History and exam

Key diagnostic factors

common

presence of risk factors

Key risk factors include prior infection with chlamydia or gonorrhoea or PID, young age at onset of sexual activity, unprotected sexual intercourse with multiple sexual partners, and IUD use.[1]

uterine tenderness

One of three findings on pelvic examination that make up minimum criteria for diagnosis.[1]

cervical motion tenderness

One of three findings on pelvic examination that make up minimum criteria for diagnosis.[1]

adnexal tenderness

In one study, adnexal tenderness was found to be a sensitive marker of endometritis (96%), but specificity was only 4%.[28]

One of three findings on pelvic examination that make up minimum criteria for diagnosis.[1]

Other diagnostic factors

common

lower abdominal pain

Non-specific but suggestive symptom. May be associated with dysuria, dyspareunia, or uterine bleeding.

abnormal cervical or vaginal discharge

Mucopurulent discharge. Non-specific but suggestive symptom.

fever

Oral temperature over 38.3°C ( >101°F). Non-specific but suggestive sign.

Risk factors

strong

prior infection with chlamydia or gonorrhoea

Most important risk factor.[10]

young age at onset of sexual activity

In one study, young women between the ages of 15 and 19 years were 5 times more likely than older women to develop PID.[10] Cervical cellularity or ectopy (common in young women) facilitates greater adherence of micro-organisms to the cervix.[11]

unprotected sexual intercourse with multiple sexual partners

Increased exposure to bacterial organisms that can lead to PID.[12][13]

prior history of PID

Presumed impaired local host defences.[14]

IUD use

Limited to the first 3 weeks after insertion in women at low risk of STIs.[1]

weak

smoking

Has been associated with PID.[15][16]

low socio-economic status

Has been associated with PID.[17]

current vaginal douching

Alters the normal vaginal flora, causes epithelial damage, and disrupts the cervical mucus barrier.[11]

intercourse during menstruation

May be related to loss of cervical plug.[10]

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