Pelvic inflammatory disease

Pelvic inflammatory disease, usually due to gonorrhea and chlamydia in younger women, ascends from the cervix to the endometrium and, sometimes, fallopian tubes. Empiric treatment should be given to sexually-active young women who have lower abdominal pain and tenderness of the cervix and adnexa.

CASES/YEAR
1,000,000 (US); 20,000,000 (Global)
AGENT TYPE
Bacteria
OTHER NAMES
PID; Salpingitis; Tubo-ovarian abscess; Fitz-Hugh-Curtis syndrome;
ACUITY
Acute-Moderate
INCUBATION
Estimated: 1 day to many weeks or months;
INITIAL SYMPTOMS
Fever, lower abdominal pain, abnormal vaginal discharge, dyspareunia, abnormal uterine bleeding, pain at the time of menses; [ABX Guide] Vomiting if pain is severe; [Merck Manual, p. 2316]
PRECAUTIONS
COMMENTS
FINDINGS:
PID is an infection that ascends from the cervix to the endometrium and, sometimes, fallopian tubes. Empiric treatment should be given to sexually-active young women who have lower abdominal pain and tenderness of the cervix and adnexa. Usually due to sexually-transmitted infections (gonorrhea, chlamydia) in younger women;. [ABX Guide] The main value of laparoscopy is in ruling out other causes of lower abdominal pain in young women. It should be considered in patients with unilateral pain because other surgical problems (appendicitis, ectopic pregnancy, corpus luteum bleeding, and ovarian tumor) are unilateral. [Harrison ID, p. 327]

COMPLICATIONS:
Complications include infertility, chronic pelvic pain, and ectopic pregnancy. Abscesses may rupture and cause septic shock. [Merck Manual, p. 2316] 10-30% of women with PID develop Fitz-Hugh-Curtis syndrome or perihepatitis secondary to inflammation of the liver capsule. Findings include RUQ abdominal pain, radiation to right shoulder, pleuritic pain, fever, and night sweats. [ABX Guide] Gonococcal or chlamydial perihepatitis (Fitz-Hugh-Curtis syndrome) are indistinguishable clinically. Findings of this complication of PID include right upper quadrant pain and low grade fever. [PPID, p. 1014] Tubo-ovarian abscess is a complication in about 7% to 16% of patients with PID. [5MCC-2020]
DIAGNOSTIC
Mucopurulent cervicitis & pelvic organ tenderness; Endocervical swab for nucleic acid amplification tests for N. gonorrhoeae & C. trachomatis; Pregnancy test; Ultrasonography used to rule out tubo-ovarian abscess; [Merck Manual, p. 2315-6]
SCOPE
Global
SIGNS & SYMPTOMS
  • >fever
  • G abdominal mass
  • G abdominal pain
  • G nausea, vomiting
  • H leukocytosis
  • R chest pain
  • *sepsis
  • *shock
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Sexual Contact
RESERVOIR
Human
RISK FACTORS
REFERENCES FOR CASES/YEAR
1. (US) CDC estimates > 1 million women have at least 1 episode every year; [Medscape: Pelvic Inflammatory Disease]
2. (Global) 20 X US cases/yr;