Pelvic inflammatory disease
- Lesion
Bacteria climb from the cervix into the uterus and tubes; the infection heals with scars that can block the tubes and cause infertility or an ectopic pregnancy.
What it is
Pelvic inflammatory disease is infection that ascends from the cervix to the endometrium, fallopian tubes, ovaries and pelvic peritoneum. Gonococcus and Chlamydia are the classic causes; after a delivery or an abortion, a mixed flora of streptococci, staphylococci, coliforms and anaerobes takes over. The acute damage is a suppurative salpingitis; the lasting damage is scarring of the tube, which is the main preventable cause of tubal infertility and ectopic pregnancy.
Structure
- Acute gonococcal salpingitis: congested, swollen tube; mucosa packed with neutrophils; purulent exudate pours from the fimbrial end into the pelvis.
- Pyosalpinx: the tube is sealed at both ends and distended with pus; tubo-ovarian abscess: tube and ovary fused into one inflammatory mass.
- Chronic stage: plicae fused into a network of spaces, a thin-walled tube full of clear fluid (hydrosalpinx), and fibrous adhesions binding tube, ovary and bowel.
- Polymicrobial (puerperal) infection: the mucosa is less involved; inflammation runs through the wall, the parametrium and the veins, sometimes with septic thrombophlebitis.
Step by step
- A sexually transmitted organism infects the endocervix (cervicitis), often with few symptoms.
- Around menstruation, or after instrumentation, delivery or abortion, bacteria pass the cervix and infect the endometrium.
- They reach the tubal mucosa, where neutrophils and the bacteria destroy ciliated cells and fill the lumen with pus.
- Pus leaks into the pelvis: pelvic peritonitis, tubo-ovarian abscess, sometimes perihepatitis or bacteraemia.
- Repair by fibrosis fuses the mucosal folds and closes the fimbriae; the damaged tube traps or blocks the embryo.
Two patterns of pelvic infection
| Feature | Sexually transmitted (gonococcus, Chlamydia) | Postpartum or post-abortion (polymicrobial) |
|---|---|---|
| Setting | Young sexually active patients; often after menses | After delivery, miscarriage or induced abortion, retained tissue |
| Route | Along the mucosal surface | Through lymphatics and veins of the wall |
| Main lesion | Suppurative salpingitis, pyosalpinx | Endomyometritis, parametritis, septic thrombophlebitis |
| Typical organisms | Neisseria gonorrhoeae, Chlamydia trachomatis | Streptococci, staphylococci, coliforms, anaerobes, Clostridium |
| Late result | Tubal scarring, hydrosalpinx, infertility, ectopic pregnancy | Sepsis, pelvic abscess, adhesions |
Clinical notes
- Presents with lower abdominal pain, fever, cervical motion tenderness and discharge, but many chlamydial infections are silent and are found only when infertility is investigated.
- Complications: peritonitis, tubo-ovarian abscess, bacteraemia with septic arthritis or endocarditis, bowel obstruction from adhesions.
- Actinomyces can cause a chronic pelvic infection in long-term intrauterine device users.
- Each episode raises the risk of tubal infertility and ectopic pregnancy, which is why screening and treating cervical chlamydia matters.
Test yourself
Think of the answer, then tap the question to see it.
Which two organisms are the classic causes of sexually transmitted pelvic inflammatory disease?
Neisseria gonorrhoeae and Chlamydia trachomatis; chlamydial infection is often silent.
Why does pelvic inflammatory disease raise the risk of ectopic pregnancy?
Healing fuses the tubal folds and damages cilia, so the embryo is delayed or trapped in the tube and implants there.
How does postpartum pelvic infection differ in its route from gonococcal infection?
Polymicrobial postpartum infection spreads through lymphatics and veins of the uterine wall, while gonococcus spreads along the mucosa.
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Pelvic Inflammatory Disease (StatPearls (NCBI Bookshelf), 2026); Gonorrhea (StatPearls (NCBI Bookshelf), 2026); Chlamydia trachomatis Infection (StatPearls (NCBI Bookshelf), 2026).
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Representative model, for educational purposes only.