Most often, PID does not produce any signs and symptoms in the early stages. When the disease progresses to more advance stages, the following symptoms are evident [7]:

• Fever
• Pain during intercourse
• Heavy menstrual bleeding
• Irregular menstrual cycle
• Foul smelling vaginal discharge
• Pain in the pelvic and lower abdomen
• Pain while urinating 
• Increase in the frequency of urination 

In addition to the above mentioned symptoms, affected women would also experience nausea, vomiting, tiredness, bleeding after intercourse and poor appetite [8]. 

• Pain

  When they are present, they may include: lower abdominal or pelvic pain abnormal vaginal discharge irregular menstrual bleeding fever pain during sexual intercourse painful or increased urination So prompt treatment of chlamydia and gonorrhoea infections [dailymail.co.uk]

  The symptoms of PID can vary, but may include the following: Dull pain or tenderness in the stomach or lower abdominal area, or pain in the right upper abdomen(though this is much less common) Abnormal vaginal discharge that is yellow or green in color [my.clevelandclinic.org]

  Lower abdominal pain is usually present and bilateral but may be unilateral, even when both tubes are involved. Pain can also occur in the upper abdomen. Nausea and vomiting are common when pain is severe. [msdmanuals.com]

  Despite treatment with broad-spectrum parenteral antibiotics, the patient remained febrile with persistent pelvic pain. [ncbi.nlm.nih.gov]

• Fever

  In severe PID, women appear very ill with fever, chills, purulent vaginal discharge, nausea, vomiting, and elevated white blood cell count (WBC). [www2a.cdc.gov]

  Pain, fever, and peritoneal signs are usually present and may be severe. An adnexal mass may be palpable, although extreme tenderness may limit the examination. [msdmanuals.com]

  We report the case of a 30-year-old housewife who presented with fever and lower abdominal pain, and was diagnosed with an adnexal collection. Initial evaluation was suggestive of tubercular pelvic inflammatory disease (PID). [ncbi.nlm.nih.gov]

• Chills

  Symptoms include pain, cramping, chills, spotting, and nausea. Pelvic Inflammatory Disease (PID) Menu Overview What is pelvic inflammatory disease (PID)? Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. [my.clevelandclinic.org]

  PID can cause pelvic pain, abdominal tenderness, vaginal discharge, fever, chills, and pain during urination and sex. Treatment includes antibiotics, especially if you have a STD. [hopkinsmedicine.org]

  In severe PID, women appear very ill with fever, chills, purulent vaginal discharge, nausea, vomiting, and elevated white blood cell count (WBC). [www2a.cdc.gov]

• High Fever

  A 62-year-old woman presented with a 2-week history of left flank pain and high fever, but no abdominal pain. She had forgotten the use of an IUD. Retrograde pyelography showed a stricture in the lower third of the left ureter. [ncbi.nlm.nih.gov]

  fever Nausea and vomiting Pain during sex Get useful, helpful and relevant health + wellness information enews More health news + info [my.clevelandclinic.org]

  fever), inability to follow a proposed outpatient regimen, as well as failure to respond to prescribed oral antibiotics with persistent or worsening symptoms. [news-medical.net]

  Fever occurs in about half of patients with PID. Suspicion of PID should be high and antibiotic therapy should be initiated even without definitive diagnosis because the risk of developing sequelae left untreated is very high. [pedclerk.bsd.uchicago.edu]

• Malaise

  Other symptoms might include: Fever Chills Night sweat Nausea and vomiting Hiccups Headaches A general feeling of poor health (malaise) The symptoms of PID -- pain in the lower belly and vaginal discharge -- are often present, as well. [webmd.com]

  Patients may also present with fever, nausea, vomiting and general malaise, but this is variable and may range from minimally symptomatic to toxic appearing. [cdemcurriculum.com]

  I had severe menstrual irregularities, fevers, bleeding between periods, bleeding after intercourse, pains, and general malaise. Several times I was treated with antibiotics, which brought only some temporary relief. [ourbodiesourselves.org]

  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. [medical-dictionary.thefreedictionary.com]

• Abdominal Pain

  This rare diagnosis of peri-implantation pelvic inflammatory disease should be considered in the differential diagnosis of abdominal pain in early pregnancy. [ncbi.nlm.nih.gov]

  Physical examination typically reveals lower abdominal pain, which may be unilateral or bilateral, although diffuse abdominal pain may also be seen. [emdocs.net]

  Tags: abdominal pain chronic recurrent abdominal pain dysuria Ovarian Torsion sexual transmitted disease Sean M. Fox I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. [pedemmorsels.com]

  Lower abdominal pain is usually present and bilateral but may be unilateral, even when both tubes are involved. Pain can also occur in the upper abdomen. Nausea and vomiting are common when pain is severe. [msdmanuals.com]

• Vomiting

  A 44-year-old Caucasian female with a history of endometriosis is admitted to the intensive care unit due to severe left lower quadrant abdominal pain, nausea and vomiting. [ncbi.nlm.nih.gov]

  If nausea and vomiting are present, this suggests peritonitis. [almostadoctor.co.uk]

  Symptoms of PID Symptoms of pelvic inflammatory disease may include: Pain in your lower abdomen and pelvis Heavy vaginal discharge with an unpleasant odor Irregular menstrual bleeding Pain during intercourse Low back pain Fever, fatigue, diarrhea, or vomiting [utswmed.org]

  Other symptoms and signs include nausea or vomiting, urinary symptoms, proctitis and an adnexal mass. Differential diagnosis Other causes of abdominal pain - eg, appendicitis (nausea and vomiting are seen more often than PID), ectopic pregnancy. [patient.info]

• Nausea

  Symptoms include pain, cramping, chills, spotting, and nausea. Pelvic Inflammatory Disease (PID) Menu Overview What is pelvic inflammatory disease (PID)? Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. [my.clevelandclinic.org]

  A 44-year-old Caucasian female with a history of endometriosis is admitted to the intensive care unit due to severe left lower quadrant abdominal pain, nausea and vomiting. [ncbi.nlm.nih.gov]

  If nausea and vomiting are present, this suggests peritonitis. [almostadoctor.co.uk]

  Other symptoms and signs include nausea or vomiting, urinary symptoms, proctitis and an adnexal mass. Differential diagnosis Other causes of abdominal pain - eg, appendicitis (nausea and vomiting are seen more often than PID), ectopic pregnancy. [patient.info]

• Lower Abdominal Pain

  Lower abdominal pain is usually present and bilateral but may be unilateral, even when both tubes are involved. Pain can also occur in the upper abdomen. Nausea and vomiting are common when pain is severe. [msdmanuals.com]

  Physical examination typically reveals lower abdominal pain, which may be unilateral or bilateral, although diffuse abdominal pain may also be seen. [emdocs.net]

  We report the case of a 30-year-old housewife who presented with fever and lower abdominal pain, and was diagnosed with an adnexal collection. Initial evaluation was suggestive of tubercular pelvic inflammatory disease (PID). [ncbi.nlm.nih.gov]

• Abdominal Tenderness

  Symptoms and physical findings vary widely and may include lower abdominal tenderness, adnexal tenderness, and cervical motion tenderness. Fever and cervical or vaginal discharge may also be present. [bestpractice.bmj.com]

  PID can cause pelvic pain, abdominal tenderness, vaginal discharge, fever, chills, and pain during urination and sex. Treatment includes antibiotics, especially if you have a STD. [hopkinsmedicine.org]

  The most common physical exam findings are bilateral adnexal tenderness and purulent cervical discharge. Cervical motion, uterine, and lower abdominal tenderness may also be present. [cdemcurriculum.com]

• Back Pain

  Symptoms of PID Symptoms of pelvic inflammatory disease may include: Pain in your lower abdomen and pelvis Heavy vaginal discharge with an unpleasant odor Irregular menstrual bleeding Pain during intercourse Low back pain Fever, fatigue, diarrhea, or [utswmed.org]

  […] tool=bestpractice.com Symptoms include fever, vomiting, back pain, dyspareunia, and bilateral lower abdominal pain, as well as symptoms of lower genital tract infection such as abnormal vaginal odour, itching, bleeding, or discharge. [bestpractice.bmj.com]

  However, severe symptoms can develop quickly, including: lower abdomen or back pain pain during sex or urination abnormal periods or increased pain during periods abnormal vaginal discharge, including bleeding after sex fever, chills, nausea or vomiting [healthdirect.gov.au]

• Low Back Pain

  Symptoms of PID Symptoms of pelvic inflammatory disease may include: Pain in your lower abdomen and pelvis Heavy vaginal discharge with an unpleasant odor Irregular menstrual bleeding Pain during intercourse Low back pain Fever, fatigue, diarrhea, or [utswmed.org]

  Symptoms There is pain in the lower part of the tummy (abdomen) most often affecting both sides. Very occasionally there may be pain in the upper abdomen, and low back pain may occur too. The monthly periods may be altered. [medinfo.co.uk]

  Pain during sex. Low back pain. Painful urination. Some women who have PID do not experience these symptoms and do not know they have it. If you have the above symptoms, or if you think you have been exposed to an STI, call your doctor. [familydoctor.org]

  Pain during sex. Abnormal vaginal discharge. High temperature (fever). Low back pain. Symptoms may develop quickly. You can become quite ill over a few days. Sometimes symptoms are mild and develop slowly. [patient.info]

• Pelvic-Girdle Pain

  (also known as visceral pain) pelvic girdle pain (SPD or DSP) Pudendal nerve entrapment Gynecologic Dysmenorrhea—pain during the menstrual period Endometriosis—pain caused by uterine tissue that is outside the uterus. [en.wikipedia.org]

• Pelvic Pain

  A 14-year-old nulligravida who presented with acute pelvic pain was diagnosed with pelvic inflammatory disease and possible tuboovarian abscess. [ncbi.nlm.nih.gov]

  Determine which women with PID require hospitalization Initial Actions and Primary Survey When a woman of reproductive age presents with vaginal discharge or pelvic pain, a pelvic exam and pregnancy test should always be performed. [cdemcurriculum.com]

  Pelvic and perineal pain Micrograph showing endometriosis (H&E stain), a common cause of chronic pelvic pain in women. Pelvic pain is pain in the area of the pelvis. Acute pain is more common than chronic pain. [en.wikipedia.org]

• Vaginal Discharge

  Culture of the vaginal discharge revealed the presence of E. coli. [ncbi.nlm.nih.gov]

  In severe PID, women appear very ill with fever, chills, purulent vaginal discharge, nausea, vomiting, and elevated white blood cell count (WBC). [www2a.cdc.gov]

  When they are present, they may include: lower abdominal or pelvic pain abnormal vaginal discharge irregular menstrual bleeding fever pain during sexual intercourse painful or increased urination So prompt treatment of chlamydia and gonorrhoea infections [dailymail.co.uk]

• Salpingitis

  KEYWORDS: Endometritis; Fitz-Hugh–Curtis syndrome; Pelvic inflammatory disease; Salpingitis; Tuboovarian abscess [ncbi.nlm.nih.gov]

  Salpingitis with endometritis and oophoritis, with or without peritonitis, is often called salpingitis even though other structures are involved. Pus may collect in the tubes (pyosalpinx), and an abscess may form (tubo-ovarian abscess). [msdmanuals.com]

• Adnexal Tenderness

  The most common physical exam findings are bilateral adnexal tenderness and purulent cervical discharge. Cervical motion, uterine, and lower abdominal tenderness may also be present. [cdemcurriculum.com]

  Seventeen days later, she presented with severe bilateral lower abdominal pain, cervical motion tenderness, uterine tenderness, and bilateral adnexal tenderness. [ncbi.nlm.nih.gov]

  […] include cervical motion tenderness, uterine tenderness, and/or adnexal tenderness. [mdedge.com]

  Uterine tenderness or cervical motion pain or adnexal tenderness is most often present on pelvic exam in most cases of moderate PID. [www2a.cdc.gov]

• Cervical Motion Tenderness

  Symptoms and physical findings vary widely and may include lower abdominal tenderness, adnexal tenderness, and cervical motion tenderness. Fever and cervical or vaginal discharge may also be present. [bestpractice.bmj.com]

  Seventeen days later, she presented with severe bilateral lower abdominal pain, cervical motion tenderness, uterine tenderness, and bilateral adnexal tenderness. [ncbi.nlm.nih.gov]

Various tests are indicated to confirm PID as well as to evaluate the extent of spread of the disease condition. The following methods are carried out to diagnose the condition [9]:

• Physical examination: A preliminary physical examination to study the signs and symptoms of the disease is done. A thorough pelvic examination is also carried out to study tenderness in the uterus, ovaries or fallopian tubes. Pelvic examination would also reveal bleeding from the cervix, pain in the cervix and presence of fluid discharge from the area.
• Laboratory tests: Samples from the cervix and vagina are collected through swabs to test for the type of organism involved. In addition, various laboratory tests such as WBC count, erythrocyte sedimentation rate and C-reactive protein tests will be conducted to check for signs of infections.
• Ultrasound: Imaging studies such as ultrasound examination would provide knowledge on the extent of spread of the infection to the reproductive organs.
• Endometrial biopsy is done for further analysis of PID.

• Nephrolithiasis

  […] disease or dysfunction (complications of pregnancy, acute infections, endometriosis, adnexal disorders, menstrual disorders), as well as gastrointestinal (appendicitis, gastroenteritis, inflammatory bowel disease), genitourinary (cystitis, pyelonephritis, nephrolithiasis [canada.ca]

  […] when evaluating a patient with suspected PID -Ectopic -Intrauterine Gynecologic Pathology: -Bacterial vaginosis -Yeast vulvovaginitis -Uterine fibroids -Endometriosis -Ovarian cysts -Ovarian torsion Genitourinary disorders: -Urinary tract infections -Nephrolithiasis [clinicaladvisor.com]

  Additional diagnostic criteria are outlined in Table 1. 5 The differential diagnosis also may include gastrointestinal conditions (e.g., acute appendicitis, inflammatory bowel disease); genitourinary conditions (e.g., urinary tract infection/pyelonephritis, nephrolithiasis [aafp.org]

• Pyuria

  Assuming a positive UA excludes the diagnosis of PID (beware sterile pyuria ) Failing to do a pelvic exam and STI testing on a woman with lower abdominal pain. [emdocs.net]

• Leukocytosis

  […] age (39.3years vs 33.1years; P=0.04), educational level (only elementary, 13 [50%] vs 5 [19%]; P=0.14), presentation with fever (23 [88%] vs 16 [62%]; P=0.025), white blood cell count (21.8×10(9)/L vs 14.9×10(9)/L; P CONCLUSION: The triad of fever, leukocytosis [ncbi.nlm.nih.gov]

  More common presentations include acute pelvic pain (of variable intensity), cervical motion tenderness, vaginal discharge, fever, dyspareunia, and leukocytosis. Right upper quadrant pain from perihepatitis in Fitz-Hugh-Curtis syndrome is possible. [radiopaedia.org]

  A CBC may show leukocytosis. [sharinginhealth.ca]

  License: CC BY-SA 3.0 Leukocytosis is found in about 50% of the patients but is not necessary for the diagnosis of PID. PID is an inflammatory condition and erythrocyte sedimentation rate, or c-reactive protein levels are expected to be high. [lecturio.com]

The following methods are employed for treatment of PID [10]:

• Antibiotic medications: Upon diagnosis, the patient is put on an antibiotic regime. Based on the lab results confirming the causative organism, the dosage or the type of antibiotic to be administered is decided.
• Partner’s treatment: The partner of the affected woman would also require treatment. This is essentially done to prevent reinfection of the disease. 
• Practice abstinence: It is necessary to avoid sexual intercourse until laboratory tests reveal that both the partners are not carrying any more pathogenic organisms.
• Surgery is rarely indicated in patients with PID. However when antibiotics fail to work or an abscess ruptures then surgery may be necessary.

The prognosis of the condition would gravely depend on when the diagnosis was made and treatment initiated. Many women with PID are completely unaware of the fact that they are living with a disease condition unless they experience severe symptoms. In such conditions, PID progresses to the advance stages causing chronic pelvic pain, infertility or ectopic pregnancy [6].

Sexually transmitted infections are the most common cause of PID. The bacteria responsible for causing such a kind of infection are gonorrhea and chlamydia. Statistical data has shown that, 10 to 20% of untreated infections caused by gonorrhea and chlamydia can progress to pelvic inflammatory disease [2]. However, these bacteria can also gain entry to the body during the process of childbirth, abortion, miscarriage and endometrial biopsy. Women who get an intrauterine device (IUD) inserted are also at an increased risk of contracting infection from the bacteria [3].

In addition to gonorrhea and chlamydia, other organisms that are responsible for causation of PID include streptococcus agalactiae, trichomonas vaginalis, ureaplasma urealyticum, mycoplasma hominis and herpes simplex virus 2 to name a few.

The incidence of pelvic inflammatory disease is on the rise owing to increase in number of cases related to sexually transmitted diseases. It has been estimated that about 1 in every 8 women who are younger than 20 years and are sexually active will develop PID. In the United States, about 1 million women suffer from PID each year. The disease causes about 2.5 million outpatient visits and 125,000 to 150,000 hospitalization every year. The rate of pelvic inflammatory amongst the high income population is known to be about 10 to 20 per 1000 women in the reproductive age group. The annual expense of PID has been calculated to be about $2 billion [4].

Pelvic inflammatory disease is thought to occur in 2 distinct stages. The primary stage, wherein the vaginal infection is acquired through sexually transmitted disease. In the secondary stage, the bacteria travel from the vagina to the reproductive organs causing infection and inflammation of the concerned organs. The exact mechanism that triggers such sequence of events is still not well understood.

Under normal conditions, the travel of the bacteria or spread of the infection to the upper genital tract is prevented by the mucus barrier of the cervix. However, certain factors such as vaginal inflammation and hormonal changes that occur during menstruation may decrease the effectiveness of the functional barrier of the cervical mucus [5].

Following are the several ways by which the risk of contracting PID can be significantly reduced:

• Women are advised to practice safe sex and limit number of partners. Use of proper contraception can also help decrease the risk of contracting infections.
• Women who are sexually active should regularly get screened for sexually transmitted diseases. They should also get their partners regularly tested for sexually transmitted infections. This would go a long way in prevention of PID.
• Douching upsets the balance of vaginal microflora. Such a practice should therefore be discouraged.

Pelvic inflammatory disease (PID) occurs when sexually transmitted disease is left untreated as a result of which an infection spreads from the vagina to the uterus, fallopian tubes and ovaries. The disease seldom produces any signs and symptoms and is diagnosed in the later stages when the affected woman complains of pelvic pain or is facing difficulty in conceiving [1].

Definition

Pelvic inflammatory disease (PID) is defined as a condition wherein the female reproductive organs undergo inflammation due to infection. It is a common phenomenon for sexually active females under 20 years of age. Sexually transmitted infections can predispose women to contract PID.

Cause

Bacterial infections responsible for causing sexually transmitted diseases are the most common cause of PID. Bacteria such as gonorrhea and chlamydia cause PID.

Symptoms

Symptoms of PID include pelvic pain, pain in the lower abdominal region, foul vaginal discharge, increased urge to urinate, pain during urination, pain during intercourse and irregular menstruation. In addition, affected women also suffer from fever, nausea and loss of appetite.

Diagnosis

Preliminary examination of pelvic region through imaging studies and physical examination is required to evaluate the underlying condition. Laboratory tests and swabs from cervix are carried out to determine the causative organism.

Treatment

PID is treated through antibiotic course. Surgery is seldom required, but in case when antibiotics did not work or an abscess has ruptured it becomes a necessity.

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2. Herzog SA, Althaus CL, Heijne JC, Oakeshott P, Kerry S, Hay P, et al. Timing of progression from Chlamydia trachomatis infection to pelvic inflammatory disease: a mathematical modelling study. BMC Infect Dis. Aug 11 2012;12:187.
3. Meirik O. Intrauterine devices - upper and lower genital tract infections. Contraception. 2007;06;75 (6 Suppl/):S4
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8. Peipert JF, Ness RB, Blume J, et al. Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease. Am J Obstet Gynecol 2001; 184:856.
9. Jacobson L, Weström L. Objectivized diagnosis of acute pelvic inflammatory disease. Diagnostic and prognostic value of routine laparoscopy. Am J Obstet Gynecol 1969; 105:1088.
10. CDC, Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006.MMWR Recomm Rep. Aug 4 2006;55(RR-11):1-94.