Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease is an ascending polymicrobial infection of the upper reproductive tract. Infection may extend from the cervix into the endometrium, fallopian tubes, and pelvic peritoneum. Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and anaerobic bacteria may contribute, so treatment must cover more than one organism. Inflammation in the fallopian tubes can heal with fibrosis and adhesions. That structural damage explains the major long-term complications: infertility, ectopic pregnancy, and chronic pelvic pain. Infection can also collect as a tubo-ovarian abscess or pyosalpinx. When inflammation reaches the liver capsule, the patient may develop Fitz-Hugh-Curtis syndrome, usually presenting with right-upper-quadrant pain in addition to pelvic symptoms. The disease may be clinically mild despite causing tubal injury. The absence of high fever does not make PID safe to ignore, and a negative result for one organism does not exclude a polymicrobial infection.