Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection of the upper female genital tract: the endometrium, fallopian tubes, pelvic peritoneum, and sometimes contiguous pelvic structures. Organisms usually ascend from the vagina and cervix. The infection is commonly polymicrobial, involving Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobic and other vaginal flora, and occasionally Mycoplasma genitalium. The clinical damage comes from inflammation as much as from the organisms themselves. Tubal inflammation can heal with scarring, narrowing or adhesions, which explains the later risks of tubal-factor infertility, ectopic pregnancy, chronic pelvic pain and recurrent PID. Repeated episodes and delayed treatment increase those risks. That is why treatment is deliberately empiric at a low threshold: waiting for a positive swab or definitive imaging can allow preventable tubal injury. PID may be mild. The patient does not need to have a high fever, dramatic discharge or an abnormal ultrasound before treatment is considered.