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Pelvic Inflammatory Disease

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Other Names

  • PID
  • Pelvic Inflammatory Disease


  • This page refers to pelvic inflammatory disease (PID)


  • 10-15% of women with Neisseria gonorrhoeae or Chlamydia trachomatis will go on to develop PID [1]
  • Often affects young, sexually active females aged 15-25
  • Incidence has been decreasing secondary to early identification and treatment and prevention, however subclinical PID remains difficult to diagnose


  • Upper genital tract infection in females, usually ascending from the lower genital tract
  • Majority (85%) of cases in women are secondary to sexually transmitted infection
  • Infection by above listed bacteria in the lower genital tract may ascend through the cervix into the upper genital tract
  • Inflammation and scarring of the upper genital tract (uterus, fallopian tubes, ovaries) can ensue
  • Inflammation and scarring specifically of the Fallopian tubes may result in infertility


  • Most common bacteria isolated are Neisseria gonorrhoeae and/or Chlamydia trachomatis
  • Other bacteria isolated: Mycoplasma genitalium, Peptostreptococcus species, Bacteroides species

Risk Factors

  • Unprotected intercourse
  • Intercourse with multiple partners
  • Untreated sexually transmitted infection
  • Intrauterine device placement

Differential Diagnosis

  • Ectopic pregnancy
  • Pelvic venous congestion syndrome
  • Appendicitis
  • Endometriosis
  • Ovarian torsion
  • Ruptured ovarian cyst
  • Urinary tract infection/cystitis
  • Cervicitis

Clinical Features


  • Abdominal pain may be insidious in onset
  • May have history of untreated or unidentified sexually transmitted infection
  • Abdominal pain is usually in the lower abdomen/pelvis
  • Dyspareunia is a common complaint
  • Abdominal pain may be associated with vaginal discharge, abnormal vaginal bleeding, or dysuria
  • Systemic symptoms such as fever, nausea, vomiting can be present
  • History of recent IUD placement

Physical Exam

  • Abdominal tenderness to palpation in lower quadrants (right and/or left may be tender)
  • Rebound, guarding, rigidity usually not present and may clue you into an alternative diagnosis (ectopic pregnancy)

Pelvic Exam

  • Should be performed in all females with lower abdominal pain or suspected PID
  • Evaluate for discharge, usually purulent and foul-smelling if present
  • Evaluate for genital lesions (may be multiple sexually transmitted infections present
  • Evaluate the cervix for friability or bleeding with cotton-tip applicator
  • Bi-manual exam to evaluate for cervical motion tenderness (Chandelier Sign)


  • PID is a clinical diagnosis
  • Labs such as CBC, CMP, UA with microscopy can aid in identification of other causes of abdominal pain
  • Urine pregnancy test should be obtained in all females of child-bearing age with lower abdominal pain to rule-out ectopic pregnancy
  • Cervical/vaginal swabs with pelvic exam - Gonococcal, Chlamydial, Trichomoniasis testing
    • Negative results do not exclude the diagnosis of PID [1]
  • Consider HIV and syphilis co-testing as well
  • Transvaginal pelvic ultrasound to identify complications such as tubo-ovarian abscess or identify ectopic pregnancy


  • N/A


  • Early identification and treatment based on clinical suspicion helps decrease risk of complications

Outpatient Treatment

  • Doxycycline 100mg PO twice daily x14 days PLUS
  • Ceftriaxone 500mg IM once OR
  • Cefoxitin 2g IM with probenecid 1g PO once OR
  • Another 3rd generation cephalosporin that is given IV or IM
  • Add metronidazole 500mg PO twice daily x14 days if recent IUD insertion
  • Remove IUD to prevent recurrent infection

Inpatient Treatment

  • Cefotetan 2g IV every 12hrs PLUS doxycycline 100mg PO every 12hrs OR
  • Cefoxitin 2g IV every 6hrs PLUS doxycycline 100mg PO every 12hrs OR
  • Clindamycin 900mg IV every 8hrs PLUS gentamicin 3-5mg/kg IV daily[1]

Rehab and Return to Sport


  • Not applicable

Return to Sport/Work

  • Athlete can usually return to play after completing antibiotic treatment unless systemically ill

Prognosis and Complications


  • Most patients do well if treated early and correctly


  • Complications can occur even with appropriate antibiotic treatment
  • Delayed or lack of treatment was found to lead to worse outcomes across the board
  • Some associated complications include ectopic pregnancy (7.8%), recurrent PID, infertility (5-fold increase), chronic abdominal or pelvic pain (33.3%)[1]
  • Untreated infection may lead to tubo-ovarian abscess formation requiring removal of Fallopian tube/ovary or drainage of abscess, thus increasing infertility

See Also


  1. 1.0 1.1 1.2 1.3 Jennings LK, Krywko DM. Pelvic Inflammatory Disease. [Updated 2023 March 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499959/
Created by:
John Kiel on 2 December 2020 15:59:00
Last edited:
26 April 2023 13:53:06