Pelvic Inflammatory Disease

Pelvic Inflammatory Disease is a topic covered in the 5-Minute Emergency Consult.

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  • Pelvic inflammatory disease (PID) is an acute, community-acquired, sexually transmitted infection of the upper genital tract, including the uterus, fallopian tubes, ovaries, or adjacent structures
  • Most frequent gynecologic cause for ED visits (350,000 per year)
  • Represents a spectrum of infection:
    • No single diagnostic gold standard
    • Requires low clinical threshold for considering the diagnosis and starting empiric antibiotic therapy
  • Progressive disease can lead to tubo-ovarian abscess (TOA)
  • Fitz-Hugh–Curtis syndrome is a capsular inflammation of the liver associated with PID:
    • Sharp right upper quadrant abdominal pain
    • Worse with inspiration, movement, or coughing


  • Risk factors:
    • Age <25 yr
    • Multiple or symptomatic sexual partners
    • Previous episode of PID
    • Nonbarrier contraception
    • Oral contraception
    • African American ethnicity
  • Most common causes of PID are Chlamydia trachomatis and Neisseria gonorrhea
  • Other organisms include groups A and B streptococci, staphylococci, gram-negative rods (commonly Klebsiella spp., Escherichia coli, and Proteus spp.), and anaerobes

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