PID is a disease of the upper genital tract.
It is a spectrum of infection and
inflammation of the upper genital tract
organs typically involving the uterus
(endometrium), fallopian tubes, ovaries,
pelvic peritoneum and surrounding
Occurs both in the developed and developing
85 per cent are spontaneous infection in
sexually active females of reproductive age.
The remaining 15 per cent follow procedures,
which favors the organisms to ascend up.
Two-thirds are restricted to young women of
less than 25 years and the remaining one-third
limited among 30 years or older.
Multiple sexual partners.
Absence of contraceptive pill use.
Previous history of acute PID.
Area with high prevalence of sexually
Bilateral lower abdominal and pelvic pain dull
Fever, lassitude and headache.
Irregular and excessive vaginal bleeding .
Abnormal vaginal discharge (purulent or
Nausea and vomiting.
Pain and discomfort in the right
(1) Tenderness on both the quadrants of lower abdomen.
(2) The liver may be enlarged and tender.
(1) Abnormal vaginal discharge (purulent).
(2) Congested external urethral meatus or openings of Bartholin’s ducts
through which pus may be seen escaping out on pressure.
(3) Speculum examination shows congested cervix with purulent discharge
from the canal.
Clinical diagnostic criteria of PID
Lower abdominal tenderness.
Cervical motion tenderness.
Oral temperature > 38.3°C.
Mucopurulent cervical or vaginal discharge.
Raised C-reactive protein and/or ESR.
Histopathologic evidence of endometritis on biopsy.
Imaging study (TVS/MRI) evidence of tubo-ovarian complex.
Laparoscopic evidence of PID
Identification of organisms
Blood: Leucocyte count shows
leucocytosis to more than 10,000 per cu mm
and an elevated ESR value of more than 15
mm per hour.
Complications Of Pid
1) Pelvic peritonitis or even generalized
(3) Chronic pelvic inflammation
(4) Formation of adhesions or hydrosalpinx or pyosalpinx and tubo-
(5) Chronic pelvic pain and ill health.
Ambulatory Management Of Acute PID
Patient should have oral therapy for 14 days
Levofloxacin 500 mg (or, ofloxacin 400 mg)
Metronidazole 500 PO bid
Ceftriaxone 250 mg IM single dose
Doxycycline 100 mg PO BID with or without
Metronidazole 500 mg PO BID for 14 days
Inpatient Antibiotic Therapy
Cefoxitin 2 gm iv every 6 hours for 2-4 days
„Doxycycline 100 mg Po for 14 days
„Clindamycin 900 mg iv every 8 hours
„Gentamicin 2 mg/kg iv
Levofloxacin 500 mg iv
Metronidazole 500 mg iv