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Infectious disorders

Pelvic inflammatory disease (PID)

Reviewer: Mohiedean Ghofrani, M.D., Southwest Washington Medical Center (see Reviewers page)
Revised: 9 August 2011, last major update August 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.


● Polymicrobial infection in women characterized by inflammation of the upper genital tract, including endometritis, salpingitis, pelvic peritonitis and occasionally leading to tubo-ovarian abscess


● Primarily affects young, sexually active and reproductive-aged women
● Inversely proportional to age with the highest rates in the 15 to 19 year old group
● Incidence steadily increased in 1970s due to rising rates of STDs and peaked in early 1980s
● Although current incidence is lower, estimates of prevalence are not exact and likely underrepresent the true prevalence of disease due to subclinical PID, increasing rates of outpatient diagnosis and inaccuracies in diagnosis


● Usually begins in endometrium and is associated with tubal involvement and tubo-ovarian abscess or cyst


● Most commonly due to gonorrhea, chlamydia, enteric bacteria or puerperal infections (from end of third stage of labor until uterus completely involutes at 3-6 weeks)
● Acute, symptomatic forms, previously primarily due to Neisseria gonorrhoeae, have been replaced by mild to moderate cases due to Chlamydia trachomatis or mycoplasmas
● Usually polymicrobial

Clinical features

● No single, subjective complaint, physical examination finding or laboratory finding is highly sensitive or specific for the diagnosis
● Pelvic pain, adnexal tenderness, fever and vaginal discharge are common
● Classified as acute, subacute or subclinical


● Peripheral white blood cell count is non-specific and elevated in only 44% of cases
● Elevations in C-reactive protein or erythrocyte sedimentation rate show good sensitivity and specificity
● A vaginal wet smear with 3+ white blood cells per high-power field has a high sensitivity for upper genital tract infection, and the absence of WBCs has a high negative predictive value
● Transvaginal ultrasound may demonstrate a swollen, tortuous fallopian tube
● Laparoscopic evaluation of the pelvic organs is considered the gold standard for diagnosing PID

Prognostic factors

● Short and long-term sequelae include tubal factor infertility, ectopic pregnancy, chronic pelvic pain, peritonitis, bacteremia or intestinal obstruction due to adhesions


● Outpatient treatments, mostly by the oral route, have replaced inpatient, intravenous treatments for uncomplicated PID (Curr Opin Infect Dis 2010;23:83)

Gross images



Additional references

eMedicine, Wikipedia, Infect Dis Clin North Am 2008;22:693

End of Ovary-nontumor > Infectious disorders > Pelvic inflammatory disease (PID)

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