Reproductive and Sexual Health Handbook

Pelvic inflammatory disease (PID) is a clinical syndrome of ascending infection and inflammation from the vagina or endocervix, and may involve the endometrium, fallopian tubes, ovaries and/or peritoneum. Patients with acute disease typically present with a short history of new onset pelvic pain and dyspareunia. Untreated PID is associated with subfertility, ectopic pregnancy and chronic pelvic pain.^{(1, 2)}

In up to 70 per cent of cases, a causative pathogen is never isolated.^{(1, 3)} When a pathogen is identified, the sexually transmitted pathogens Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium may be implicated. PID is thought to be polymicrobial in aetiology,⁽¹⁾ with anaerobes and other vaginal flora also implicated in the development of disease.⁽²⁾

Negative swabs do not exclude a diagnosis of PID.

Australian STI Management Guidelines for use in primary care – provides a detailed discussion of the management of PID

NSW STI Program Unit

Common causes of low abdominal (pelvic) pain in women of reproductive age – a useful algorithm for primary care Australian STI Management Guidelines for use in Primary Care [internet]. Australasian Sexual Health Alliance. PID – Pelvic Inflammatory Disease; [updated 2018 July 11; 2019 March 1]. Available from: http://www.sti.guidelines.org.au/syndromes/pid-pelvic-inflammatory-disease. Ross J, Cole M, Evans C, Lyons D, Dean G, Cousins D, et al. United Kingdom National Guideline for the Management of Pelvic Inflammatory disease (2019 Interim Update). [Internet]. British Association for Sexual Health and HIV (BASHH); 2019. Available from: https://www.bashhguidelines.org/media/1217/pid-update-2019.pdf. Goller J, De Livera AM, Fairley CK, Guy RJ, Bradshaw CS, Chen MY, et al. Characteristics of pelvic inflammatory disease where no sexually transmitted infection is identified: a cross-sectional analysis of routinely collected sexual health clinic data. Sexually Transmitted Infections 2017;93(1):68 – 70. Sexually transmitted disease treatment guidelines 2015 [internet].US Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). [updated 2015 June 4]. Available from: https://www.cdc.gov/std/tg2015/default.htm. Reekie J, Donovan B, Guy R, Hocking JS, Kaldor JM, Mak DB, et al Risk of Pelvic Inflammatory Disease in Relation to Chlamydia and Gonorrhea Testing, Repeat Testing, and Positivity: A Population-Based Cohort Study. Clinical Infectious Diseases. 2018 66(3):437-43. Short V, Totten PA, Ness RB, Astete SG, Kelsey SF, Haggerty CL. Clinical Presentation of Mycoplasma genitalium Infection versus Neisseria gonorrhoeae Infection among Women