This is a flowchart on pelvic inflammatory disease (PID), covering the etiology, pathophysiology, and manifestations.
ADDITIONAL TAGS:
Infection ascends to infect the upper reproductive tract (endometrium, fallopian tubes, ovaries) and/or peritoneal cavity:
Ovarian adhesions
IUDs
↑ risk pathogen ascension
Risk factors / SDOH
Cell / tissue damage
Structural factors
Medicine / iatrogenic
Infectious / microbial
Biochem / metabolic
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Environmental, toxin
Neurology pathology
Flow physiology
Pathophysiology
Etiology
Manifestations
Pathogens:
Chlamydia trachomatis
Neisseria gonorrhoeae
Escherichia coli
Ureaplasma
Mycoplasma
Other anaerobes
Infection in the lower genital tract (vagina, cervix)
Less common; consider coinfections
Risk factors:
Multiple sexual partners
Unprotected sex
History of prior STIs
Imbalance of intravaginal flora (vaginal dysbiosis)
Modern devices: ↑ risk is limited to the first 3 weeks after IUD placement
Endometrium: endometritis
Fallopian tubes: salpingitis
Ovaries: oophoritis
Uterine adnexa: adnexitis
Surrounding pelvis: parametritis
Peritoneum: peritonitis
Lower abdominal pain (generally bilateral)
Nausea, vomiting
Fever
Dysuria, urinary urgency
Menorrhagia, metrorrhagia
Dyspareunia
Abnormal vaginal discharge (yellow/green color)
Complications:
Pelvic peritonitis
Acute abdomen
Fitz-Hugh-Curtis syndrome: inflammation of the liver capsule (perihepatitis)
Violin-string-like adhesions from peritoneum to liver
RUQ abdominal pain
Tubo-ovarian abscess: pus collection in uterine adnexa
Spread to adjacent organs (bladder, bowel)
Pelvic inflammatory disease
Adnexitis
Fallopian tube adhesions
Tubal scarring
Impaired ciliary function and tubal occlusion
Ectopic pregnancy
Infertility
Chronic pelvic pain
Hydrosalpinx/pyosalpinx: fluid/pus in fallopian tubes