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This group of diseases generally affects women aged 15 to 40 years and can pose a serious health risk if not managed in a timely manner. Improper treatment of PID can lead to damage to the female reproductive organs and various complications.
Types
Depending on the affected anatomical area, pelvic inflammatory diseases include several pathologies described below.
Endometritis
This is an inflammation of the endometrium, which may be associated with other pelvic infections. Endometritis can be caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycobacterium tuberculosis, or by a combination of normal vaginal flora bacteria.
Typical symptoms include:
• Abdominal bloating
• Abnormal vaginal bleeding
• Constipation
• Uterine pain
The patient’s condition usually improves after a course of antibiotic therapy.
Oophoritis
This refers to inflammation of one or both ovaries. It typically occurs between 25 and 35 years of age, with risk factors including sexually transmitted infections (STIs), abortion, and others.
Oophoritis is caused by Streptococcus spp., Staphylococcus spp., Escherichia coli, and Neisseria gonorrhoeae. Symptom severity varies by case.
Myometritis
An infection of the uterine musculature, generally secondary to endometritis. It is most commonly associated with Arcanobacterium pyogenes and may coexist with other pathogens such as Fusobacterium necrophorum, Bacteroides spp., and Escherichia coli.
Parametritis
Parametritis is considered a pelvic inflammatory disease because it involves inflammation of the parametrium — a connective and smooth muscle structure that attaches the uterus to the pelvic wall and lies within the broad ligament.
It typically develops after complicated abortions, childbirth, gynecologic surgeries, or uterine diseases. Symptoms include fever, lower abdominal pain, and urinary disturbances.
Salpingitis
One of the most frequent infectious diseases of the female genital tract, salpingitis is the inflammation of the fallopian tubes. It can lead to infertility due to tubal damage and increases the risk of ectopic pregnancy. The most common cause is a sexually transmitted infection.
Causes
Pelvic inflammatory diseases are usually caused by bacteria ascending from the vagina and cervix to colonize the upper genital tract. This leads to tissue damage and exudate formation that affects the mucosa.
If not properly treated, the condition can become chronic.
Main risk factors include:
• Sexual intercourse with multiple partners
• Sexually transmitted infections caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis, etc.
• Alterations in vaginal flora (due to aerobic or anaerobic pathogens, or excessive vaginal douching)
• Insertion of intrauterine devices (IUDs), which may favor Actinomyces infection — the longer the device is used, the higher the risk
• Endometrial biopsy
• Induced or spontaneous abortion
• Childbirth
• Other infections, such as Mycobacterium tuberculosis–related salpingitis or viral infections
Approximately 20% of PID cases show no bacterial growth, usually in older women with subacute or chronic pelvic pain.
Symptoms and Signs
Symptoms of PID are variable. The most common include:
• Abdominal pain: present in 95% of cases, typically in the lower abdomen
• Changes in vaginal discharge: color, consistency, or odor alterations
• Abnormal bleeding: after intercourse or between periods
• Urinary symptoms: dysuria or urinary frequency
• Nausea and vomiting
Other symptoms may include loss of appetite, fatigue, and chills.
Diagnosis
There is no single definitive test for diagnosing PID. Diagnosis usually relies on a combination of laboratory and instrumental studies, including:
• Gynecological examination for signs of inflammation
• Complete blood count showing elevated leukocyte levels
• Pelvic ultrasound to exclude other possible causes (e.g., pregnancy, appendicitis)
• Cervical colposcopy
• Laparoscopy
• Endometrial biopsy (presence of plasma cells confirms PID)
In women wishing to conceive, ultrasound and laparoscopy can assess tubal patency and determine whether in vitro fertilization (IVF) or surgical intervention is required.
Classification according to clinical severity:
• Class I: uncomplicated disease, no peritoneal irritation
• Class II: complicated disease with adnexal masses or abscesses; possible peritoneal inflammation
• Class III: infection spreads beyond the pelvis, causing a systemic inflammatory response
Treatment
The longer treatment initiation is delayed, the higher the risk of complications. Prompt consultation with a specialist is crucial for proper diagnosis and management.
Therapeutic objectives:
• Eradicate infection
• Relieve symptoms
• Prevent complications
Mild PID is managed with antibiotic therapy to eliminate the causative bacteria. Preventive measures such as maintaining sexual hygiene and using condoms should also be followed.
If outpatient treatment is ineffective or poorly tolerated, hospitalization is indicated. The patient receives intravenous antibiotics, along with antipyretics and analgesics.
If an IUD is present, it should be removed once antibiotic treatment begins.
Hospitalization is also indicated in the following cases:
• Pregnancy
• PID of class II or III severity
• Uncertain diagnosis (PID vs ectopic pregnancy vs appendicitis)
• Uterine abnormalities in medical history
Surgical treatment is reserved for cases unresponsive to medical therapy or with severe complications. Surgical intervention is rarely required.
Complications
Without timely or effective treatment, complications may include:
• Chronic pelvic pain
• Infertility (due to tubal damage impairing conception or gestation)
• Ectopic pregnancy (due to altered tubal physiology preventing implantation in the uterus)
• Recurrent infections
• Increased risk of preterm birth and neonatal complications
• Other sequelae such as Reiter’s syndrome or reactive arthritis
Prevention
Preventive measures against PID are similar to those for STIs, aiming to prevent infection and its spread. However, it is important to note that not all PID cases are caused by sexually transmitted pathogens.
Barrier contraceptives (condoms) should be used, and the number of sexual partners should be limited to minimize infection risk.
For women already diagnosed with PID, early treatment is essential to prevent complications — representing secondary prevention.
Types
Depending on the affected anatomical area, pelvic inflammatory diseases include several pathologies described below.
Endometritis
This is an inflammation of the endometrium, which may be associated with other pelvic infections. Endometritis can be caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycobacterium tuberculosis, or by a combination of normal vaginal flora bacteria.
Typical symptoms include:
• Abdominal bloating
• Abnormal vaginal bleeding
• Constipation
• Uterine pain
The patient’s condition usually improves after a course of antibiotic therapy.
Oophoritis
This refers to inflammation of one or both ovaries. It typically occurs between 25 and 35 years of age, with risk factors including sexually transmitted infections (STIs), abortion, and others.
Oophoritis is caused by Streptococcus spp., Staphylococcus spp., Escherichia coli, and Neisseria gonorrhoeae. Symptom severity varies by case.
Myometritis
An infection of the uterine musculature, generally secondary to endometritis. It is most commonly associated with Arcanobacterium pyogenes and may coexist with other pathogens such as Fusobacterium necrophorum, Bacteroides spp., and Escherichia coli.
Parametritis
Parametritis is considered a pelvic inflammatory disease because it involves inflammation of the parametrium — a connective and smooth muscle structure that attaches the uterus to the pelvic wall and lies within the broad ligament.
It typically develops after complicated abortions, childbirth, gynecologic surgeries, or uterine diseases. Symptoms include fever, lower abdominal pain, and urinary disturbances.
Salpingitis
One of the most frequent infectious diseases of the female genital tract, salpingitis is the inflammation of the fallopian tubes. It can lead to infertility due to tubal damage and increases the risk of ectopic pregnancy. The most common cause is a sexually transmitted infection.
Causes
Pelvic inflammatory diseases are usually caused by bacteria ascending from the vagina and cervix to colonize the upper genital tract. This leads to tissue damage and exudate formation that affects the mucosa.
If not properly treated, the condition can become chronic.
Main risk factors include:
• Sexual intercourse with multiple partners
• Sexually transmitted infections caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis, etc.
• Alterations in vaginal flora (due to aerobic or anaerobic pathogens, or excessive vaginal douching)
• Insertion of intrauterine devices (IUDs), which may favor Actinomyces infection — the longer the device is used, the higher the risk
• Endometrial biopsy
• Induced or spontaneous abortion
• Childbirth
• Other infections, such as Mycobacterium tuberculosis–related salpingitis or viral infections
Approximately 20% of PID cases show no bacterial growth, usually in older women with subacute or chronic pelvic pain.
Symptoms and Signs
Symptoms of PID are variable. The most common include:
• Abdominal pain: present in 95% of cases, typically in the lower abdomen
• Changes in vaginal discharge: color, consistency, or odor alterations
• Abnormal bleeding: after intercourse or between periods
• Urinary symptoms: dysuria or urinary frequency
• Nausea and vomiting
Other symptoms may include loss of appetite, fatigue, and chills.
Diagnosis
There is no single definitive test for diagnosing PID. Diagnosis usually relies on a combination of laboratory and instrumental studies, including:
• Gynecological examination for signs of inflammation
• Complete blood count showing elevated leukocyte levels
• Pelvic ultrasound to exclude other possible causes (e.g., pregnancy, appendicitis)
• Cervical colposcopy
• Laparoscopy
• Endometrial biopsy (presence of plasma cells confirms PID)
In women wishing to conceive, ultrasound and laparoscopy can assess tubal patency and determine whether in vitro fertilization (IVF) or surgical intervention is required.
Classification according to clinical severity:
• Class I: uncomplicated disease, no peritoneal irritation
• Class II: complicated disease with adnexal masses or abscesses; possible peritoneal inflammation
• Class III: infection spreads beyond the pelvis, causing a systemic inflammatory response
Treatment
The longer treatment initiation is delayed, the higher the risk of complications. Prompt consultation with a specialist is crucial for proper diagnosis and management.
Therapeutic objectives:
• Eradicate infection
• Relieve symptoms
• Prevent complications
Mild PID is managed with antibiotic therapy to eliminate the causative bacteria. Preventive measures such as maintaining sexual hygiene and using condoms should also be followed.
If outpatient treatment is ineffective or poorly tolerated, hospitalization is indicated. The patient receives intravenous antibiotics, along with antipyretics and analgesics.
If an IUD is present, it should be removed once antibiotic treatment begins.
Hospitalization is also indicated in the following cases:
• Pregnancy
• PID of class II or III severity
• Uncertain diagnosis (PID vs ectopic pregnancy vs appendicitis)
• Uterine abnormalities in medical history
Surgical treatment is reserved for cases unresponsive to medical therapy or with severe complications. Surgical intervention is rarely required.
Complications
Without timely or effective treatment, complications may include:
• Chronic pelvic pain
• Infertility (due to tubal damage impairing conception or gestation)
• Ectopic pregnancy (due to altered tubal physiology preventing implantation in the uterus)
• Recurrent infections
• Increased risk of preterm birth and neonatal complications
• Other sequelae such as Reiter’s syndrome or reactive arthritis
Prevention
Preventive measures against PID are similar to those for STIs, aiming to prevent infection and its spread. However, it is important to note that not all PID cases are caused by sexually transmitted pathogens.
Barrier contraceptives (condoms) should be used, and the number of sexual partners should be limited to minimize infection risk.
For women already diagnosed with PID, early treatment is essential to prevent complications — representing secondary prevention.
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