregular bleeding (intermenstrual, postcoital).
• Dysuria, dyspareunia.
• Nausea/vomiting (if severe).

Diagnosis

Clinical (CDC criteria: pelvic pain + cervical motion/uterine/adnexal tenderness + no other cause). Labs: NAAT for CT/GC, CBC, CRP, wet mount, pregnancy test. Imaging (US) if abscess suspected or diagnosis uncertain.

Treatment

Outpatient (mild-moderate): Ceftriaxone 500mg IM single dose + Doxycycline 100mg BID ×14d ± Metronidazole 500mg BID ×14d.

Inpatient (severe, pregnant, abscess, failed outpatient): IV cefotetan/cefoxitin + doxycycline; switch to oral after 24h improvement.

Critical Follow-Up

• Re-evaluate at 72h; if no improvement, reassess diagnosis/imaging.
• Partner notification/treatment (expedited partner therapy).
• Abstain until both partners treated.
• Screen for HIV/syphilis.

Complications: tubal infertility, ectopic pregnancy, chronic pelvic pain, tubo-ovarian abscess.