[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Female genital tract](https://durgical.com/en/general-pathology/areas/female-genital/) › Pelvic inflammatory disease

# 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.

Updated Nov 12, 2026

## Key points

- Ascending route: cervix to endometrium to tube to ovary and peritoneum; gonococcal disease often starts around menstruation, when the cervical mucus barrier is weakest.
- Gonococcus and Chlamydia spread along the mucosa; postpartum and post-abortion polymicrobial infection spreads through lymphatics and veins into deeper layers.
- Acute salpingitis: swollen red tube, pus in the lumen (pyosalpinx), neutrophils in the mucosa and wall; can form a tubo-ovarian abscess.
- Healing leaves adhesions, fused plicae and blocked fimbriae (hydrosalpinx): infertility, ectopic pregnancy, chronic pelvic pain.
- Spread to the liver capsule causes perihepatitis with violin-string adhesions (Fitz-Hugh–Curtis).

## 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.

## Memory aid

PID climbs a ladder: cervix, womb, tube, pelvis; and when it leaves, it pulls the ladder's top rungs (the fimbriae) together with scar.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/general-pathology/pelvic-inflammatory-disease/)

[More Pathology questions →](https://durgical.com/en/practice/?f=pathology)

## Elsewhere in DurgiPedia

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

## Connections

## Related 8

- [Infections of the vulva, vagina and cervix](https://durgical.com/en/general-pathology/infections-of-the-vulva-vagina-and-cervix/)
- [Cervicitis and endocervical polyps](https://durgical.com/en/general-pathology/cervicitis-and-endocervical-polyps/)
- [Acute and chronic endometritis](https://durgical.com/en/general-pathology/acute-and-chronic-endometritis/)
- [Diseases of the fallopian tube](https://durgical.com/en/general-pathology/diseases-of-the-fallopian-tube/)
- [Ectopic pregnancy](https://durgical.com/en/general-pathology/ectopic-pregnancy/)
- [Patterns of acute inflammation: serous, fibrinous, purulent, abscess, ulcer](https://durgical.com/en/general-pathology/patterns-of-acute-inflammation-serous-fibrinous-purulent-abscess-ulcer/)
- [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/)
- [Fibrosis in organs: TGF-β and the myofibroblast](https://durgical.com/en/general-pathology/fibrosis-in-organs-tgf-and-the-myofibroblast/)

## Related conditions 7

- [Pelvic inflammatory disease](https://durgical.com/en/conditions/pelvic-inflammatory-disease/)
- [Gonorrhoea](https://durgical.com/en/conditions/gonorrhoea/)
- [Chlamydia infection](https://durgical.com/en/conditions/chlamydia-infection/)
- [Puerperal infection (postpartum endometritis and maternal sepsis)](https://durgical.com/en/conditions/puerperal-infection/)
- [Septic and unsafe abortion](https://durgical.com/en/conditions/septic-and-unsafe-abortion/)
- [Female infertility](https://durgical.com/en/conditions/female-infertility/)
- [Ectopic pregnancy](https://durgical.com/en/conditions/ectopic-pregnancy/)

## Microorganisms 3

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

[← All of general pathology](https://durgical.com/en/general-pathology/)

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](https://www.ncbi.nlm.nih.gov/books/NBK499959/) (StatPearls (NCBI Bookshelf), 2026); [Gonorrhea](https://www.ncbi.nlm.nih.gov/books/NBK558903/) (StatPearls (NCBI Bookshelf), 2026); [Chlamydia trachomatis Infection](https://www.ncbi.nlm.nih.gov/books/NBK537286/) (StatPearls (NCBI Bookshelf), 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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