Pelvic Inflammatory Disease



  • 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
  • Occurs in 4.4% of women of reproductive age
  • 85% of cases caused by sexually transmitted pathogens or bacterial vaginosis pathogens
  • 15% of cases due to colonization of respiratory or enteric pathogens
  • 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
    • Delayed care is associated with worse long-term outcomes including chronic pelvic pain and increased risk of ectopic pregnancy
  • Likely missed often and responsible for many cases of tubal-factor infertility
  • 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
  • Chronic PID:
    • Symptoms > 30 d
    • Mycobacterium tuberculosis
    • Actinomyces


  • Risk factors:
    • Age <25 yr
    • Earlier sexual activity:
      • 8 times higher if sexually active at age 12 yr vs. 18 yr
    • Multiple or symptomatic sexual partners
    • Prior sexually transmitted infection
    • Previous episode of PID
    • Lesbian/bisexual relationships:
      • Prevalence is 2 times higher
    • Nonbarrier contraception
    • Oral contraception
    • African American ethnicity
  • Most common causes of PID are:
    • Chlamydia trachomatis
    • Neisseria gonorrhoeae
  • Other organisms include:
    • Groups A and B streptococci
    • Staphylococci
    • Gram-negative rods (commonly Klebsiella spp., Escherichia coli, and Proteus spp.)
    • Anaerobes

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