What is PID?

Pelvic inflammatory disease (PID) is a clinical condition involving inflammation of one or more organs of the female upper genital tract (endometrium, fallopian tubes, ovaries, pelvic peritoneum). PID generally occurs as an acute infection of less than 30 days’ duration that follows ascent of pathogens through the cervix to the endometrium before spreading to the fallopian tubes.

Chlamydia is the most commonly detected STI associated with PID.¹ It is estimated that approximately 15% of new chlamydia infections will progress to symptomatic PID if left untreated.² 

Diagnosing PID

PID is diagnosed clinically. Clinicians should have a low threshold for diagnosing PID in young sexually active people with female reproductive organs and people diagnosed with an STI if they are experiencing pelvic or lower abdominal pain where no other cause can be identified. 

It is essential to exclude life-threatening causes of acute abdominal pain requiring emergency management such as ectopic pregnancy or appendicitis when considering a diagnosis of PID. 

For help diagnosing PID, see:

• Common causes of low abdominal (pelvic) pain in women of reproductive age (PDF)
• Pelvic Inflammatory Disease diagnosis flowchart (PDF)
• Speculum and bimanual examination (PDF)

Chlamydia is the most commonly detected STI associated with PID, followed by Neisseria gonorrhoea and Mycoplasma genitalium. In many cases however, no causal organism is identified.¹ 

Ask about new onset lower abdominal pain and/or dyspareunia in any patient with female reproductive organs attending for chlamydia or gonorrhoea treatment. 

Treating PID

Antibiotic treatment should be initiated at the time a clinical diagosis of PID is made and without waiting for STI test results. A rapid response to treatment confirms a diagnosis of PID. 

Current sexual partners should be treated to cover chlamydia irrespective of test results.³ 

Patient resources for PID

For a patient factsheet about PID, click below

PID Factsheet

For all patient resources, click below

Patient resources

GP resources for PID

Need more help?

Contact your local Family Planning organisation or specialist sexual health clinic for further support. 

You can also view an article and quiz on Pelvic inflammatory disease that was written for Australian Doctor. Please register (requires an AHPRA number) and logon to the site https://www.ausdoc.com.au/ to read the article and complete the quiz. If already registered/logged on, the education can be found at: https://www.ausdoc.com.au/how-treat/pelvic-inflammatory-disease 

For all GP resources, click below

GP Resources

Key guidelines for chlamydia case management

For PID diagnosis, treatment and management

Australian STI Management Guidelines (updated March 2018). 

For guidance on acute abdominal pain in women, including differential diagnosis, speculum and bimanual examinations, and a PID flowchart

NSW Health STI Programs Unit (STIPU) Acute Abdominal Pain in Women

For guidance on contact tracing with PID

Australasian Contact Tracing Guidelines (updated May 2021).

References

1. Goller JL, De Livera AM, Fairley CK, 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. Sex Transm Infect. 2017;93(1):68. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27091727
2. Price M J, Ades A, Soldan K, et al. The natural history of Chlamydia trachomatis infection in women: a multi parameter evidence synthesis. Health Technol Assess. 2016;20(22). Available from: https://www.ncbi.nlm.nih.gov/pubmed/27007215
3. Australasian Society for HIV Viral Hepatitis and Sexual Health Medicine. Australasian Contact Tracing Guidelines 2016 [updated 2020]. Available: http://contacttracing.ashm.org.au/conditions/when-contact-tracing-should-be-considered/pelvic-inflammatory-disease-pid