PELVIC INFLAMMATORY DISEASE (PID)

Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium

Polymicrobial. Vaginal bacteria also implicated

Presence of an STI supports the diagnosis but up to two-thirds of cases do not have a causative organism identified.

Note: PID occurs almost exclusively in people who are sexually active whether or not a pathogen is identified. 

Rarely PID can be associated with a gynecological procedure such as an intra-uterine device (IUD) insertion, although in most cases post-procedural PID is also related to the presence of an STI.  

Poorly defined; depends on pathogen

 See relevant sections if chlamydia, gonorrhoea or Mycoplasma genitalium are isolated

PID is a clinical diagnosis. Acute PID is difficult to diagnose because of its non-specific symptoms and its diagnosis can be missed. A PID diagnosis should be considered in all sexually active people assigned female at birth presenting with recent onset pelvic pain.

Investigations include

• Pregnancy test to exclude ectopic pregnancy
• Chlamydia, gonorrhoea, M. genitalium swabs (clinician or self-collected if examination declined)
• Speculum and /or bimanual examination to visualise the cervix and assess for cervical motion, uterine or adnexal tenderness.

PID treatment should be initiated promptly without waiting for STI test results if any of cervical motion, uterine or adnexal tenderness are present on bimanual examination and following exclusion of important differential diagnoses (e.g. ectopic pregnancy). Recommended treatment covers potential infection with chlamydia, gonorrhoea and polymicrobial vaginal flora.

The symptoms and signs of PID vary widely in their presentation and severity. Mild or moderately severe PID can be managed in primary care while severe PID may require inpatient management.

The key symptom is recent onset pelvic pain in sexually active people assigned female at birth, particularly those aged 15-30 years

Pelvic pain may be similar to period pain, initially bilateral then localizing to the right or left iliac fossa

Other symptoms can include intermenstrual or post-coital bleeding and/or vaginal discharge, deep dyspareunia

Fever, nausea, vomiting or may indicate severe infection

Low

Depends on specific pathogen

Infertility due to scarring /blockage of fallopian tubes

Chronic pelvic pain

Ectopic pregnancy

Fitz-Hugh Curtis Syndrome

Cure where a pathogen is isolated

Stopping ongoing STI transmission where a pathogen is isolated.

Reducing the risk of reinfection with an STI in the index case where a pathogen is isolated.

Current sexual partners should be treated to cover chlamydia, (and gonorrhoea if likely) immediately irrespective of test results.

Contact trace past sexual partners if chlamydia, gonorrhoea or M. genitalium is diagnosed

High — Where C. trachomatis, N. gonorrhoeae or M. genitalium are isolated

Contact your local specialist service if no pathogen is identified