What are the symptoms of Pelvic Inflammatory Disease (PID)?

From the Guidelines

Pelvic Inflammatory Disease (PID) symptoms include lower abdominal pain, abnormal vaginal discharge, fever, painful urination, painful intercourse, irregular menstrual bleeding, and pain in the upper right abdomen, and prompt medical attention is necessary to prevent serious complications such as infertility, chronic pelvic pain, and increased risk of ectopic pregnancy. The pain typically starts during or after menstruation and may range from mild to severe. Many women experience abnormal vaginal discharge with an unpleasant odor. Fever, often above 101°F (38.3°C), can indicate infection. Urination may become painful due to inflammation of nearby structures. Sexual intercourse can be painful when the reproductive organs are inflamed. Menstrual periods might become irregular or heavier than usual. In severe cases, inflammation can spread to the liver capsule, causing pain in the upper right abdomen (Fitz-Hugh-Curtis syndrome) 1.

Some key points to consider in the management of PID include:

• The decision to hospitalize a patient with PID should be based on the discretion of the healthcare provider, taking into account factors such as the severity of symptoms, the presence of surgical emergencies, and the patient's ability to follow or tolerate an outpatient oral regimen 1.
• Patients with tubo-ovarian abscess that does not respond to antibiotics should undergo surgical drainage 1.
• The global epidemiologic profile of pelvic inflammatory disease has not been well defined, and prevention programs that are based on screening are simply unavailable in most countries, where the burden of pelvic inflammatory disease may be the greatest 1.

It's also important to note that some women with PID may have mild or no symptoms, which can delay diagnosis and treatment. The symptoms result from infection spreading from the vagina or cervix to the upper reproductive organs, causing inflammation of the uterus, fallopian tubes, and surrounding tissues. The sexually transmitted Neisseria gonorrhoeae and Chlamydia trachomatis are present in many cases; however, microorganisms including the endogenous vaginal and cervical flora may also cause PID 1.

In terms of prevention, the best strategies for preventing PID are: a) prevention of lower-genital-tract infection with Chlamydia trachomatis and Neisseria gonorrhoeae among both men and women, b) when this fails, early detection of lower-tract infection followed by prompt and effective treatment 1.

Overall, prompt medical attention and appropriate treatment are essential to prevent serious complications and improve outcomes for women with PID.

From the Research

PID Symptoms

• The symptoms of Pelvic Inflammatory Disease (PID) can vary widely, with some women being asymptomatic 2
• Common symptoms include lower abdominal or pelvic pain, cervical motion, uterine, or adnexal tenderness on examination 3
• The type and severity of symptoms can vary by microbiologic etiology, with women who have chlamydial PID more likely to be asymptomatic than those with gonococcal PID 2
• PID can also present with chronic pelvic pain, infertility, ectopic pregnancy, and intra-abdominal infections if left untreated 3, 2, 4, 5

Diagnosis and Treatment

• The diagnosis of PID is made primarily on clinical suspicion, and empiric treatment is recommended in sexually active young women or women at risk for sexually transmitted infections who have unexplained lower abdominal or pelvic pain and cervical motion, uterine, or adnexal tenderness on examination 3
• Treatment for PID typically involves broad-spectrum antibiotics with coverage against gonorrhea, chlamydia, and common anaerobic and aerobic bacteria 4, 5
• Mild to moderate disease can be treated in an outpatient setting with a single intramuscular injection of a recommended cephalosporin followed by oral doxycycline for 14 days, while hospitalization for parenteral antibiotics is recommended in patients who are pregnant or severely ill 3

Etiology

• PID is a polymicrobial infection, with a wide range of potential causal pathogens, including Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and other lower genital tract endogenous anaerobic and facultative bacteria 2, 4, 6
• The etiology of PID can vary, with some cases associated with bacterial vaginosis (BV)-associated species and genera, and others associated with genera and species usually associated with the gastrointestinal or respiratory tracts 6