Pelvic Inflammatory Disease
Obstetrics & Gynecology
Illness script · Obstetrics & Gynecology
Pelvic Inflammatory Disease
Ascending polymicrobial infection of the upper female genital tract (uterus, tubes, ovaries), most often sexually transmitted.
This illness script for Pelvic Inflammatory Disease covers predisposing factors, classic presentation, mechanism, workup, management, and the clinical pivots that separate it from look-alikes—written for USMLE Step 1 and clerkship reasoning.
01
Predisposing factors
- Sexually active women <25 years old; highest-risk demographic
- Prior PID episode (greatest single risk factor for recurrence)
- Multiple or new sexual partners
- Lack of barrier contraception
- IUD insertion (risk window: first 3 weeks post-placement)
- History of chlamydia or gonorrhea
02
Presentation
- Lower abdominal/pelvic pain — bilateral, dull, onset often during/after menses
- Cervical motion tenderness (CMT) — pathognomonic 'chandelier sign' on exam
- Uterine or adnexal tenderness on bimanual exam
- Mucopurulent cervical discharge; cervical friability
- Fever >38.3°C, nausea, vomiting if severe
- Fitz-Hugh–Curtis syndrome: RUQ pain from perihepatitic adhesions (violin-string adhesions)
03
Pathophysiology
- N. gonorrhoeae and C. trachomatis most common; often polymicrobial (anaerobes, G. vaginalis)
- Cervical barrier disrupted → ascending infection to endometrium, fallopian tubes
- Tubal inflammation → edema, exudate → risk of abscess (tubo-ovarian abscess)
- Scarring of tubes → ectopic pregnancy, infertility, chronic pelvic pain
04
Diagnostics
- Clinical diagnosis: CMT + uterine/adnexal tenderness in sexually active woman is sufficient to treat
- Cervical NAAT for gonorrhea/chlamydia (high sensitivity; guides therapy)
- Elevated WBC, ESR, CRP support diagnosis but not required
- Pelvic ultrasound: first-line imaging; identifies TOA (thick-walled adnexal mass with fluid)
- Laparoscopy: gold standard (rarely needed); shows tubal erythema, exudate
05
Management
- Outpatient (mild-moderate): ceftriaxone 500 mg IM × 1 + doxycycline 100 mg PO BID × 14 days + metronidazole 500 mg PO BID × 14 days
- Inpatient indications: TOA, pregnancy, surgical emergency cannot be excluded, failed outpatient therapy, severe illness
- Inpatient IV regimen: cefoxitin + doxycycline OR clindamycin + gentamicin
- TOA: IV antibiotics first; surgical drainage if no improvement at 72 hours
- All sexual partners within 60 days must be treated; counsel on STI prevention
06
Clinical pivots
How to separate this script from the look-alikes that show up on exams and on the wards.
Appendicitis
Appendicitis pain is RLQ/periumbilical and unilateral; PID is bilateral with CMT and vaginal discharge
Ectopic Pregnancy
Positive β-hCG differentiates ectopic; always check pregnancy test before diagnosing PID
Tubo-Ovarian Abscess
TOA is a complication of PID with palpable adnexal mass and failure to improve on antibiotics alone
Ovarian Torsion
Torsion is sudden, severe, unilateral pain with absent Doppler flow; no CMT or discharge
Keep reading
Full library- Ovarian TorsionTwisting of the ovary (and often fallopian tube) on its ligamentous supports, compromising blood flow and causing ischemia.
- Placental AbruptionPremature separation of a normally implanted placenta from the uterine wall before delivery, causing hemorrhage and fetal compromise.
Educational use only. This illness script is a study framework, not medical advice. Confirm decisions with current guidelines and your clinical supervisors.