polymicrobial infection of the upper genital tract which is normally sterile.
PID is typically preceded by cervicitis due to Neisseria gonorrhoeae or Chlamydia trachomatis can be asymptomatic or subtle (eg, irregular intermenstrual bleeding). Untreated cervicitis allows polymicrobial vaginal flora to ascend into the upper reproductive tract (eg, uterus, fallopian tubes)
PID is characterized by inflammation of the upper genital tract and pelvis and presents with fever, abdominopelvic pain, and mucopurulent vaginal discharge, as well as cervical motion and uterine tenderness on examination. Ascending Chlamydia trachomatis or Neisseria gonorrhoeae infections are common pathogens involved in the development of PID.
| Symptoms | • Lower abdominal pain • Abnormal bleeding | | --- | --- | | Risk factors | • Multiple sexual partners • Age 15-25 • Previous pelvic inflammatory disease • Inconsistent barrier contraception use • Partner with sexually transmitted infection | | Physical examination | • Fever >38.3 C (>100.9 F) • Cervical motion, uterine, or adnexal tenderness • Mucopurulent cervical discharge | | Diagnosis | • Clinical | | Treatment | • Inpatient: IV broad-spectrum antibiotics • Outpatient: PO broad-spectrum antibiotics | | Complications | • Tuboovarian abscess • Infertility • Ectopic pregnancy • Perihepatitis |
intermenstrual spotting and lower abdominal pain
initially have intermittent pain; however, as infection and inflammation spread throughout the peritoneal cavity, constant pelvic pain (eg, uterine, bilateral adnexal tenderness) develops.
Patients diagnosed with PID should be tested for other common sexually transmitted infections as well, such as HIV and syphilis.
Uncommon during the third trimester of pregnancy, as thickened cervical mucus provides protection to the uterus from lower pelvic pathogens is more likely in nonpregnant or first-trimester patients.
Untreated C trachomatis infection can result in ascending infection of the upper genital tract (eg, pelvic inflammatory disease, tubo-ovarian abscess), resulting in inflammation and adhesion formation. Scarring of the Fallopian tubes can lead to long-term consequences (eg, infertility, ectopic pregnancy).