- Home
- Search
- Tools
- CME
- Help & Feedback
- About epocrates
- Business Solutions
Highlights & Basics
- Pelvic inflammatory disease is an acute ascending polymicrobial infection of the female gynecologic tract that is frequently associated with Neisseria gonorrhoeae or Chlamydia trachomatis.
- Symptoms and physical findings vary widely and may include lower abdominal tenderness, adnexal tenderness, and cervical motion tenderness. Fever and cervical or vaginal discharge may also be present.
- Diagnosis may be difficult because symptoms range from absent to severe and may be nonspecific. Possible laboratory findings include abundant white blood cells on saline microscopy of vaginal secretions, elevated erythrocyte sedimentation rate, elevated C-reactive protein, and laboratory documentation of cervical infection with Neisseria gonorrhoeae or Chlamydia trachomatis. Laparoscopy is the definitive procedure but is invasive and is not recommended for routine diagnosis.
- Antibiotic treatment should be initiated in patients who are sexually active and who have pelvic pain, cervical motion tenderness, or adnexal or uterine tenderness for which no other cause can be found. Patients may need hospitalization and parenteral antibiotics.
- Complications include tubo-ovarian abscess and subsequent infertility or ectopic pregnancy due to scarred or obstructed fallopian tubes.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.[Full Text]
Ross J, Guaschino S, Cusini M, et al. 2017 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS. 2018 Feb;29(2):108-14.[Abstract][Full Text]
American College of Radiology. ACR appropriateness criteria: acute pelvic pain in the reproductive age group. 2023 [internet publication].[Full Text]
1. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.[Full Text]
2. Grodstein F, Rothman KJ. Epidemiology of pelvic inflammatory disease. Epidemiology. 1994 Mar;5(2):234-42.[Abstract]
3. Crossman SH. The challenge of pelvic inflammatory disease. Am Fam Physician. 2006 Mar 1;73(5):859-64.[Abstract][Full Text]
4. Sutton MY, Strenberg M, Zaidi A, et al. Trends in pelvic inflammatory disease hospital discharges and ambulatory visits, United States 1985-2001. Sex Trans Dis. 2005 Dec;32(12):778-84.[Abstract]
5. Kreisel K, Torrone E, Bernstein K, et al. Prevalence of pelvic inflammatory disease in sexually experienced women of reproductive age - United States, 2013-2014. MMWR Morb Mortal Wkly Rep. 2017 Jan 27;66(3):80-3.[Abstract][Full Text]
6. Price MJ, Ades AE, Welton NJ, et al. Pelvic inflammatory disease and salpingitis: incidence of primary and repeat episodes in England. Epidemiol Infect. 2017 Jan;145(1):208-15.[Abstract][Full Text]
7. Goller JL, De Livera AM, Fairley CK, et al. Population attributable fraction of pelvic inflammatory disease associated with chlamydia and gonorrhoea: a cross-sectional analysis of Australian sexual health clinic data. Sex Transm Infect. 2016 Nov;92(7):525-31.[Abstract][Full Text]
8. Price MJ, Ades AE, Welton NJ, et al. Proportion of pelvic inflammatory disease cases caused by Chlamydia trachomatis: consistent picture from different methods. J Infect Dis. 2016 Aug 15;214(4):617-24.[Abstract][Full Text]
9. Scholes D, Stergachis A, Heidrich FE, et al. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med. 1996 May 23;334(21):1362-6.[Abstract][Full Text]
10. Dayan L. Pelvic inflammatory disease. Aust Fam Physician. 2006 Nov;35(11):858-62.[Abstract]
11. National STD Curriculum. Self-study STD module: PID. Feb 2017 [internet publication].[Full Text]
12. Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bull World Health Organ. 2004 Jun;82(6):454-61.[Abstract][Full Text]
13. Ness RB, Randall H, Richter HE, et al. Pelvic Inflammatory Disease Evaluation and Clinical Health Study Investigators. Condom use and the risk of recurrent pelvic inflammatory disease, chronic pelvic pain, or infertility following an episode of pelvic inflammatory disease. Am J Public Health. 2004 Aug;94(8):1327-9.[Abstract][Full Text]
14. McCormack, WM. Pelvic inflammatory disease. N Engl J Med. 1994 Jan 13;330(2):115-9.[Abstract]
15. Scholes D, Daling JR, Stergachis AS. Current cigarette smoking and risk of acute pelvic inflammatory disease. Am J Public Health. 1992 Oct;82(10):1352-5.[Abstract][Full Text]
16. Marchbanks PA, Lee NC, Peterson HB. Cigarette smoking as a risk factor for pelvic inflammatory disease. Am J Obstet Gynecol. 1990 Mar;162(3):639-44.[Abstract]
17. Simms I, Stephenson JM. Pelvic inflammatory disease epidemiology: what do we know and what do we need to know? Sex Transm Infect. 2000 Apr;76(2):80-7.[Abstract][Full Text]
18. Simms I, Stephenson JM, Mallinson H, et al. Risk factors associated with pelvic inflammatory disease. Sex Transm Infect. 2006 Dec;82(6):452-7.[Abstract][Full Text]
19. Henderson JT, Senger CA, Henninger M, et al. Behavioral counseling interventions to prevent sexually transmitted infections: updated evidence report and systematic review for the US preventive services task force. JAMA. 2020 Aug 18;324(7):682-99.[Abstract][Full Text]
20. Public Health England. Health matters: preventing STIs. Aug 2019 [internet publication].[Full Text]
21. US Preventive Services Task Force. Screening for chlamydia and gonorrhea: US Preventive Services Task Force recommendation statement. JAMA. 2021 Sep 14;326(10):949-56.[Abstract][Full Text]
22. British Association for Sexual Health and HIV (BASHH). UK national guideline for the management of pelvic inflammatory disease. Jan 2019 [internet publication].[Full Text]
23. Evans D, Goldstein S, Loewy A, et al. SOGC Committee Opinion no. 385 - indications for pelvic examination. J Obstet Gynaecol Can. 2019 Aug;41(8):1221-34.[Abstract]
24. Peipert JF, Ness RB, Blume J, et al. Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease. Am J Obstet Gynecol. 2001 Apr;184(5):856-63; discussion 863-4.[Abstract]
25. Pinto-Sander N, Soni S. Mycoplasma genitalium infection. BMJ. 2019 Oct 18;367:l5820.[Abstract]
26. Jensen JS, Cusini M, Gomberg M, et al. 2021 European guideline on the management of Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 2022 May;36(5):641-50.[Abstract][Full Text]
27. Horrow MM. Ultrasound of pelvic inflammatory disease. Ultrasound Q. 2004 Dec;20(4):171-9.[Abstract]
28. Vandermeer FQ, Wong-You-Cheong JJ. Imaging of acute pelvic pain. Clin Obstet Gynecol. 2009 Mar;52(1):2-20.[Abstract]
29. Yudin MH, Hillier SL, Wiesenfeld HC, et al. Vaginal polymorphonuclear leukocytes and bacterial vaginosis as markers for histologic endometritis among women without symptoms of pelvic inflammatory disease. Am J Obstet Gynecol. 2003 Feb;188(2):318-23.[Abstract]
30. Ross J, Guaschino S, Cusini M, et al. 2017 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS. 2018 Feb;29(2):108-14.[Abstract][Full Text]
31. Molander P, Sjoberg J, Paavonen J, et al. Transvaginal power Doppler findings in laparoscopically proven acute pelvic inflammatory disease. Ultrasound Obstet Gynecol. 2001 Mar;17(3):233-8.[Abstract]
32. American College of Radiology. ACR appropriateness criteria: acute pelvic pain in the reproductive age group. 2023 [internet publication].[Full Text]
33. Balthazar EJ, Birnbaum BA, Yee J, et al. Acute appendicitis: CT and US correlation in 100 patients. Radiology. 1994 Jan;190(1):31-5.[Abstract]
34. Low N, Bender N, Nartey L, et al. Effectiveness of chlamydia screening: systematic review. Int J Epidemiol. 2009 Apr;38(2):435-48.[Abstract][Full Text]
35. Nelson HD, Helfand M. Screening for chlamydial infection. Am J Prev Med. 2001;20:95-107.[Abstract]
36. Roberts TE, Robinson S, Barton PM, et al. Cost effectiveness of home based population screening for Chlamydia trachomatis in the UK: economic evaluation of chlamydia screening studies (ClaSS) project. BMJ. 2007 Aug 11;335(7614):291.[Abstract][Full Text]
37. Taylor BD, Haggerty CL. Management of Chlamydia trachomatis genital tract infection: screening and treatment challenges. Infect Drug Resist. 2011 Jan;2011(4):19-29.[Abstract][Full Text]
38. Oakeshott P, Kerry S, Aghaizu A, et al. Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ. 2010 Apr 8;340:c1642.[Abstract][Full Text]
39. Price MJ, Ades AE, De Angelis D, et al. Risk of pelvic inflammatory disease following Chlamydia trachomatis infection: analysis of prospective studies with a multistate model. Am J Epidemiol. 2013 Aug 1;178(3):484-92.[Abstract][Full Text]
40. American College of Radiology. ACR-SPR practice parameter for the performance of computed tomography (CT) of the abdomen and computed tomography (CT) of the pelvis. 2021 [internet publication].[Full Text]
41. Australian Sexual Health Alliance. PID - Pelvic inflammatory disease. Jan 2018 [internet publication].[Full Text]
42. Savaris RF, Fuhrich DG, Maissiat J, et al. Antibiotic therapy for pelvic inflammatory disease. Cochrane Database Syst Rev. 2020 Aug 20;(8):CD010285.[Abstract][Full Text]
43. Boukes FS, Dekker JH, Wiersma TJ, et al. Nederlands Huisartsen Genootschap. Summary of the practice guideline 'Pelvic inflammatory disease' (first revision) from the Dutch College of General Practitioners [in Dutch]. Ned Tijdschr Geneeskd. 2007 Mar 31;151(13):753-6.[Abstract]
44. Rusu A, Munteanu AC, Arbănași EM, et al. Overview of side-effects of antibacterial fluoroquinolones: new drugs versus old drugs, a step forward in the safety profile? Pharmaceutics. 2023 Mar 1;15(3).[Abstract][Full Text]
45. Royal College of General Practitioners/British Association for Sexual Health and HIV. Sexually transmitted infections in primary care 2013 (RCGP/BASHH). 2013 [internet publication].[Full Text]
46. American College of Obstetricians and Gynecologists. Expedited partner therapy. Jun 2018 [internet publication].[Full Text]
47. Ross J. Pelvic inflammatory disease. Clin Evid. 2006 Jun;(15):2176-82.[Abstract]
48. Terao M, Koga K, Fujimoto A, et al. Factors that predict poor clinical course among patients hospitalized with pelvic inflammatory disease. J Obstet Gynaecol Res. 2014 Feb;40(2):495-500.[Abstract]
49. Chappell CA, Wiesenfeld HC. Pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and tuboovarian abscess. Clin Obstet Gynecol. 2012 Dec;55(4):893-903.[Abstract]
50. Farhi J, Ben-Haroush A. Distribution of causes of infertility in patients attending primary fertility clinics in Israel. Isr Med Assoc J. 2011 Jan;13(1):51-4.[Abstract][Full Text]
