Pelvic inflammatory disease (PID)

Causes and pathogenesis

PID is most often caused by bacteria that ascend from the lower genital tract. Sexually transmitted organisms such as Chlamydia trachomatis and Neisseria gonorrhoeae are common contributors, but other mixed bacterial infections can produce similar disease. Procedures that introduce bacteria into the uterus or retained products of conception may also precipitate PID. The infection damages delicate tissues in the reproductive tract through inflammation and scarring.

Signs and diagnosis

Common symptoms include lower abdominal pain, unusual vaginal discharge, fever, painful urination, pain during intercourse, and abnormal uterine bleeding. Many of these are nonspecific, and some affected persons have minimal complaints. Typical signs and tests used to support the diagnosis include a pelvic examination, cervical swabs, blood tests, and imaging such as ultrasound; laparoscopy is sometimes used when the diagnosis is uncertain or when an abscess is suspected.

• Vaginal discharge often accompanies PID.
• Fever may indicate a more intense infection.
• Burning on urination can occur when inflammation involves nearby structures.

Treatment and prevention

Treatment typically consists of prompt, broad-spectrum antibiotics to cover likely organisms. Many cases are managed with outpatient antibiotic regimens; severe illness, failure to improve, or a tubo-ovarian abscess may require hospital care, intravenous antibiotics, or surgery. Sexual partners should be evaluated and treated when appropriate to prevent reinfection. Preventive measures include safer-sex practices, condom use, and routine screening for sexually transmitted infections in at-risk populations.

Complications and significance

If untreated or recurrent, PID can cause scarring of the fallopian tubes leading to infertility, increased risk of ectopic pregnancy, chronic pelvic pain, and formation of abscesses. Early recognition and treatment substantially reduce the risk of long-term damage. Public-health efforts aimed at STI screening and education have reduced, but not eliminated, the burden of PID.

Notable points

Because symptoms overlap with other conditions, PID is a clinical diagnosis often guided by laboratory and imaging tests. Anyone with new pelvic pain, abnormal discharge, fever, or bleeding should seek medical evaluation to allow timely treatment and limit complications.