From the Guidelines
The diagnosis of Pelvic Inflammatory Disease (PID) should be considered in sexually active women with pelvic or lower abdominal pain, and the minimum diagnostic criteria include uterine/adnexal tenderness or cervical motion tenderness, as outlined in the 2002 CDC guidelines 1. The diagnostic criteria for PID can be divided into minimum and additional criteria. The minimum criteria include:
- Uterine/adnexal tenderness
- Cervical motion tenderness These criteria should be used to initiate empiric treatment in sexually active young women and other women at risk for STDs if no other cause(s) for the illness can be identified 1. Additional criteria that support a diagnosis of PID include:
- Oral temperature >101 F (>38.3 C)
- Abnormal cervical or vaginal mucopurulent discharge
- Presence of white blood cells (WBCs) on saline microscopy of vaginal secretions
- Elevated erythrocyte sedimentation rate
- Elevated C-reactive protein
- Laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis 1. It's essential to maintain a low threshold for diagnosis and treatment because delayed treatment can lead to serious complications, including infertility, ectopic pregnancy, and chronic pelvic pain 1. Many women with PID have subtle or mild symptoms, so clinicians should consider PID diagnosis in sexually active women with pelvic or lower abdominal pain when no other cause for the pain can be identified.
From the Research
Diagnostic Criteria for Pelvic Inflammatory Disease (PID)
The diagnostic criteria for PID include a combination of clinical features, laboratory findings, and imaging studies. The following are some of the key diagnostic criteria:
- Bilateral lower abdominal tenderness
- Abnormal vaginal or cervical discharge
- Fever (higher than 38 degrees C)
- Abnormal vaginal bleeding
- Dyspareunia
- Cervical motion tenderness and adnexal tenderness, with or without a palpable mass 2
- Presence of excess leucocytes, elevated erythrocyte sedimentation rate or C-reactive protein 2
- Transvaginal ultrasound scanning may be helpful, with a sensitivity of up to 85% 2
- Magnetic resonance imaging can be helpful in making a final diagnosis in 95% of cases 2
Clinical Features
The clinical features of PID can vary, but may include:
- Lower abdominal pain (typically bilateral, sometimes radiating to the legs) 3
- Abnormal vaginal or cervical discharge (often purulent) 3
- Dysuria 3
- Deep dyspareunia 3
- Abnormal vaginal bleeding (postcoital, intermenstrual and breakthrough) 3
Laboratory and Imaging Studies
Laboratory and imaging studies can help support the diagnosis of PID, including:
- Laboratory findings such as presence of excess leucocytes, elevated erythrocyte sedimentation rate or C-reactive protein 2
- Transvaginal ultrasound scanning 2
- Magnetic resonance imaging 2
- Endocervical cultures for Neisseria gonorrhoeae and Chlamydia trachomatis 4
CDC Diagnostic Criteria
The Centers for Disease Control and Prevention (CDC) diagnostic criteria for PID include:
- Uterine, adnexal, or cervical motion tenderness with no other obvious cause in women at risk of PID 5
- Empiric treatment should be initiated promptly and must cover Chlamydia trachomatis and Neisseria gonorrhoeae 5
Limitations of Diagnostic Criteria
The diagnostic criteria for PID may not always be straightforward, and some studies have shown that PID may be overdiagnosed in certain populations 6. Therefore, it is essential to carefully evaluate each patient's symptoms and laboratory findings to make an accurate diagnosis.