pelvic inflammatory disease

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Related to pelvic inflammatory disease: endometriosis, pelvic congestion syndrome, Pelvic pain

Pelvic Inflammatory Disease



Pelvic inflammatory disease (PID) is a term used to describe any infection in the lower female reproductive tract that spreads to the upper female reproductive tract. The lower female genital tract consists of the vagina and the cervix. The upper female genital tract consists of the body of the uterus, the fallopian or uterine tubes, and the ovaries.


PID is the most common and the most serious consequence of infection with sexually transmitted diseases (STD) in women. Over one million cases of PID are diagnosed annually in the United States, and it is the most common cause for hospitalization of reproductive-age women. Sexually active women aged 15-25 are at highest risk for developing PID. The disease can also occur, although less frequently, in women having monogamous sexual relationships. The most serious consequences of PID are increased risk of infertility and ectopic pregnancy.
To understand PID, it is helpful to understand the basics of inflammation. Inflammation is the body's response to disease-causing (pathogenic) microorganisms. The affected body part may swell due to accumulation of fluid in the tissue or may become reddened due to an excessive accumulation of blood. A discharge (pus) may be produced that consists of white blood cells and dead tissue. Following inflammation, scar tissue may form by the proliferation of scar-forming cells and is called fibrosis. Adhesions of fibrous tissue form and cause organs or parts of organs to stick together.
PID may be used synonymously with the following terms:
  • salpingitis (Inflammation of the fallopian tubes)
  • endometritis (Inflammation of the inside lining of the body of the uterus)
  • tubo-ovarian abscesses (Abscesses in the tubes and ovaries)
  • pelvic peritonitis (Inflammation inside of the abdominal cavity surrounding the female reproductive organs)

Causes and symptoms

A number of factors affect the risk of developing PID. They include:
  • Age. The incidence of PID is very high in younger women and decreases as a woman ages.
  • Race. The incidence of PID is 8-10 times higher in nonwhites than in whites.
  • Socioeconomic status. The higher incidence of PID in women of lower socioeconomic status is due in part to a woman's lack of education and awareness of health and disease and her accessibility to medical care.
  • Contraception. Induced abortion, use of an IUD, non-use of barrier contraceptives such as condoms, and frequent douching are all associated with a higher risk of developing PID.
  • Lifestyle. High risk behaviors, such as drug and alcohol abuse, early age of first intercourse, number of sexual partners, and smoking all are associated with a higher risk of developing PID.
  • Types of sexual practices. Intercourse during menses and frequent intercourse may offer more opportunities for the admission of pathogenic organisms to the inside of the uterus.
  • Disease. Sixty to 75% of cases of PID are associated with STDs. A prior episode of PID increases the chances of developing subsequent infections.
The two major causes of STDs are the organisms Neisseria gonorrhoeae and Chlamydia trachomatis. The main symptom of N. gonorrheae infection (gonorrhea) is a vaginal discharge of mucus and pus. Sometimes bacteria from the colon normally in the vaginal cavity may travel upward to infect the upper female genital organs, facilitated by the infection with gonorrhea. Infections with C. trachomatis and other nongonoccal organisms are more likely to have mild or no symptoms.
Normally, the cervix produces mucus which acts as a barrier to prevent disease-causing microorganisms, called pathogens, from entering the uterus and moving upward to the tubes and ovaries. This barrier may be breached in two ways. A sexually transmitted pathogen, usually a single organism, invades the lining cells, alters them, and gains entry. Another way for organisms to gain entry happens when trauma or alteration to the cervix occurs. Childbirth, spontaneous or induced abortion, or use of an intrauterine contraceptive device (IUD) are all conditions that may alter or weaken the normal lining cells, making them susceptible to infection, usually by several organisms. During menstruation, the cervix widens and may allow pathogens entry into the uterine cavity.
Recent evidence suggests that bacterial vaginosis (BV), a bacterial infection of the vagina, may be associated with PID. BV results from the alteration of the balance of normal organisms in the vagina, by douching, for example. While the balance is altered, conditions are formed that favor the overgrowth of anaerobic bacteria, which thrive in the absence of free oxygen. A copious discharge is usually present. Should some trauma occur in the presence of anaerobic bacteria, such as menses, abortion, intercourse, or childbirth, these organisms may gain entrance to the upper genital organs.
The most common symptom of PID is pelvic pain. However, many women with PID have symptoms so mild that they may be unaware that an infection exists.
In acute salpingitis, a common form of PID, swelling of the fallopian tubes may cause tenderness on physical examination. Fever may be present. Abscesses may develop in the tubes, ovaries, or in the surrounding pelvic cavity. Infectious discharge may leak into the peritoneal cavity and cause peritonitis, or abscesses may rupture causing a life-threatening surgical emergency.
Chronic salpingitis may follow an acute attack. Subsequent to inflammation, scarring and resulting adhesions may result in chronic pain and irregular menses. Due to blockage of the tubes by scar tissue, women with chronic salpingitis are at high risk of having an ectopic pregnancy. The fertilized ovum is unable to travel down the fallopian tube to the uterus and implants itself in the tube, on the ovary, or in the peritoneal cavity. This condition can also be a life-threatening surgical emergency.


IUD usage has been strongly associated with the development of PID. Bacteria may be introduced to the uterine cavity while the IUD is being inserted or may travel up the tail of the IUD from the cervix into the uterus. Uterine tissue in association with the IUD shows areas of inflammation that may increase its susceptibility to pathogens.

Susceptibility to stds

Susceptibility to STDs involves many factors, some of which are not known. The ability of the organism to produce disease and the circumstances that place the organism in the right place at a time when a trauma or alteration to the lining cells has occurred are factors. The individual's own immune response also helps to determine whether infection occurs.


If PID is suspected, the physician will take a complete medical history and perform an internal pelvic examination. Other diseases that may cause pelvic pain, such as appendicitis and endometriosis, must be ruled out. If pelvic examination reveals tenderness or pain in that region, or tenderness on movement of the cervix, these are good physical signs that PID is present.
Specific diagnosis of PID is difficult to make because the upper pelvic organs are hard to reach for samplings. The physician may take samples directly from the cervix to identify the organisms that may be responsible for infection. Two blood tests may help to establish the existence of an inflammatory process. A positive C-reactive protein (CRP) and an elevated erythrocyte sedimentation rate (ESR) indicate the presence of inflammation. The physician may take fluid from the cavity surrounding the ovaries called the cul de sac; this fluid may be examined directly for bacteria or may be used for culture. Diagnosis of PID may also be done using a laparoscope, but laparoscopy is expensive, and it is an invasive procedure that carries some risk for the patient.


The goals of treatment are to reduce or eliminate the clinical symptoms and abnormal physical findings, to get rid of the microorganisms, and to prevent long term consequences such as infertility and the possibility of ectopic pregnancy. If acute salpingitis is suspected, treatment with antibiotics should begin immediately. Early intervention is crucial to keep the fallopian tubes undamaged. The patient is usually treated with at least two broad spectrum antibiotics that can kill both N. gonorrhoeae and C. trachomatis plus other types of bacteria that may have the potential to cause infection. Hospitalization may be required to ensure compliance. Treatment for chronic PID may involve hysterectomy, which may be helpful in some cases.
If a woman is diagnosed with PID, she should see that her sexual partner is also treated to prevent the possibility of reinfection.

Alternative treatment

Alternative therapy should be complementary to antibiotic therapy. For pain relief, an experienced practitioner may apply castor oil packs, or use acupressure or acupuncture. Some herbs, such as Echinacea (Echinacea spp.) and calendula (Calendula officinalis) are believed to have antimicrobial activity and may be taken to augment the action of prescribed antibiotics. General tonic herbs, as well as good nutrition and rest, are important in recovery and strengthening after an episode of PID. Blue cohosh (Caulophyllum thalictroides) and false unicorn root (Chamaelirium luteum) are recommended as tonics for the general well-being of the female genital tract.


PID can be cured if the initial infection is treated immediately. If infection is not recognized, as frequently happens, the process of tissue destruction and scarring that results from inflammation of the tubes results in irreversible changes in the tube structure that cannot be restored to normal. Subsequent bouts of PID increase a woman's risks manyfold. Thirty to forty percent of cases of female infertility are due to acute salpingitis.
With modern antibiotic therapy, death from PID is almost nonexistent. In rare instances, death may occur from the rupture of tubo-ovarian abscesses and the resulting infection in the abdominal cavity. One recent study has linked infertility, a consequence of PID, with a higher risk of ovarian cancer.


The prevention of PID is a direct result of the prevention and prompt recognition and treatment of STDs or of any suspected infection involving the female genital tract. The main symptom of infection is an abnormal discharge. To distinguish an abnormal discharge from the mild fluctuations of normal discharge associated with the menstrual cycle takes vigilance and self-awareness. Sexually active women must be able to detect symptoms of lower genital tract disease. Ideally these women will be able to have a frank dialogue regarding their sexual history, risks for PID, and treatment options with their physicians. Also, these women should have open discussions with their sexual partners regarding disclosure of significant symptoms of possible infection.
Lifestyle changes should be geared to preventing the transfer of organisms when the body's delicate lining cells are unprotected or compromised. Barrier contraceptives, such as condoms, diaphragms, and cervical caps should be used. Women in monogamous relationships should use barrier contraceptives during menses and take their physician's advice regarding intercourse following abortion, childbirth, or biopsy procedures.



Landers, D. V., and R. L. Sweet, editors. Pelvic Inflammatory Disease. New York: Springer, 1997.

Key terms

Adhesion — The joining or sticking together of parts of an organ that are not normally joined together.
C-reactive protein (CRP) — A protein present in blood serum in various abnormal states, like inflammation.
Ectopic — Located away from normal position; ectopic pregnancy results in the attachment and growth of the fertilized egg outside of the uterus, a life-threatening condition.
Endometriosis — The presence and growth of functioning endometrial tissue in places other than the uterus; often results in severe pain and infertility.
Erythrocyte sedimentation rate (ESR) — The rate at which red blood cells settle out in a tube of unclotted blood, expressed in millimeters per hour; elevated sedimentation rates indicate the presence of inflammation.
Fibrosis — The formation of fibrous, or scar, tissue which may follow inflammation and destruction of normal tissue.
Hysterectomy — Surgical removal of the uterus.
Laparoscope — A thin flexible tube with a light on the endthat is used to examine the inside of the abdomen; the tube is inserted into the abdomen by way of a small incision just below the navel.


pertaining to the pelvis.
pelvic diameter any diameter of the pelvis. The diagonal conjugate joins the posterior surface of the pubis to the tip of the sacral promontory; the external conjugate joins the depression under the last lumbar spine to the upper margin of the pubis; the true or internal conjugate is the anteroposterior diameter of the pelvic inlet, measured from the upper margin of the pubic symphysis to the sacrovertebral angle; the oblique joins one sacroiliac articulation to the iliopubic eminence of the other side; the transverse diameter of the inlet joins the two most widely separated points of the pelvic inlet; and the transverse diameter of the outlet joins the medial surfaces of the ischial tuberosities.
pelvic inflammatory disease any pelvic infection involving the upper female genital tract beyond the cervix; such diseases are a major cause of female infertility.

pel·vic in·flam·ma·to·ry dis·ease (PID),

acute or chronic suppurative inflammation of female pelvic structures (endometrium, uterine tubes, pelvic peritoneum) due to infection by Neisseria gonorrhoeae, Chlamydia trachomatis, or other organisms, typically a complication of sexually transmitted infection of the lower genital tract, may be precipitated by menstruation, parturition, or surgical procedures including abortion; complications include tuboovarian abscess, tubal stenosis with resulting infertility or sterility and heightened risk of ectopic pregnancy, and peritoneal adhesions.

pelvic inflammatory disease

n. Abbr. PID
Inflammation of the female genital tract, especially of the fallopian tubes, caused by any of several bacteria, chiefly chlamydia and gonococci, and characterized by severe abdominal pain, high fever, vaginal discharge, and in some cases destruction of tissue that can result in sterility.

pelvic inflammatory disease (PID)

any inflammatory condition of the female pelvic organs, especially one caused by bacterial infection. Characteristics of the condition include fever; foul-smelling vaginal discharge; pain in the lower abdomen; abnormal uterine bleeding; pain with coitus; and tenderness or pain in the uterus, affected ovary, or fallopian tube on bimanual pelvic examination. If an abscess has already developed, a soft, tender fluid-filled mass may be palpated. Bed rest and antibiotics are usually prescribed, but surgical drainage of an abscess may be required. Severe, fulminating PID may necessitate hysterectomy to prevent fatal septicemia. If the cause is infection by gonococci or chlamydiae, the woman's sexual partners are also treated with antibiotics. Severe PID is usually very painful. The woman may be prostrate and require narcotic analgesia. Recurrent or severe PID often results in scarring of the fallopian tubes, obstruction, and infertility.
observations PID may be either acute or chronic. Acute onset typically occurs after onset of menses. Symptoms typically include progressive lower abdominal pain with guarding and rebound tenderness, fever, copious purulent cervical discharge, nausea and vomiting, malaise, urinary urgency and frequency, vaginal itching, and maceration. Chronic PID is manifested as chronic pain, menstrual irregularities, and recurrence and exacerbation of acute symptoms. Diagnosis is made through a clinical exam that reveals typical symptomatology coupled with elevated WBCs and erythrocyte sedimentation rate plus a positive culture of secretions. On pelvic examination, moving of the cervix causes severe pain and rebound tenderness that is present in the abdomen. Transvaginal ultrasound may show thickened fluid-filled fallopian tubes or adnexal mass. MRI and laparoscopy may be used to detect pelvic abnormalities. Common complications include general peritonitis, sterility, and ectopic pregnancy.
interventions Acute treatment is aimed at control and alleviation of infection with combinations of antiinfective drugs. Laparoscopy may be used to drain antibiotic-resistant abscesses, salpingolysis to remove adhesions, salpingostomy to reopen blocked fallopian tubes, and salpingo-oophorectomy for ruptured fallopian tubes or ectopic pregnancy. In vitro fertilization may be used in women with PID-induced sterility who wish to have children.
nursing considerations Nursing plays a key role in prevention, early recognition, and prompt treatment. Education is aimed at reducing factors that place women at increased risk, such as unprotected sex, multiple sex partners, exposure to urethritis, or STDs, and frequent vaginal douching; recognizing conditions that make one more susceptible to PID, such as IUD insertion, recent abortion, or pelvic surgery, and improper use of antibiotics; and seeking treatment for any signs of vaginal infection, such as any evidence of abnormal vaginal odor or discharge. Acute care is supportive and aimed at adequate rest in a semi-Fowler's position and adequate hydration. IUDs require removal during treatment. Instruction is given about the proper use of antibiotics. Education stresses sexual abstinence and avoidance of tampons and douching during treatment. Sexual partners need to be tracked and treated if PID was associated with an STD.
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Routes of spread of pelvic inflammatory disease
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Pelvic inflammatory disease

pelvic inflammatory disease

PID, salpingo-oophoritis Gynecology An imprecise term for intense pain due to direct extension of a lower genital tract infection–often sexually-transmitted along mucosae, first causing asymptomatic endometritis, then acute salpingitis, ↑ Sx as it spreads into fallopian tubes engorged with pus–pyosalpinx, pus in the peritoneum; PID is accompanied by leukostasis, fever, chills, N&V, extreme tenderness of uterine cervix and adnexae Epidemiology PID is 3–4-fold more common in IUD users and in those who douche 3+ times/month; ectopic pregnancy is 7–10-fold more common in PID; 500,000 cases of PID are reported/yr–US Etiology12 are due to N gonorrhoeae, less commonly, Chlamydia trachomatis; 15% of Pts with gonococcal cervicitis develop PID Clinical Severe pain, peritonitis, low-grade fever Complications Fallopian tube scarring, in14, infertility Epidemiology Primarily disadvantaged urban ♀, affecting ±1 million ♀–US, cost ±$4 billion Treatment Cefoxitin, doxocycline, clindamycin, ofloxacin

pel·vic in·flam·ma·to·ry dis·ease

(PID) (pel'vik in-flam'ă-tōr-ē di-zēz')
Acute or chronic inflammation in the organs of the female pelvic cavity, particularly suppurative lesions of the upper genital tract; most commonly due to infection by Chlamydia trachomatis or Neisseria gonorrhoeae, which have ascended into the uterus, uterine tubes, or ovaries from the lower genital tract as a result of childbirth or surgical procedures. The chief symptoms are pelvic pain and fever; complications include abscess formation and generalized peritonitis. Scarring may cause tubal infertility and raise the risk of ectopic pregnancy.

pelvic inflammatory disease

Persistent infection of the internal reproductive organs of the female. This may be due to a sexually transmitted disease or may follow childbirth or an ABORTION.

Pelvic Inflammatory Disease

DRG Category:744
Mean LOS:5.9 days
Description:SURGICAL: D&C, Conization, Laparoscopy and Tubal Interruption With CC or Major CC
DRG Category:758
Mean LOS:5.4 days
Description:MEDICAL: Infections, Female Reproductive System With CC

Pelvic inflammatory disease (PID) is a polymicrobial infectious disease of the pelvic cavity and the reproductive organs. PID may be localized and confined to one area or it can be widespread and involve the whole pelvic region including the uterus (endometritis), fallopian tubes (salpingitis), ovaries (oophoritis), pelvic peritoneum, and pelvic vascular system. The infection can be acute and recurrent or chronic.

PID can be a life-threatening and life-altering condition. Complications of PID include pelvic (or generalized) peritonitis and abscess formations, with possible obstruction of the fallopian tubes. Obstructed fallopian tubes can cause infertility or an ectopic pregnancy. Other complications of PID are bacteremia with septic shock, thrombophlebitis with the possibility of an embolus, chronic abdominal pain, and pelvic adhesions.


The causes of PID vary by geographic location and population. Many types of microorganisms, such as a virus, bacteria, fungus, or parasite, can cause PID. Common organisms involved in PID include Chlamydia trachomatis, Neisseria gonorrheae, staphylococci, streptococci, coliform bacteria, mycoplasmas, and Clostridium perfringens. The means of transmission is usually by sexual intercourse, but PID can also be transmitted by childbirth or by an abortion. Organisms enter the endocervical canal and proceed into the upper uterus, tubes, and ovaries. During menses, the endocervical canal is slightly dilated, facilitating the movement of bacteria to the upper reproductive organs. Bacteria multiply rapidly in the favorable environment of the sloughing endometrium. Douching increases the risk for PID because it destroys the protective normal flora of the vagina, and it could flush bacteria up into the uterus. Risk of reoccurrence of PID is possible with the use of latex condoms. Actinomyces bacteria may lead to PID cases when linked with the use of an intrauterine device (IUD).

Genetic considerations

Heritable immune responses could be protective or increase susceptibility.

Gender, ethnic/racial, and life span considerations

PID is the most common cause for hospitalization of reproductive-age women. It predominantly affects women who are sexually active, particularly those who have multiple partners or who change partners frequently. Associated risk factors for PID include 16 to 24 years of age, unmarried, nulliparous, history of sexually transmitted infections, and use of an IUD with multiple sex partners. Ethnicity and race have no known effects on the risk for PID. In the future, men may be screened for chlamydia to decrease PID in females.

Global health considerations

PID is a serious problem internationally. The causative organism is highly dependent on geographical region.



A thorough history of past infections, a sexual history, and a history of contraceptive use are essential to evaluate a woman with PID. The patient may describe a vaginal discharge, but the characteristics of the discharge (e.g., color, presence of an odor, consistency, amount) depend on the causative organism. For example, a gonorrhea or staphylococcus infection causes a heavy, purulent discharge. With a streptococcus infection, however, the discharge is thinner with a mucoid consistency. The woman may also experience pain or tenderness, described as aching, cramping, and stabbing, particularly in the lower abdomen, pelvic region, or both. Low back pain may also be present. Other symptoms include dyspareunia (painful sexual intercourse); fever greater than 101°F; general malaise; anorexia; headache; nausea, possibly with vomiting; urinary problems such as dysuria, frequency, urgency, and burning; menstrual irregularity; and constipation or diarrhea.

Physical examination

Observe closely for vaginal discharge and the characteristics of this discharge. Common symptoms include pain or tenderness, described as aching, cramping, and stabbing, particularly in the lower abdomen or pelvic region. Inspect the vulva for signs of maceration. Note if the woman has experienced pruritus that has led to irritated, red skin from scratching. If vomiting is reported, inspect the skin for signs of fluid deficit, such as dryness or poor skin turgor. Rebound tenderness may be noted. When the cervix is manipulated, the woman may complain of pain in this area. Uterine adnexal tenderness is usually present. Auscultate the bowel; at first, the bowel sounds are normal, but as the disease progresses, if it is not treated, the bowel sounds are diminished or even absent if a paralytic ileus is present.


Because PID may be a life-threatening and life-altering disease, assess the patient’s emotional ability to cope with the disease process. In particular, explore the woman’s and her partner’s concerns about fertility. Because sexual partners need to be treated to prevent reinfection, the patient may have concerns about discussing her illness with her partner or partners. Studies show that many teens with PID are reinfected within 48 months.

Diagnostic highlights

General Comments: A variety of tests, along with clinical symptoms and sexual history, support the diagnosis of PID. All females of childbearing age should have a pregnancy test.

TestNormal ResultAbnormality With ConditionExplanation
White blood cell (WBC) count5,000–10,000/mm3> 10,500/mm3Infection and inflammation elicit an increase in WBCs
Erythrocyte sedimentation rateUp to 20/hr> 20 mm/hrInflammation increases the protein content of plasma, thus increasing the weight of red blood cells and causing them to descend faster
C-reactive proteinNegative to traceElevatedIndicates inflammation
Laparoscopy (the gold standard)Normal-appearing reproductive organsPelvic structures are red and inflamed; possible adhesions and scarringDirect visualization of the pelvic cavity
FalloposcopyNormal-appearing fallopian tubesTubes are red and inflamed; possible adhesions and scarringVisual inspection of the tubes to detect damage

Other Tests: Transvaginal sonography or magnetic resonance imaging; endometrial biopsy with histopathological evidence of infection

Primary nursing diagnosis


Pain related to infectious process


Pain control; Pain level; Comfort level


Medication administration; Pain management; Heat/cold application; Analgesic administration

Planning and implementation


Without treatment, this disease process can be lethal for women. The goal is to rid the patient of infection and preserve fertility if possible. Because no single antibiotic is active against all possible pathogens, the Centers for Disease Control and Prevention (CDC) recommends combination regimens. These regimens vary if the patient is hospitalized or treated on an outpatient basis. Usually, the treatment is with broad-spectrum antibiotics. Both the affected woman and her sexual partner(s) should be treated with antibiotics. Women with PID are usually treated as outpatients, but if they become acutely ill, they may require hospitalization. Women should be followed up in an outpatient setting within 72 hours to check on the effectiveness of treatment. The hospitalized patient with PID usually is placed on bedrest in a semi-Fowler's position to promote vaginal drainage. Priority should be given to timely administration of intravenous (IV) antibiotics to maintain therapeutic blood levels. IV fluids may be initiated to prevent or correct dehydration and acidosis. If an ileus or abdominal distention is present, a nasogastric tube is usually inserted to decompress the gastrointestinal tract. Urinary catheterization is contraindicated to avoid the spread of the disease process; tampons are also contraindicated.

If antibiotic therapy is not successful and the patient has an abscess, hydrosalpinx (distention of the fallopian tube by fluid), or some type of obstruction, a hysterectomy with bilateral salpingo-oophorectomy (removal of ovaries and fallopian tubes) may be done. A laparotomy may be done to incise adhesions and to drain an abscess. Signs of peritonitis, such as abdominal rigidity, distention, and guarding, need to be reported immediately so that medical or surgical intervention can be initiated. If the patient is poorly nourished, a dietary consultation is indicated.

Analgesics are prescribed to manage the pain that accompanies PID. Comfort measures can include the use of heat applied to the abdomen or, if they are approved by the physician, warm douches to improve circulation to the area. (See other interventions for pain in the following section.)

Two outpatient oral/oral-parenteral antibiotic regimens are also newly recommended by the CDC: (1) ofloxacin 400 mg by mouth (PO) twice a day for 14 days or levofloxacin 500 mg PO daily for 14 days with or without metronidazole 500 mg PO twice a day for 14 days or (2) ceftriaxone 250 mg intramuscular (IM) single dose or cefoxitin 2 g IM single dose and probenecid 1 g PO plus doxycycline 100 mg PO twice a day for 14 days with or without metronidazole 500 mg PO twice a day for 14 days.

Pharmacologic highlights

Medication or Drug ClassDosageDescriptionRationale
Cefoxitin or cefotetan and doxycycline2 g IV q 6 hr, 2 g IV q 12 hr, 100 mg q 12 hr PO × 10–14 daysCephalosporin, second-generation cephalosporin, second-generation tetracycline antibioticInpatient treatment recommended by the CDC
Clindamycin and gentamycin900 mg IV q 8 hr, 2 mg/kg IV or IM loading dose, then 1.5 mg/kg q 8 hrAntibiotic, aminoglycosideInpatient treatment recommended by the CDC


Monitor vital signs and the patient’s symptoms to evaluate the course of the infection and its response to treatment. Always follow universal precautions; ensure that any item used by the patient is carefully disinfected. Provide perineal care every 2 to 4 hours with warm, soapy water to keep the area clean. Teach the patient that she needs to do these procedures as well. Allow the patient time to express her concerns. If appropriate, include the woman’s partner in a question-and-answer session about the couple’s potential to have children. Note that the inability to bear children is a severe loss for most couples, and they may need a referral for counseling.

Interventions that can help relieve pain include having the patient lie on her side with the knees flexed toward the abdomen. Massaging the lower back also increases her comfort. Use diversions such as music, television, and reading to take the patient’s mind off the discomfort.

Teach the patient interventions to prevent the recurrence of PID: to use condoms, to have all current sexual partners examined, to wash hands before changing pads or tampons, and to wipe the perineum from front to back. Encourage her to obtain immediate medical attention if fever, increased vaginal discharge, or pain occurs. Discuss with the patient when sexual intercourse or douching may be resumed (usually at least 7 days after hospital discharge).

Evidence-Based Practice and Health Policy

Trent, M., Haggerty, CL., Jennings, J.M., Lee, S., Bass, D.C., & Ness, R. (2011). Adverse adolescent reproductive health outcomes after pelvic inflammatory disease. Archives of Pediatric and Adolescent Medicine, 165(1), 49–54.

  • PID has significant implications for sexual and reproductive health, especially among adolescents. In one study among 831 female participants between ages 14 to 38, 21.3% had recurrent PID over an 84-month follow-up period.
  • Investigators found that the adolescent women (ages 14 to 19) were 1.54 times more likely than the adult women (ages 20 to 38) to experience recurrent PID (95% CI, 1.03 to 2.3; p = 0.03). In this sample, 25.1% were adolescents.
  • Although the adolescent women were more likely than the adult women to report consistent condom use as well as recent condom use within the previous 30 days (p < 0.001 and p = 0.006, respectively), a larger proportion of the adolescent women tested positive for Neisseria gonorrhoeae/Chlamydia trachomatis infection at baseline (63.2% versus 40.8%; p < 0.001) and at 30 days posttreatment (20% versus 5.2%; p < 0.001).
  • Additionally, a larger proportion of adolescent women compared to adult women had evidence of endometritis at baseline (56.1% versus 44.7%; p = 0.01) and had become pregnant during the follow-up period (72% versus 52.6%; p < 0.001).

Documentation guidelines

  • Physical findings: Vital signs, abdominal assessment, condition of integument
  • Occurrence of pain: Location, intensity, duration, triggers, response to pain interventions
  • Presence of vaginal discharge: Characteristics, amount of discharge

Discharge and home healthcare guidelines

To prevent a recurrence of PID, teach the patient the following:
  • Take showers instead of baths
  • Wear clean, cotton, nonconstrictive underwear
  • Avoid using tampons if they were the problem
  • Do not douche
  • Change sanitary pads or tampons at a minimum of every 4 hours
  • If using a diaphragm, remove it after 6 hours
  • If any unusual vaginal discharge or odor occurs, contact a healthcare provider immediately
  • Maintain a proper diet, with exercise and weight control
  • Maintain proper relaxation and sleep
  • Have a gynecological examination at least annually
  • Use a condom if there is any chance of infection in the sexual partner
  • Use a condom if the sexual partner is not well known or has had another partner recently

Ensure that the patient knows the correct dosage and time that the medication is to be taken and that she understands the importance of adhering to this regimen.

Teach all patients who have had PID the signs and symptoms of an ectopic pregnancy, which are pain, abnormal vaginal bleeding, faintness, dizziness, and shoulder pain. Explain alternative means of contraception to the woman if she previously used an IUD. Ensure that the woman is familiar with the manifestation of PID so she can report a recurrence of the disease.

References in periodicals archive ?
The findings also suggest an 80 percent reduction in the risk of pelvic inflammatory disease in women treated for chlamydial infection.
Management of chronic pelvic inflammatory disease with shortwave diathermy-A case report.
For dyspareunia, associated factors were having undergone female genital mutilation, having clinically suspected pelvic inflammatory disease, and being peri- or postmenopausal.
The role of chronic genital viral infections in the pathogenesis of pelvic inflammatory disease (PID) may be more significant than currently recognized, although no etiologic link has been defined yet, noted Dr.
Keywords: gonorrhea, pelvic inflammatory disease, pid, symptoms, chlamydia, diagnosis
Risk Factors for Pelvic Inflammatory Disease (PID):
Untreated chlamydia can lead to serious reproductive morbidity, including pelvic inflammatory disease, infertility and ectopic pregnancy (Scholes et al.
We therefore report the case of a 39-year-old woman with severe pelvic inflammatory disease (PID) caused by Cp.
Before one is diagnosed with endometriosis, it is important to distinguish between this and other diseases, such as the rotating, twisting or turning of ovarian cysts or chronic Pelvic Inflammatory Disease (PID).
Other causes of peritoneal inclusion cysts include trauma, pelvic inflammatory disease, and endometriosis.
It is known that women who use low dose birth control pills have lower incidence of heavy bleeding or irregular bleeding, endometrial cancer, several types of benign breast disease, ovarian cancer, rheumatoid arthritis, and pelvic inflammatory disease.