Pelvic inflammatory disease !
Pelvic inflammatory disease is an infection of the uterus, tubes and ovaries, usually spreading up from the cervix; it can cause infertility and pelvic pain.
Updated 2026-10-29
Structures involved
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- Uterine tubes
- Endometrium
- Ovaries
- Cervix
- Rectouterine pouch
- Ampulla of uterine tube
- Infundibulum and fimbriae
- Broad ligament
- Vagina
In biochemistry
Microorganisms that cause it
In histology
In the clinical exam
Why it happens
What it is
Infection and inflammation of the upper female genital tract (endometrium, uterine tubes, ovaries and pelvic peritoneum), usually ascending from the cervix. It can cause infertility, ectopic pregnancy and chronic pelvic pain.
Who gets it
Mainly affects sexually active young women; many cases are mild or silent. The sexually transmitted infections behind it are common and under-reported in the region.
Causes
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Mycoplasma genitalium
- Polymicrobial vaginal flora: anaerobes, bacterial vaginosis organisms, enteric gram-negatives
- Less often after uterine instrumentation
Risk factors
- Age under 25
- New or multiple sexual partners, or a partner with an STI
- Previous PID or STI
- Inconsistent condom use
- Recent IUD insertion (first weeks) or uterine procedure
- Bacterial vaginosis
Pathophysiology
Organisms ascend from the cervix through the endometrium into the tubes, causing salpingitis. Inflammation destroys ciliated epithelium and leaves tubal scarring and adhesions, raising the risk of infertility and ectopic pregnancy. Pus may collect as a tubo-ovarian abscess; spread to the liver capsule causes perihepatitis (Fitz-Hugh–Curtis syndrome).
Classification
- Mild to moderate (outpatient treatment) or severe (hospital treatment)
- With or without tubo-ovarian abscess
- Acute, or subclinical with silent tubal damage
- Fitz-Hugh–Curtis syndrome: associated perihepatitis
Symptoms and signs
- Lower abdominal or pelvic pain, often on both sides
- Abnormal vaginal discharge; bleeding between periods or after intercourse
- Deep dyspareunia and dysuria
- Fever (not always present)
- On exam: cervical motion tenderness, uterine and adnexal tenderness
- Right upper quadrant pain (Fitz-Hugh–Curtis)
Diagnosis
- Clinical
- A clinical diagnosis: pelvic pain with cervical motion, uterine or adnexal tenderness and no other cause; treatment starts on suspicion. Laparoscopy is reserved for uncertain cases.
- Tests
- Pregnancy test; nucleic acid amplification tests (NAAT) for chlamydia and gonorrhoea; microscopy of discharge; blood count and CRP; HIV and syphilis tests.
- Imaging
- Transvaginal ultrasound looks for a tubo-ovarian abscess or other causes of pain.
Differential diagnosis
- Ectopic pregnancy
- Acute appendicitis
- Ovarian torsion or ruptured ovarian cyst
- Endometriosis
- Urinary tract infection or pyelonephritis
Goal of treatment
Clear the infection early to relieve symptoms and protect fertility, treat partners and prevent reinfection.
Treatment
- Medical
- Empirical broad-spectrum antibiotics covering chlamydia, gonorrhoea and anaerobes, started without waiting for results (for example a cephalosporin plus a tetracycline, with or without a nitroimidazole), per guidelines.
- Acute
- Hospital admission and intravenous antibiotics for severe illness, pregnancy, tubo-ovarian abscess, vomiting or no response to oral treatment.
- Procedure
- Drainage of a tubo-ovarian abscess (image-guided or surgical) when it does not respond to antibiotics or ruptures.
- Follow-up
- Review within about three days; notification and treatment of partners; no intercourse until treatment ends; retesting for reinfection. An IUD can usually stay if the patient improves.
Drugs for this condition
Complications
- Tubal factor infertility
- Ectopic pregnancy
- Chronic pelvic pain
- Tubo-ovarian abscess
- Fitz-Hugh–Curtis perihepatitis
- Recurrent PID
Prognosis
Most improve quickly with early antibiotics, but tubal damage can persist, and every new episode raises the risk of infertility and ectopic pregnancy.
Prevention
- Condom use
- Screening sexually active young women for chlamydia and gonorrhoea
- Treating partners
- Sexual health education
Test yourself
Think of the answer, then tap the question to see it.
What are the two classic sexually transmitted causes of PID?
Chlamydia trachomatis and Neisseria gonorrhoeae.
Which exam finding is a key clinical criterion for PID?
Cervical motion tenderness, together with uterine or adnexal tenderness.
What is Fitz-Hugh–Curtis syndrome?
Perihepatitis with adhesions of the liver capsule, causing right upper quadrant pain in PID.
Which test must always be done when PID is suspected?
A pregnancy test, to exclude ectopic pregnancy.
What are the main long-term complications of PID?
Tubal infertility, ectopic pregnancy and chronic pelvic pain.
Related conditions
- Endometriosis
- Urinary tract infection (acute cystitis)
- Ectopic pregnancy
- Acute appendicitis
- Ovarian torsion
- Acute pyelonephritis
- Peritonitis
- Dysmenorrhoea
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Pelvic Inflammatory Disease (StatPearls (NCBI Bookshelf), 2025).
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