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[Conditions](https://durgical.com/en/conditions/) · [Pelvis](https://durgical.com/en/anatomy/region/pelvis/)

# Pelvic inflammatory disease

Pelvic inflammatory disease is an infection of the uterus, tubes and [ovaries](https://durgical.com/en/anatomy/ovary/), usually spreading up from the [cervix](https://durgical.com/en/anatomy/cervix-of-uterus/); it can cause infertility and pelvic pain.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Uterine tubes](https://durgical.com/en/anatomy/uterine-tube/)
- [Endometrium](https://durgical.com/en/anatomy/endometrium/)
- [Ovaries](https://durgical.com/en/anatomy/ovary/)
- [Cervix](https://durgical.com/en/anatomy/cervix-of-uterus/)
- [Rectouterine pouch](https://durgical.com/en/anatomy/rectouterine-pouch/)
- [Ampulla of uterine tube](https://durgical.com/en/anatomy/ampulla-of-uterine-tube/)
- [Infundibulum and fimbriae](https://durgical.com/en/anatomy/infundibulum-of-uterine-tube/)
- [Broad ligament](https://durgical.com/en/anatomy/broad-ligament-of-uterus/)
- [Vagina](https://durgical.com/en/anatomy/vagina/)

## In biochemistry

- [CA-125](https://durgical.com/en/biochemistry/topics/ca-125/)

## Microorganisms that cause it

- [Neisseria gonorrhoeae](https://durgical.com/en/microbiology/neisseria-gonorrhoeae/)
- [Chlamydia trachomatis](https://durgical.com/en/microbiology/chlamydia-trachomatis/)

## In histology

- [Uterine tube](https://durgical.com/en/histology/uterine-tube/)

## In the clinical exam

- [McBurney point](https://durgical.com/en/clinical-exam/mcburney-point/)
- [Rovsing, psoas and obturator signs](https://durgical.com/en/clinical-exam/rovsing-psoas-and-obturator-signs/)
- [Gynecologic examination: speculum and bimanual exam](https://durgical.com/en/clinical-exam/gynecologic-examination-speculum-and-bimanual-exam/)

## Why it happens

- [Outcomes of acute inflammation: resolution, abscess, scar or chronic inflammation](https://durgical.com/en/general-pathology/outcomes-of-acute-inflammation-resolution-abscess-scar-or-chronic-inflammation/)

## What it is

Infection and inflammation of the upper female genital tract ([endometrium](https://durgical.com/en/anatomy/endometrium/), [uterine tubes](https://durgical.com/en/anatomy/uterine-tube/), ovaries and pelvic [peritoneum](https://durgical.com/en/anatomy/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](https://durgical.com/en/anatomy/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)

## Red flags

- Positive pregnancy test (exclude ectopic pregnancy)
- High fever, vomiting or peritonism
- Adnexal mass suggesting a tubo-ovarian abscess
- Signs of sepsis or abscess rupture
- No improvement after about three days of treatment

## 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

- [Piperacillin + tazobactam](https://durgical.com/en/pharmacology/piperacillin-tazobactam/)
- [Ampicillin + sulbactam](https://durgical.com/en/pharmacology/ampicillin-sulbactam/)
- [Cefoxitin](https://durgical.com/en/pharmacology/cefoxitin/)

## 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.

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## Related conditions

- [Endometriosis](https://durgical.com/en/conditions/endometriosis/)
- [Urinary tract infection (acute cystitis)](https://durgical.com/en/conditions/urinary-tract-infection/)
- [Ectopic pregnancy](https://durgical.com/en/conditions/ectopic-pregnancy/)
- [Acute appendicitis](https://durgical.com/en/conditions/acute-appendicitis/)
- [Ovarian torsion](https://durgical.com/en/conditions/ovarian-torsion/)
- [Acute pyelonephritis](https://durgical.com/en/conditions/acute-pyelonephritis/)
- [Peritonitis](https://durgical.com/en/conditions/peritonitis/)
- [Dysmenorrhoea](https://durgical.com/en/conditions/dysmenorrhoea/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Pelvic Inflammatory Disease](https://www.ncbi.nlm.nih.gov/books/NBK499959/) (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/pelvic-inflammatory-disease/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/pelvic-inflammatory-disease/