When to Escalate
What the Infection Does
Pelvic inflammatory disease is an ascending infection of the upper female genital tract.
Pelvic inflammatory disease is an ascending infection of the upper female genital tract. Organisms move from the vagina and cervix into the uterus, fallopian tubes, and adjacent pelvic tissues, producing endometritis, salpingitis, tubo-ovarian abscess, or pelvic peritonitis. Chlamydia trachomatis and Neisseria gonorrhoeae are classic causes, but PID is often polymicrobial. Anaerobes and bacterial-vaginosis-associated flora contribute substantially, and Mycoplasma genitalium is a recognized contributor. A negative test for one organism does not exclude the syndrome. Inflammation of the tubes can heal with fibrosis and adhesions. That damage explains the major long-term consequences: tubal-factor infertility, ectopic pregnancy, and chronic pelvic pain. Each additional episode and each delay in treatment increases the likelihood of permanent injury. Perihepatitis, known as Fitz-Hugh–Curtis syndrome, produces right-upper-quadrant pain that may worsen with breathing while the pelvic infection is present. PID is not always dramatic. Some patients have only mild lower abdominal pain, abnormal discharge, intermenstrual or postcoital bleeding, dyspareunia, or dysuria. The absence of high fever does not make the condition safe to ignore.