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
|How far to trace back|
|Usual testing method and treatment||
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.
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.
|Common signs and symptoms||
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
|Likelihood of transmission per act of condomless intercourse||Depends on specific pathogen|
|Likelihood of long-term sexual partner being infected||Depends on specific pathogen|
|Protective effect of condoms||High for sexually transmitted pathogens|
|Transmission by oral sex||
|Duration of potential infectivity||
Depends on specific pathogen
Infertility due to scarring /blockage of fallopian tubes
Chronic pelvic pain
Fitz-Hugh Curtis Syndrome
|Direct benefit of detection and treatment of contacts||
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.
|Usual management of contacts|
|Contact tracing priority||
High — Where C. trachomatis, N. gonorrhoeae or M. genitalium are isolated
Contact your local specialist service if no pathogen is identified
Australasian Sexual Health Alliance. Australasian STI Management Guidelines for Use in Primary Care: ASHA; 2018 [Available from: http://www.sti.guidelines.org.au/
Bateson D, Edmiston N. Pelvic inflammatory disease: Management of new onset low abdominal pain in young women. MedicineToday. 2016;17 (7):14-22.
NSW STI Programs Unit. Acute abdominal pain in women. NSW Health. 2017. Available online at: https://stipu.nsw.gov.au/gp/hiv-and-sti-clinical-management/acute-abdominal-pain-in-women/
Page last updated May 2021