Diagnostic Approach and Treatment for Pelvic Inflammatory Disease (PID)

Diagnostic Criteria

The Centers for Disease Control and Prevention (CDC) recommends empiric treatment for sexually active women at risk for STDs if they present with either uterine/adnexal tenderness or cervical motion tenderness 1, 2, 3
The CDC suggests that a diagnosis of PID should be considered in sexually active women with pelvic pain and any of the following: oral temperature >101°F (>38.3°C) 1, 4, abnormal cervical or vaginal mucopurulent discharge 1, 2, presence of white blood cells (WBCs) on saline microscopy of vaginal secretions 1, 4, elevated erythrocyte sedimentation rate (ESR) 1, 2, or elevated C-reactive protein (CRP) 1, 4
Laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis supports the diagnosis of PID 1, 2

The CDC recommends that treatment regimens for PID provide empiric, broad-spectrum coverage of likely pathogens, including N. gonorrhoeae, C. trachomatis, anaerobes, gram-negative facultative bacteria, and streptococci 1, 6
The CDC suggests that treatment should be initiated as soon as the presumptive diagnosis is made, and that all regimens should be effective against N. gonorrhoeae and C. trachomatis, even with negative endocervical screening 6, 3

The CDC recommends emphasizing the need to take all medication regardless of symptom improvement, avoiding sex until treatment is completed, and referring sex partners for evaluation and treatment 7, 8