|Minimum Symptom Requirement For Diagnosis
The Centers for Disease Control and Prevention (CDC) minimum requirement for a diagnosis of PID are the presentation of the following symptoms:
1. Lower abdominal tenderness.
2. Adnexal tenderness: pain from the ovary and fallopian tube.
3. Cervical motion tenderness (chandelier sign): the patient experiences significant pain in the cervix when it is pressed and manipulated during a physical examination.
Typical Symptoms Of PID
Symptoms can range from nothing to mild to severe. In mild cases there may be slight cramping and in severe cases there is usually constant pain, vaginal discharge and heavy periods. The longer the condition is undiagnosed and untreated, the more severe it can become and the more damage it causes to the internal reproductive organs. In some women with early symptoms of PID however, the infection can spontaneously clear without treatment. They may never know they were even infected.
Signs Of Early PID
• Heavy/foul smelling vaginal discharge (cervicitis).
• Mild cramps not related to the menstrual cycle.
• Thickened endometrium (wall of the womb thickens, visible on an ultrasound scan).
• Small amounts of fluid in the cul-de-sac (this is the space just behind the vagina which is only visible on an ultrasound or with a procedure called a culdocentesis. Some fluid collection here is normal, increasing amounts signify a problem).
• Endometritis: inflammation of the lining of the uterus (chlamydia and gonorrhea infections are a common cause of this condition).
• Mild Salpingitis: inflammation of the fallopian tubes (again bacterial STD infections are a common cause).
Mid Stage PID
• Diffuse pain and tenderness in the lower abdomen.
• Back Pain.
• Heavier vaginal discharge.
• Heavy periods (metrorrhagia) and severe menstrual cramps (dysmenorrhea).
• Painful sexual intercourse.
• Pain on urination.
• Pain on one side of the abdomen if one fallopian tube develops an abscess.
• Constant fatigue.
• Increasing amounts of fluid and some pus found in the cul-de-sac.
• Oophitis: small abscesses found on surface of the ovary.
• Small abscesses on the fallopian tubes.
• Moderate salpingitis: fallopian tubes become more inflamed.
• Pyosalpinx: pus gathers in the fallopian tubes.
• Nausea and vomiting.
• Multiple large abscesses on the fallopian tubes and ovaries.
• Large amounts of fluid and pus found in the cul-de-sac.
How Does A Typical Patient Present At Her Doctors?
The most common case presenting at a doctor for treatment is that of a woman who has suffered lower abdominal pain for 2 weeks or less. She typically complains of recently more painful and heavier periods and has been suffering from dysuria (painful urination) and dyspareunia (painful sexual intercourse). Fever occurs in about half of patients. STD testing will show gonorrheal and chlamydial infections in about 50 percent of cases. A pelvic examination is likely to show up some sort of cervical discharge.
Conditions With Similar Symptoms
As there is no specific test for PID (see pelvic inflammatory disease diagnosis), your doctor will need to rule out other conditions which present with similar symptoms. These include:
Septic abortion (miscarriage associated with uterine infection).
Ruptured ovarian cysts.
Twisted ovarian cyst.
Degeneration of a uterine fibroid.
Acute enteritis (sudden and brief inflammation of the small intestine).
I developed PID after having an IUD device put in. I didn’t notice any problems for the first few months. Then I started getting mild cramps which eventually turned into stabbing pains with chills and vomiting. The infection was severe by the time I was treated.
My main symptoms were irregular, heavy bleeding with bad cramps and a fever. In one really nasty flare up the pains were so bad I felt like I was in labor. There was also extremely heavy bleeding that I had to change my sanitary protection every half an hour. It got so bad I was almost hospitalized to get an intravenous antibiotic. Even though I’ve had regular Pap and blood tests they never found a cause. My doctor told me I now have severe internal scaring but fortunately I’ve already had my family. I have been left with really bad menstrual cramping, which I didn't have before the infection.
According to my doctor, I got PID from having untreated bacterial vaginosis - it was the only conclusion he said because I’ve never had an STD or an IUD. I’m in constant pain (pain all over the abdomen), my periods have become irregular and I’m always tired and have chronic headaches. Apparently I’ve had PID for years without knowing it. I’ve been treated but a lot of damage has been done which is why I’m left with these symptoms. My doctor told me that I also have cervical ectropion which is why I’ve noticed spotting after sexual intercourse.
Hailey, Wichita Kansas
Causes of pelvic inflammatory disease.
Pelvic inflammatory disease diagnosis.