Pelvic Inflammatory Disease (PID)

Presentation

A sexually active female, possibly with a new sex partner or multiple sex partners, presents with lower abdominal pain beginning with or soon after her last menstrual period. There may be associated vaginal discharge, malodor, dysuria, dyspareunia, menorrhagia, or intermenstrual bleeding. In patients with more severe infections, systemic symptoms such as fever, chills, malaise, nausea, and vomiting may also be present.

Women with severe pelvic pain tend to ambulate in a slightly bent-over position, holding their lower abdomen and shuffling their feet. Abdominal examination reveals lower quadrant tenderness, sometimes with rebound, and occasionally right upper quadrant tenderness resulting from perihepatitis (Fitz-Hugh–Curtis syndrome). Pelvic examination typically demonstrates bilateral adnexal tenderness as well as uterine fundal and cervical motion tenderness.

Many women with pelvic inflammatory disease (PID) exhibit subtle or mild symptoms with absence of fever and leukocytosis as well as minimal cervical motion tenderness and adnexal tenderness. Asymptomatic infections or atypical presentations may occur.