Clinical criteria for the diagnosis of PID

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Clinical criteria for the diagnosis of PID

The clinical criteria for diagnosing pelvic inflammatory disease (PID) are as follows.¹

Minimum criteria

Any of these three criteria diagnose PID if no other cause can be found.

• Lower abdominal tenderness or pain
• Pain or tenderness when the ovaries or fallopian tubes are touched or moved during examination
• Pain or tenderness when the cervix is touched or moved during examination

Criteria that increase the likelihood of PID

The presence of any of the following symptoms increases the likelihood that you have PID:

• Green or yellow vaginal discharge
• A laboratory test result confirming gonorrhea or chlamydia
• Oral temperature of or higher
• Many white blood cells in vaginal or cervical discharge
• Higher than normal erythrocyte sedimentation rate (ESR) or C-reactive protein. These are signs of possible infection.

Additional criteria for diagnosis of PID

Other clinical criteria used to diagnose PID include the following:

• Cells removed from the uterus by endometrial biopsy indicate infection and inflammation (endometritis).
• A tubo-ovarian abscess is visible on ultrasound.
• An exam of the abdomen or pelvis by laparoscopy finds inflammation or abscesses of the fallopian tubes, ovaries, or other pelvic structures. Laparoscopy and ultrasound are considered the best procedures for diagnosing PID. However, these procedures are not done unless the diagnosis is in doubt or the results from the procedure will change the method used in treatment.

Many health professionals think that even if a woman has no pelvic symptoms, she should be treated for PID if she has pain or tenderness when the cervix is moved and has signs of cervicitis (inflammation of the cervix).

The treatment for PID is longer and may use different medications than the treatment for a vaginal or cervical infection.

If symptoms come back after treatment, other possible causes for the symptoms are considered each time. It sometimes takes more than one course of medication treatment to cure PID. It is also possible that a reinfection has occurred or that the original diagnosis may not have been correct. Your sex partner(s) must be treated at the same time you are.

References

Citations

1. Centers for Disease Control and Prevention (2006). Pelvic inflammatory disease section of Sexually transmitted diseases treatment guidelines, 2006. MMWR, 55(RR-11): 56–61.

Credits

Last updated:	November 28, 2006
Author:	Kathe Gallagher, MSW
Reviewed By:	Joy Melnikow, MD, MPH - Family Medicine, Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC