Obstetrics and Gynecology · MU Sofia

49. Pelvic inflammatory disease

Covers pelvic inflammatory disease as an ascending upper genital tract infection, starting with its causes and risk factors, then the clinical picture including Fitz-Hugh–Curtis syndrome. It goes on to investigations and a differential diagnosis, a treatment table with outpatient and inpatient regimens and admission criteria, and a table of long-term complications such as tubal infertility and chronic pelvic pain.

Inside: 6 sections · 2 tables · 16 flashcards · 2 min

Topic 49 of 61 in the MU Sofia syllabus for Obstetrics and Gynecology (Medicine, Year 5). The free AceMed note covers it in 6 sections, about 257 words (2 min of reading), with 16 flashcards.

In this note

  1. Introduction
  2. Causes
  3. Clinical picture
  4. Investigations
  5. Treatment
  6. Long-term sequelae

Introduction

Pelvic inflammatory disease (PID) is infection of the upper genital tract: endometritis, salpingitis, tubo-ovarian abscess and pelvic peritonitis. It is usually an ascending infection from the cervix in sexually active young women.

Causes

  • Chlamydia trachomatis and Neisseria gonorrhoeae; Mycoplasma genitalium; polymicrobial anaerobes and bacteria from the vaginal flora.
  • Risk factors: age < 25, new or multiple partners, previous PID or STI, no barrier contraception, procedures through the cervix (IUD insertion in the first weeks, abortion, HSG).

Clinical picture

  • Lower abdominal pain (usually bilateral), deep dyspareunia, abnormal discharge, abnormal bleeding, fever.
  • Signs: cervical motion tenderness, adnexal tenderness, uterine tenderness; a mass in tubo-ovarian abscess.
  • Fitz-Hugh–Curtis syndrome: perihepatitis with right upper quadrant pain ("violin-string" adhesions).

The diagnosis is clinical: treat when a sexually active woman has pelvic tenderness with no other cause. The threshold is low because untreated PID damages the tubes.

Investigations

  • Pregnancy test (exclude ectopic), NAAT swabs for chlamydia and gonorrhoea, HIV and syphilis tests.
  • FBC, CRP; ultrasound for abscess; laparoscopy if the diagnosis is uncertain.
  • Differential diagnosis: ectopic pregnancy, appendicitis, ovarian torsion or cyst rupture, endometriosis, UTI.

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