Pelvic Inflammatory Disease — an Evidence-based Approach to Diagnosis

Abstract

Pelvic inflammatory disease (PID) is inflammation of the upper female genital tract and related structures. It may arise from blood borne infection, such as tuberculosis, or from spread from an area of intra-abdominal sepsis, but in practice these are rare sources and most cases result from ascending infection from the lower genital tract. PID may arise de novo or may be secondary to a breach of the cervical mucous barrier, in particular by surgical instrumentation and the events of pregnancy. There is a wide range of pathology from mild endometritis to generalized peritonitis. PID is important economically and socially because of its sequelae, tubal infertility, ectopic pregnancy and chronic pelvic pain.1 It is thus a major cause of short-term and long-term morbidity and the cost of assisted reproduction techniques to overcome tubal infertility is high. Infertile women and those with chronic pelvic pain may suffer considerable psychological distress. In addition, ectopic pregnancy still results in a number of maternal deaths every year. Traditionally, the diagnosis of PID has been based on the finding of bilateral tenderness of the uterine appendages in women complaining of lower abdominal or pelvic pain. Associated symptoms include deep dyspareunia, menstrual disturbances, vaginal discharge, urinary and bowel symptoms and features suggestive of a systemic illness, such as fevers and malaise. Associated physical signs include abdominal tenderness, pain on moving the cervix (excitation pain) and the presence of palpable adnexal masses. There may be objective signs of fever and tachycardia.