Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection and inflammatory disorder of the upper genital tract involving the endometrium, fallopian tubes, pelvic peritoneum or contiguous structures. Microbes usually ascend from the vagina and cervix. PID is commonly polymicrobial: Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, anaerobes and other vaginal flora may be involved, and a specific pathogen is often not identified. Inflammation can injure the fallopian tubes and heal with scarring or adhesions. This explains the later risks of tubal-factor infertility, ectopic pregnancy, chronic pelvic pain and recurrent PID. The likelihood of long-term sequelae rises with repeated episodes, and delayed treatment can permit further upper-tract injury. PID may be mild, nonspecific or clinically silent. A patient does not need a high fever, dramatic discharge or an abnormal ultrasound before empiric treatment is considered. The practical mental model is therefore to recognize a compatible pain-and-tenderness syndrome, test for likely pathogens and pregnancy, exclude emergencies in parallel, and begin broad-spectrum therapy promptly when the clinical threshold is met.