Pelvic inflammatory disease is an infection of the upper genital tract, including the uterus, fallopian tubes and ovaries, most often started by sexually transmitted bacteria such as chlamydia and gonorrhea. Prompt treatment matters because scarring can lead to infertility, ectopic pregnancy and chronic pelvic pain.
Key symptoms
- Lower abdominal or pelvic pain, often on both sides
- Abnormal vaginal discharge
- Pain during sex or bleeding after sex
- Fever, chills or bleeding between periods
- Burning with urination
What you find on exam
- Cervical motion tenderness
- Uterine or adnexal tenderness on bimanual exam
- Mucopurulent discharge from the cervix
- Fever; right upper quadrant pain suggests perihepatitis (Fitz-Hugh-Curtis)
Tests
- Pregnancy test to rule out ectopic pregnancy
- Nucleic acid amplification tests (NAAT) for chlamydia and gonorrhea
- Wet mount, HIV and syphilis testing
- Pelvic ultrasound if a tubo-ovarian abscess is suspected
Treatment basics
- Start antibiotics on the clinical diagnosis; do not wait for results
- Outpatient: one dose of IM ceftriaxone plus doxycycline and metronidazole for 14 days
- Admit if pregnant, severely ill, with an abscess or if oral therapy fails
- Treat sex partners and advise no sex until treatment is complete
- Recheck in 72 hours and retest for infection in 3 months
Red flags
- High fever, vomiting or inability to take oral medicine
- Tubo-ovarian abscess or signs of peritonitis or sepsis
- Positive pregnancy test with pelvic pain
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.