How should I assess suspected PID?

The following symptoms in the history suggest PID:

  • Lower abdominal or pelvic pain, most commonly bilateral but sometimes unilateral
  • Deep dyspareunia
  • Abnormal vaginal discharge, which is usually purulent
  • Abnormal vaginal bleeding, most commonly post-coital or menorrhagia
  • Fever (although temperature often normal)

The following findings on examination are suggestive of PID:

  • Lower abdominal tenderness
  • Adnexal or uterine tenderness or cervical excitation on bimanual examination
  • Abnormal discharge on speculum examination2, 4

PID can be asymptomatic. Even when present, signs and symptoms have low sensitivity and specificity so have a low threshold for diagnosis and empirical treatment.