Symptoms of Pelvic Inflammatory Disease (PID)
PID often presents with a spectrum of symptoms ranging from subtle or mild to severe, including lower abdominal pain (typically bilateral), adnexal tenderness, and cervical motion tenderness, though many cases are asymptomatic or have nonspecific presentations that go unrecognized. 1
Common Symptoms of PID
Primary Clinical Manifestations:
- Lower abdominal pain - typically bilateral, sometimes radiating to the legs 2
- Adnexal tenderness on examination 3
- Cervical motion tenderness 3
Additional Symptoms:
- Abnormal vaginal or cervical discharge (often purulent) 1, 2
- Fever (temperature >38.3°C/101°F) 3, 1
- Dyspareunia (painful intercourse), particularly deep dyspareunia 2, 4
- Abnormal vaginal bleeding (postcoital, intermenstrual, or breakthrough bleeding) 2, 4
- Dysuria 2
- Urinary frequency 5
- Metrorrhagia (irregular uterine bleeding) 5
Diagnostic Challenges
Many cases of PID go unrecognized because:
- Some cases are completely asymptomatic 3
- Patients or healthcare providers fail to recognize mild or nonspecific symptoms 3, 1
- The clinical diagnosis is imprecise (positive predictive value of 65-90% compared to laparoscopy) 1
- No single finding is both sensitive and specific for diagnosis 1
Clinical Pearls
- The CDC recommends maintaining a low threshold for diagnosis due to potential reproductive health damage, even in mild or atypical cases 1
- Most women with PID have either mucopurulent cervical discharge or evidence of white blood cells on microscopic evaluation of vaginal fluid 3
- Requiring all three minimum criteria (lower abdominal pain, adnexal tenderness, and cervical motion tenderness) may reduce diagnostic sensitivity, particularly in high-risk patients 1
- PID should be considered in sexually active young women with unexplained lower abdominal or pelvic pain 6
Common Diagnostic Pitfalls
- Relying on a single clinical finding 1
- Waiting for fever or elevated inflammatory markers before diagnosis 1
- Failing to consider PID in women with subtle symptoms 1
- Overlooking the diagnosis in adolescents 1
- Missing atypical presentations (abnormal bleeding, dyspareunia, vaginal discharge) 3
Risk Factors to Consider
- Young, sexually active women 4
- Multiple sexual partners 4
- Intrauterine contraceptive device use 4
- History of sexually transmitted infections 4
Remember that untreated PID can lead to serious long-term sequelae including chronic pelvic pain, tubal factor infertility, ectopic pregnancy, and tubo-ovarian abscess 1, 2. Early recognition of symptoms and prompt treatment are essential to prevent these complications.