Pelvic Inflammatory Disease

Aka: Pelvic Inflammatory Disease, PID, Tubo-Ovarian Inflammatory Disease, Salpingo-Oophoritis, Fitz-Hugh-Curtis Syndrome, Chlamydial Perihepatitis, Gonococcal Perihepatitis

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II. Definitions

  1. Pelvic Inflammatory Disease (PID)
    1. Inflammation of the upper genital tract (Uterus, fallopian tubes, ovaries and peritoneum)
    2. PID is a broad term that includes Endometritis, salpingitis, Tuboovarian Abscess and pelvic peritonitis

III. Epidemiology

  1. Incidence: 750,000 cases per year in United States
    1. May affect up to 4% of women of reproductive age
  2. Age: Peaks between ages 15 to 29 years (up to age 40 years)

IV. Pathophysiology

  1. Intra-abdominal spread (most common)
    1. Ascending Bacterial Infection of the lower genital tract (e.g. Vaginitis, Cervicitis) to the upper tract
    2. Vagina to Cervix to endometrium and via fallopian tubes to the peritoneal cavity
    3. Spread may be from sexual intercourse or retrograde Menstruation
  2. Lymphatic spread
    1. Example: IUD related infection
  3. Hematogenous spread (rare)
    1. Example: Tuberculosis

V. Causes

  1. Sexually Transmitted Disease (most common initial causes of PID)
    1. Chlamydia Trachomatis (15% of untreated cases progress to PID)
    2. NeisseriaGonorrhea
    3. Mycoplasma Genitalium (4 to 22% of PID cases, esp. post-abortive)
      1. Associated with treatment failures (not covered by all Antibiotic regimens)
  2. Polymicrobial Bacteria
    1. Includes Gram Negative Bacteria and Anaerobic Bacteria
      1. May occur from superinfected STD (esp. with abscess formation)
    2. Bacteroides fragilis
    3. Escherichia coli
    4. Klebsiella species
    5. Mycoplasma hominis
    6. Haemophilus Influenzae
    7. Ureaplasma Urealyticum
    8. Facultative or anaerobic organisms
  3. Bacterial Vaginosis associated infections
    1. Anaerobic Bacterial Infection related to BV is associated with PID
    2. Bacterial Vaginosis may disrupt cervical barrier and allow for ascending Bacterial Infections

VI. Risk Factors

  1. Sexually Transmitted Disease (STD) history
    1. Chlamydia is asymptomatic in 80-90% of women
    2. Gonorrhea is asymptomatic in 10% of women
    3. Untreated Chlamydia or Gonorrhea is associated with a 10-20% risk of PID
  2. Age younger than 25 years
  3. Onset sexual intercourse at a young age (younger than 15 years old)
  4. Prior history of Pelvic Inflammatory Disease
  5. High number of sexual partners (or new sexual partner) or sex workers
  6. Incarcerated Patients
  7. Substance Abuse or mental health disorders
  8. Non-barrier Contraception (e.g. IUD, Oral Contraceptives)
  9. Recent procedures
    1. Surgical abortion
    2. Recently placed Intrauterine Device (IUD) within last 3 to 6 weeks

VII. History

  1. See Sexual History
  2. Review risk factors as above
  3. Lesbian Women are still at risk of Sexually Transmitted Infection and PID
    1. Sexually Transmitted Infection still occurs between women
    2. Of Women Who Have Sex With Women, 30% also report having sex with men within the last year
    3. Xu (2010) Sex Transm Dis 37(7): 407-13 [PubMed]
  4. Pregnancy does not protect against PID in the first trimester
    1. Cervical Mucus plug and amniotic sac does not protect from ascending infection until later first trimester
  5. Transgender men (transmasculine, female to male transition)
    1. Many or most have not had gender affirming surgery ("bottom surgery")
    2. Perform a careful history and exam to identify presence of female genital organs

VIII. Symptoms

  1. Precautions
    1. Pelvic Inflammatory Disease is often initially missed
    2. Only 40% of women with PID are symptomatic, and symptoms are often nonspecific initially
  2. Onset within first week of Menses is common (50% of cases)
    1. Menses allows infection to spread proximally via an open Cervix to endometrial cavity
  3. Acute Abdominal Pain, Pelvic Pain or cramping (most common presentation, varying intensity)
  4. Vaginal Discharge (new or abnormal)
  5. Fever or chills (fever may be high grade)
  6. Dyspareunia
  7. Dysuria
  8. Heavy or prolonged Menses or post-coital bleeding
  9. Pleuritic right upper quadrant pain (liver capsule inflammation in Fitz-High-Curtis Syndrome, Perihepatitis)

IX. Exam

  1. Bimanual exam and speculum exam in all suspected cases
    1. Cervical motion tenderness
    2. Uterine tenderness
    3. Adnexal tenderness
    4. Abnormal mucopurulent discharge per Cervix or vagina
  2. See Diagnosis below for signs
  3. Clinical diagnosis alone is accurate (when compared with imaging and laparoscopy)
    1. Test Sensitivity: 87%
    2. Test Specificity: 50%
    3. Positive Predictive Value: 65-90%

X. Diagnosis: 2002 CDC Criteria

  1. Major Criteria (Required)
    1. Uterine or Adnexal tenderness to palpation or
    2. Cervical motion tenderness
    3. No other apparent cause
  2. Minor Criteria (Supporting, but not required)
    1. Fever >101 F (38.3 C)
    2. Abnormal mucopurulent discharge per Cervix or vagina
    3. WBCs on Gram Stain or Saline of Cervix swab
    4. Gonorrhea or Chlamydia testing positive
    5. Increased Erythrocyte Sedimentation Rate or C-Reactive Protein
    6. PID findings on diagnostic study (see below)
  3. Most specific findings (not required and rarely indicated unless refractory to management or unclear diagnosis)
    1. Laparoscopy findings consistent with Pelvic Inflammatory Disease
    2. Endometrial Biopsy with histology suggestive of Endometritis
    3. Imaging (Transvaginal Ultrasound or MRI) with classic findings
      1. Thickened, fluid filled tubes
      2. Free pelvic fluid may be present
      3. Tubo-ovarian complex
      4. Tubal hyperemia on Doppler Ultrasound

XI. Differential Diagnosis

  1. See Acute Pelvic Pain
  2. See Acute Pelvic Pain Causes
  3. Lower genital tract infection (Cervicitis, Vaginitis)
    1. Vaginal discomfort, mucopurulent discharge and Dysuria may be present
    2. Pelvic Pain and fever are absent (contrast with PID)
  4. Ruptured Ovarian Cyst
    1. Sudden onset of mid-cycle, unilateral Pelvic Pain
  5. Ectopic Pregnancy
    1. Unilateral pain
    2. Positive Pregnancy Test
    3. Afebrile
    4. White Blood Cell Count normal
    5. Hypotension or Anemia
  6. Appendicitis
    1. Periumbilical or Right Lower Quadrant Abdominal Pain
    2. Peritoneal signs
    3. Vomiting, Anorexia
  7. Urinary Tract Infection (including Pyelonephritis)
    1. Dysuria, frequency, urgency
    2. No Cervical Motion Tenderness or Vaginal Discharge
  8. Ovarian Torsion
    1. More localized, unilateral severe, sudden onset Pelvic Pain
    2. Afebrile
    3. White Blood Cell Count normal
  9. Endometriosis
    1. Dysmenorrhea
    2. Dyspareunia
  10. Endometritis (component of Pelvic Inflammatory Disease)
    1. Fever
    2. Pelvic Pain
    3. Vaginal Discharge
  11. Ureteral Stone
    1. Unilateral Flank Pain or Pelvic Pain
    2. Nausea, Vomiting
  12. Other common causes
    1. Nephrolithiasis
    2. Inflammatory Bowel Disease

XII. Labs

  1. General
    1. Do not delay treatment while waiting for lab results
    2. Delayed Antibiotics by 2-3 days increases Infertility and future Ectopic Pregnancy risk by 3 fold
  2. Inflammatory markers (if all normal, PID is very unlikely)
    1. Complete Blood Count (CBC)
    2. Elevated Erythrocyte Sedimentation Rate or C-Reactive Protein
    3. Vaginal secretion exam (saline Wet Prep)
      1. Identifies Trichomonas vaginalis and Bacterial Vaginosis
      2. White Blood Cells >10/hpf is suggestive of Cervicitis
        1. Vaginal PMNs (Negative Predictive Value 95%)
  3. Sexually Transmitted Infection screening
    1. DNA probe PCR for Gonorrhea and Chlamydia
      1. Cervical specimen recommended over urine specimen
      2. Test Sensitivity and Test Specificity are high
    2. Trichomonas PCR
    3. Mycoplasma Genitalium PCR
    4. Rapid Plasma Reagin (RPR)
    5. Human Immunodeficiency Virus Test (HIV Test)
  4. Other initial labs
    1. Urinalysis
    2. Urine Pregnancy Test (all patients)
      1. Exclude Ectopic Pregnancy if positive
    3. Blood Cultures
    4. Complete Blood Count
    5. C-Reactive Protein (CRP)
      1. High CRP levels are associated with Tubo-Ovarian Abscess

XIII. Imaging

  1. Indications
    1. Imaging is not required for PID diagnosis (PID is a clinical diagnosis)
    2. Consider in nonspecific or vague clinical presentations
    3. Tuboovarian Abscess suspected
    4. Ectopic Pregnancy suspected
    5. Ovarian Torsion
    6. Alternative intraabdominal diagnosis is considered (e.g. Diverticulitis, Appendicitis)
  2. Transvaginal pelvic Ultrasound
    1. Preferred first-line imaging
    2. Efficacy for diagnosing PID
      1. Test Sensitivity: 30%
      2. Test Specificity: 76%
    3. Pelvic free fluid in cul-de-sac
    4. Tubo-Ovarian Abscess may be present
    5. Doppler demonstrates tubal hyperemia
    6. Fallopian tube changes
      1. Thickened fallopian tube wall >5 mm
      2. Fluid filled fallopian tubes
      3. Incomplete septae in fallopian tube (tuboovarian complex or mass)
        1. Cogwheel sign on tube cross-section view
  3. CT Pelvis with IV contrast
    1. Consider when differential diagnosis is broad (e.g. Appendicitis, Diverticulitis, malignancy)
    2. Efficacy for diagnosing PID
      1. Test Sensitivity: 79%
      2. Test Specificity: 99%
    3. Findings
      1. Pelvic floor fascial, Adnexal inflammation
      2. Uterosacral ligament thickening
      3. Pelvic free fluid
  4. MRI Pelvis
    1. Efficacy for diagnosing PID
      1. Test Sensitivity: 81-95%
      2. Test Specificity: 89-100%
    2. Tubo-Ovarian Abscess may be present
    3. Pelvic free fluid
    4. Fallopian tube changes
      1. Fluid filled fallopian tubes
      2. Ovaries have polycystic appearance
    5. References
      1. Tukeva (1999) Radiology 210:209-16 [PubMed]

XIV. Diagnostics

  1. Endometrial Biopsy: Endometritis
    1. Test Sensitivity: 74%
    2. Test Specificity: 84%
  2. Laparoscopy
    1. Indicated for unclear diagnosis
    2. Pelvic Inflammatory Disease misdiagnosed 25% time

XV. Management: General

  1. Treat patient's sexual contacts within last 60 days empirically for Gonorrhea and Chlamydia
    1. Abstain from sexual intercourse for >7 days AND until patient and partner have completed treatment
    2. Counsel on safe sex
    3. Consider Expedited Partner Treatment (esp. if sex partners do not have medical contact)
      1. Cefixime 800 mg orally once AND Doxycycline 100 mg orally twice daily for 7 days (or Azithromycin 1 g once)
      2. Legality varies by U.S. State
  2. Start empiric therapy if minimal criteria present
    1. Do not delay treatment
    2. Delay >2-3 days increases ectopic and Infertility risk by 3 fold (see above)
  3. Antibiotics should cover Gonorrhea and Chlamydia
  4. Follow-up
    1. Within 48 to 72 hours of hospital discharge or start of outpatient management
    2. Repeat STD testing in 3 months (Gonorrhea and Chlamydia)
      1. Intended to test for new infection
    3. Discuss risk of PID complications (Ectopic Pregnancy, Infertility)

XVI. Management: Special Populations

  1. Intrauterine Device (IUD) removal is controversial
    1. IUD increases PID for only first 3 to 6 weeks following insertion
      1. Risks are similar between the Copper-T IUD and the Mirena IUD
    2. Historically, IUD has been removed at time of PID diagnosis
    3. No evidence supports removal of IUD in PID
    4. Close follow-up is critical for those who developed PID with IUD in place
    5. IUD may be left in place if improving by 48 to 72 hours
      1. If not improving at 48 to 72 hours, remove IUD
    6. Tubo-Ovarian Abscess may occur with Actinomyces infection (Tubo-Ovarian Actinomycosis)
      1. Complicated by multiple abscesses, fibrosis and granulation tissue development
      2. Imaging demonstrates multiple solid lesions of contrast enhancement within abscesses
  2. HIV positive women
    1. May be treated with same Antibiotics and guidelines as non-HIV patients
    2. Higher risk of Tubo-Ovarian Abscess
    3. More likely to be infected with Mycoplasma genitalum or Streptococcus than with Gonorrhea or Chlamydia
      1. Consult infectious disease and consider Antibiotic modification if not improving
  3. Pregnant women
    1. PID is less common in pregnancy, but can occur in first trimester before formation of mucous plug
    2. Pregnant women with PID have increased complications (Preterm Labor, Chorioamnionitis, higher mortality)
    3. Admit and initiate ParenteralAntibiotics for initial PID treatment in pregnancy
    4. Treat with Cefoxitin and Azithromycin one gram
  4. Antibiotic resistant cases
    1. Consider Mycoplasma genitalum

XVII. Management: Outpatient

  1. Indications
    1. Temperature <=38 C (100.4 F)
    2. White Blood Cell Count <11,000 mm3
    3. Minimal peritoneal findings
    4. Tolerating food and fluids
  2. Step 1: Initial Treatment at Diagnosis (with step 2)
    1. Gonorrhea management
      1. Ceftriaxone 500 mg IM/IV for 1 dose (1 gram IM/IV if weight > 150 kg or Tubo-Ovarian Abscess) OR
      2. Gentamicin 240 mg IM and Azithromycin 2 g orally for one dose (if true Cephalosporin allergy) OR
      3. Cefoxitin 2 g IM AND probenacid 1 g orally
      4. Cefixime 800 mg orally once is an alternative but NOT recommended due to Antibiotic Resistance
    2. Chlamydia management
      1. Doxycycline 100 mg twice daily for 7 days (preferred as of 2020, 14 days covers full PID course) OR
      2. Azithromycin 1 g orally for 1 dose (NOT recommended - see below)
    3. References
      1. Cyr (2020) MMWR Morb Mortal Wkly Rep 69(50): 1911-6 [PubMed]
        1. https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a6.htm
  3. Step 2: Outpatient 14 day Antibiotic course
    1. Select general Antibiotic coverage
      1. Doxycycline 100 mg PO every 12 hours for 14 days (75% cure, preferred agent) or
      2. Azithromycin 1 gram orally once weekly for 2 weeks (alternative option, not CDC guideline)
        1. Savaris (2007) Obstet Gynecol 110:53–60 [PubMed]
    2. Consider adding anaerobic coverage (if Trichomoniasis, BV, recent uterine instrumentation)
      1. Anaerobic coverage (esp. Metronidazole) is frequently recommended in PID cases as of 2023
      2. Metronidazole 500 mg orally twice daily for 14 days (preferred) OR
      3. Clindamycin 450 mg PO four times daily for 14 days
    3. Agents to avoid
      1. Fluoroquinolones are no longer recommended
        1. However may be considered as alternative agent in cases where Gonorrhea is unlikely
          1. Patient/community are low risk for GC, GC testing obtained, patient reliable for followup
        2. In these cases, Fluoroquinolones are combined WITH Metronidazole 500 mg every 12 hours for 14 days:
          1. Ofloxacin 400 mg orally twice daily OR
          2. Levofloxacin 500 mg orally daily OR
          3. Moxifloxacin (Avelox) 400 mg orally daily
            1. Preferred treatment if Mycoplasma genitalum is identified
      2. Cohorts at highest risk for Fluoroquinolone resistance
        1. Homosexual men and any female sexual contacts
        2. Endemic areas
          1. Asia: China, Japan, Korea, Philippines, Vietnam
          2. Other: England, Wales, Australia
          3. US: California

XVIII. Management: Inpatient

  1. Hospitalization Indications
    1. Severe illness
      1. Toxic appearance
      2. High fever (>101.3 F)
    2. Unable to take oral fluids or oral medications (intractable Nausea, Vomiting)
    3. Unclear diagnosis
      1. Appendicitis
      2. Ectopic Pregnancy
      3. Ovarian Torsion
    4. Pelvic abscess (Tubo-Ovarian Abscess)
      1. Requires at least 24 hours of Parenteral therapy inpatient
    5. Pregnancy
      1. PID increases the risk of Intrauterine Fetal Demise and preterm birth
    6. Adolescents
    7. Outpatient treatment failure
      1. Failure to improve after 3 days of outpatient Antibiotics
      2. Persistent fever, pain or tenderness
    8. Unreliable patient
    9. HIV Infection alone is NOT an indication for hospitalization (unless other factors present)
  2. Inpatient treatment Regimens
    1. General
      1. Treat for at least 48 hours IV or oral regimen tolerated, affebrile and decreasing Leukocytosis
    2. Regimen A (preferred)
      1. Cefoxitin 2g IV every 6 hours OR Cefotetan 2g IV every 12 hours OR Ceftriaxone 1 g IV every 24 hours AND
      2. Doxycycline 100 mg oral or IV q12h AND
      3. Metronidazole 500 mg IV or oral every 12 hours (if using Ceftriaxone)
    3. Regimen B (consider in Cephalosporin allergy or pregnancy)
      1. Clindamycin 900 mg IV every 8 hours AND
      2. Gentamicin 2 mg/kg IV load, then 1.5 mg/kg IV every 8 hours
        1. Alternative: Conversion to single daily dosing (at 3-5 mg/kg)
    4. Alternative
      1. Ampicillin/Sulbactam (Unasyn) 3g IV q6 hours AND
      2. Doxycycline 100 mg PO or IV q12 hours
    5. Other options that are not recommended (if Cephalosporin and Penicillin allergic)
      1. Regimen C (only used as alternative if low Gonorrhea criteria met as listed above)
        1. Ofloxacin 400 mg IV q12h or Levoquin 500 IV qd and
        2. Metronidazole 500 IV q8 hours
    6. Discharge Regimen (after IV Antibiotics above)
      1. See Outpatient Management Step 2 above
      2. Discontinue 24 hours after clinical improvement and complete therapy with oral Antibiotics
        1. Doxycycline 100 mg orally twice daily for 14 days or
        2. Clindamycin 450 mg PO qid for 14 days

XIX. Course

  1. Expect clinical symptom improvement within first 72 hours of treatment
  2. Lack of improvement after 72 hours requires additional evaluation
    1. Consider inpatient Parenteral therapy
    2. Broaden Antibiotic coverage
    3. Consider Ultrasound to assess for Tubo-Ovarian Abscess

XX. Prevention

  1. Screen all sexually active women age <25 years for Chlamydia
  2. Re-screen for STD 3 months after PID episode (Gonorrhea and Chlamydia)
    1. Re-screen pregnant patients after 4 weeks
  3. Encourage barrier Contraception (Condom use)
  4. Prophylactic Antibiotic indications for women with history of PID
    1. Hysterosalpingography
    2. Uterine evacuation for pregnancy loss

XXI. Complications: Acute

  1. Fitz-Hugh-Curtis Syndrome or Perihepatitis (5-10% of PID patients)
    1. Hematogenous or transperitoneal spread of Chlamydia or Gonorrhea to peri-hepatic region
    2. Presents with right upper quadrant pain and tenderness, as well as Pleuritic Chest Pain
    3. Liver Function Tests may be elevated
  2. Tubo-Ovarian Abscess (17-20% of PID patients)
    1. See Tubo-Ovarian Abscess
    2. Associated with peritonitis and Sepsis risk
    3. More common with delay in treatment
    4. Admit all patients with Tubo-Ovarian Abscess
    5. Management is a combination of IV Antibiotics and in some cases surgical drainage
  3. Refractory Infection
    1. Mycoplasma Genitalium
      1. Consider if persistent findings at 7-10 days
      2. Treat with Moxifloxacin 400 mg orally daily for 14 days

XXII. Complications: Chronic

  1. Chronic Pelvic Inflammatory Disease
  2. Infertility associated with tubal scarring (16 to 20%)
  3. Chronic Pelvic Pain (18%)
  4. Tubal Pregnancy (9%)

XXIII. Resources

  1. Munro (2018) Diagnosis and Management of Tubo-Ovarian Abscess, TOG, 20(1):11-9
    1. https://obgyn.onlinelibrary.wiley.com/doi/10.1111/tog.12447

XXIV. References

  1. Harmon and Welsh (2018) Crit Dec Emerg Med 32(9): 16
  2. Martin and Khoujah (2023) Crit Dec Emerg Med 37(10): 22-9
  3. (2002) MMWR Recomm Rep 51(RR-6):1-78 [PubMed]
  4. Brunham (2015) N Engl J Med 372(21):2039-48 [PubMed]
  5. Crossman (2006) Am Fam Physician 73(5):859-64 [PubMed]
  6. Curry (2019) Am Fam Physician 100(6): 357-64 [PubMed]
  7. Gradison (2012) Am Fam Physician 85(8): 791-6 [PubMed]
  8. Miller (2003) Am Fam Physician 67(9):1915-22 [PubMed]
  9. Workowski (2010) MMWR Recomm Rep 59(RR-12): 1-110 [PubMed]
  10. Workowski (2015) MMWR Recomm Rep 64(RR-3):1-137 [PubMed]

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Related Studies

Ontology: Tubo-ovarian inflammatory disease (C0036133)

Concepts Disease or Syndrome (T047)
ICD9 614.2
ICD10 N70 , N70.9, N70.93
SnomedCT 198150005, 155971007, 198153007, 198147007, 266650009, 46536000
Italian Salpingo-ooforite, Salpingite e ovarite non specificato se acuta, subacuta o cronica
English Salpingitis and oophoritis unspecified, Salpingitis and oophoritis, unspecified, Salpingitis/oophor.unspec.NOS, Salpingitis/oophoritis unspec., Salpingo-oophoritis unspecif., Salpingo-oophoritis unspecified, Unspecified salpingitis and oophoritis NOS, Salpingitis/oophoritis NOS, tubo-ovarian inflammatory disease (diagnosis), salpingo-oophoritis, tubo-ovarian inflammatory disease, salpingo-oophoritis (diagnosis), Salpingo-oophoritis NOS, salpingo oophoritis, Salpingo-oophoritis unspecified (disorder), Salpingitis/oophoritis NOS (disorder), Unspecified salpingitis and oophoritis NOS (disorder), Salpingitis and oophoritis unspecified (disorder), Inflammation of ovary and fallopian tube, Salpingitis and oophoritis, Salpingo-oophoritis, Tubo-ovarian inflammatory disease, Tubo-ovarian inflammatory disease (disorder), infection; tubo-ovarian, inflammation; tubo-ovarian, salpingo-ovaritis, tubo-ovarian; disorder, inflammatory, tubo-ovarian; infection, tubo-ovarian; inflammation, Salpingitis and oophoritis not specified as acute, subacute, or chronic
Dutch salpingitis en oöforitis niet-gespecificeerd als acuut, subacuut of chronisch, infectie; tubo-ovarieel, ontsteking; tubo-ovarieel, tubo-ovarieel; aandoening, inflammatoir, tubo-ovarieel; infectie, tubo-ovarieel; ontsteking, Salpingitis en oforitis, niet gespecificeerdm, salpingo-oöforitis, Salpingitis en oforitis
French Oophorite et salpingite non précisées comme aiguës, subaiguës ou chroniques, Salpingo-ovarite
German Salpingitis und Oophoritis, ohne Angabe ob akut, subakut oder chronisch, Salpingitis und Oophoritis, nicht naeher bezeichnet, Salpingitis und Oophoritis, Salpingo-Oophoritis
Portuguese Salpingite e ooforite NE se aguda, subaguda ou crónica, Salpingo-ooforite
Spanish Salpingitis y ooforitis no especificadas como agudas, subagudas o crónicas, salpingitis y ooforitis no especificadas, SAI, Salpingitis/oophoritis NOS, salpingooforitis, no especificada (trastorno), salpingitis/ooforitis, SAI, salpingitis/ooforitis, SAI (trastorno), salpingitis y ooforitis, no especificadas (trastorno), salpingitis y ooforitis no especificadas, SAI (trastorno), salpingooforitis, no especificada, salpingitis y ooforitis, no especificadas, enfermedad inflamatoria tubo - ovárica (trastorno), enfermedad inflamatoria tubo - ovárica, ovariosalpingitis, Salpingo-ooforitis, salpingo - ovaritis, salpingooforitis
Japanese 卵管卵巣炎, ﾗﾝｶﾝﾗﾝｿｳｴﾝ
Czech Salpingo-ooforitida, Salpingitida a ooforitida neurčená jako akutní, subakutní nebo chronická
Korean 자궁관염 및 난소염, 상세불명의 자궁관염 및 난소염
Hungarian Salpingitis és oophoritis nem meghatározott, mint acut, subacut vagy chronicus, salpingo-oophoritis
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Pelvic Inflammatory Disease (C0242172)

Definition (MSHCZE) Spektrum zánětlivých procesů u žen v oblasti horního genitálního traktu a souvisejících tkáních. To je obvykle způsobeno postupující infekcí v organismu z oblasti endocervixu výše. Infekce může být omezena na dělohu (ENDOMETRITIDA), VEJCOVODY (SALPINGITIDA), vaječníky (OOFORITIDA), podpůrné ligamenty (PARAMETRITIDA) nebo může napadnout více uvedených orgánů. Takový zánět může vést k funkčnímu poškození těchto orgánů a k neplodnosti.
Definition (MEDLINEPLUS)

Pelvic inflammatory disease (PID) is an infection and inflammation of the uterus, ovaries, and other female reproductive organs. It causes scarring in these organs. This can lead to infertility, ectopic pregnancy, pelvic pain, abscesses, and other serious problems. PID is the most common preventable cause of infertility in the United States.

Gonorrhea and chlamydia, two sexually transmitted diseases, are the most common causes of PID. Other bacteria can also cause it. You are at greater risk if you

  • Are sexually active and younger than 25
  • Have more than one sex partner
  • Douche

Some women have no symptoms. Others have pain in the lower abdomen, fever, smelly vaginal discharge, irregular bleeding, and pain during intercourse or urination. Doctors diagnose PID with a physical exam, lab tests, and imaging tests. Antibiotics can cure PID. Early treatment is important. Waiting too long increases the risk of infertility.

NIH: National Institute of Allergy and Infectious Diseases
Definition (NCI_FDA) Any pelvic infection involving the upper female genital tract beyond the cervix.
Definition (NCI) Pelvic inflammatory disease (PID) is an acute or chronic inflammation in the pelvic cavity. It is most commonly caused by sexually transmitted diseases, including chlamydia and gonorrhea that have ascended into the uterus, fallopian tubes, or ovaries as a result of intercourse or childbirth, or of surgical procedures, including insertion of IUDs or abortion. PID may be either symptomatic or asymptomatic. It may cause infertility and it may raise the risk of ectopic pregnancy. PID is a disease associated with HIV infection.
Definition (NCI_NCI-GLOSS) A condition in which the female reproductive organs are inflamed. It may affect the uterus, fallopian tubes, ovaries, and certain ligaments. Pelvic inflammatory disease is usually caused by a bacterial infection. It may cause infertility and an increased risk of an ectopic pregnancy (pregnancy in the fallopian tubes).
Definition (NCI_CTCAE) A disorder characterized by an infectious process involving the pelvic cavity.
Definition (CSP) spectrum of inflammation involving the female upper genital tract and the supporting tissues; is usually caused by an ascending infection of organisms from the endocervix that may be confined to the uterus, fallopian tubes, ovaries, the supporting ligaments, or may involve several of the above uterine appendages; such inflammation can lead to functional impairment and infertility.
Definition (MSH) A spectrum of inflammation involving the female upper genital tract and the supporting tissues. It is usually caused by an ascending infection of organisms from the endocervix. Infection may be confined to the uterus (ENDOMETRITIS), the FALLOPIAN TUBES; (SALPINGITIS); the ovaries (OOPHORITIS), the supporting ligaments (PARAMETRITIS), or may involve several of the above uterine appendages. Such inflammation can lead to functional impairment and infertility.
Concepts Disease or Syndrome (T047)
MSH D000292
ICD9 614.9, 614-616.99
ICD10 N70-N77.9 , N73.9, N70-N77
SnomedCT 198130006, 198244005, 155974004, 155967009, 266584000, 266648001, 155968004, 198570007, 266651008, 198178006, 155986001, 37518008, 198131005
English Disease, Pelvic Inflammatory, Diseases, Pelvic Inflammatory, Inflammatory Disease, Pelvic, Inflammatory Diseases, Pelvic, Pelvic Inflammatory Diseases, PELVIC INFLAMMATION, Disease, Inflammatory Pelvic, Diseases, Inflammatory Pelvic, Inflammatory Pelvic Disease, Inflammatory Pelvic Diseases, Pelvic Disease, Inflammatory, Pelvic Diseases, Inflammatory, Female pelvic inflam disease, Female pelvic inflam.dis.NOS, Female pelvic inflammatory disease NOS, Female pelvic inflammatory diseases NOS, Inflammatory diseases of female pelvic organs, Inflammtry dis/fem pelv org, [X]Inflammatory diseases of female pelvic organs, [X]Inflammtry dis/fem pelv org, Female pelvic inflammatory disease, unspecified, PELVIC INFLAMM DIS, INFLAMM PELVIC DIS, PELVIC DIS INFLAMM, INFLAMM DIS PELVIC, pelvic inflammatory disease, pelvic inflammatory disease (diagnosis), PID, PID - pelvic inflammatory dis, Disease pelvic inflammatory, Pelvic inflammatory disease NOS, PID Pelvic inflammatory disease, Inflammation pelvic, Pelvic inflammation, Pelvic Infection, Fem pelv inflam dis NOS, Pelvic inflammatory disease (PID), Pelvic Inflammatory Disease [Disease/Finding], pelvic inflammation, pelvic inflammatory diseases, Disease;pelvic inflammatory, Infection;pelvic inflammatory, inflammatory pelvic disease, pelvic inflammatory disease (PID), pid, Inflammatory diseases of female pelvic organs (N70-N77), Female pelvic inflammatory disease NOS (disorder), Pelvic inflam. disease NOS, [X]Inflammatory diseases of female pelvic organs (disorder), Female pelvic infection, Inflammatory disease of female pelvic organs AND/OR tissues (disorder), Inflam. dis.- pelvic, Female pelvic inflammatory diseases NOS (disorder), DISEASE (PID), PELVIC INFLAMMATORY, PELVIC INFLAMMATORY DISEASE, (PID), PELVIC INFLAMMATORY DISEASE, Pelvic infection, PID, PELVIC INFLAMMATORY DISEASE, INFLAMMATORY DISEASE (PID), PELVIC, Pelvic inflammatory disease, Female pelvic inflammation, Female pelvic inflammatory disease, PID - pelvic inflammatory disease, Female pelvic inflammatory disease (disorder), Inflammatory disease of female pelvic organs AND/OR tissues, inflammation; pelvic, pelvic inflammatory disease; female, Inflammatory disease of female pelvic organs and tissues, NOS, Inflammatory disease of female pelvic organs AND/OR tissues [Ambiguous], Pelvic Inflammatory Disease, Unspecified inflammatory disease of female pelvic organs and tissues, INFLAMMATORY DISEASE OF FEMALE PELVIC ORGANS, pelvic inflammatory infection
Dutch ontsteking bekken, niet-gespecificeerde ontstekingsziekte van de vrouwelijke bekkenorganen en -weefsels, bekkenontstekingsziekte NAO, ontstekingsziekte bekken, PID Pelvic inflammatory disease, bekkenontsteking, Ontsteking kleine bekken/ PID, bekkenontsteking; vrouw, ontsteking; bekken, Ontstekingsprocessen in vrouwelijk bekken, niet gespecificeerd, bekkenontstekingsziekte, Adnexitis, PID, Pelvic inflammatory disease
French Pelvi-péritonite, Inflammation pelvienne SAI, Maladie inflammatoire pelvienne (MIP), Maladie inflammatoire non précisée des organes et tissus pelviens chez la gemme, Inflammation pelvienne, Atteinte inflammatoire pelvienne, AIP (Atteinte inflammatoire pelvienne), MIP (Maladie inflammatoire pelvienne), Syndrome inflammatoire pelvien, INFLAMMATION PELVIENNE, PID, Maladie pelvienne inflammatoire, Maladie inflammatoire pelvienne, Inflammation du pelvis
German Beckenentzuendung NNB, Entzuendung des Beckens, PID Beckenentzuendung, unspezifische Entzuendungen der Organe und Gewebe des weiblichen Beckens, BECKENENTZUENDUNG, Entzuendliche Krankheit im weiblichen Becken, nicht naeher bezeichnet, PID, Beckenentzuendung, Entzündliche Erkrankung des Beckens
Italian Infiammazione pelvica, Malattia infiammatoria non specificata degli organi e dei tessuti pelvici femminili, Malattia infiammatoria pelvica NAS, Malattia infiammatoria pelvica
Portuguese Inflamação pélvica, Doença inflamatória pélvica, Doença inflamatória pélvica NE, Doença inflamatória NE dos órgãos e tecidos pélvicos femininos, INFLAMACAO PELVICA, DIP, Doença Inflamatória da Pelve, Doença Pélvica Inflamatória, Doença pélvica inflamatória, Doença Inflamatória Pélvica
Spanish Enfermedad inflamatoria no especificada de los órganos y tejidos pélvicos femeninos, Inflamación pélvica, Enfermedad inlamatoria pélvica, Enfermedad inflamatoria de la pelvis NEOM, Enfermedad inflamatoria pélvica EIP, PELVIS, INFLAMACION, enfermedad inflamatoria pélvica femenina, SAI (trastorno), enfermedad inflamatoria pélvica, [X]enfermedades inflamatorias de órganos pélvicos femeninos, enfermedad inflamatoria pélvica femenina, SAI, enfermedad inflamatoria de los órganos Y/O tejidos pélvicos (concepto no activo), enfermedad pélvica inflamatoria, [X]enfermedades inflamatorias de órganos pélvicos femeninos (trastorno), enfermedad inflamatoria pelviana, enfermedad inflamatoria de los órganos Y/O tejidos pelvianos, enfermedades inflamatorias pélvicas femeninas, SAI (trastorno), EPI, enfermedades inflamatorias pélvicas femeninas, SAI, Female pelvic inflammatory disease NOS, enfermedad inflamatoria de los órganos Y/O tejidos pélvicos, EIP, enfermedad inflamatoria pélvica en la mujer (trastorno), enfermedad inflamatoria pélvica en la mujer, enfermedad inflamatoria pélvica femenina, inflamación pélvica femenina, Enfermedad inflamatoria pélvica, Enfermedad Inflamatoria Pélvica
Japanese 骨盤内炎症性疾患ＮＯＳ, 骨盤内炎症, ｺﾂﾊﾞﾝﾅｲｴﾝｼｮｳｾｲｼｯｶﾝ, ｺﾂﾊﾞﾝﾅｲｴﾝｼｮｳ, ｺﾂﾊﾞﾝﾅｲｴﾝｼｮｳｾｲｼｯｶﾝNOS, 骨盤内炎症性疾患, 子宮付属器炎, 付属器炎
Finnish Sisäsynnytintulehdus
Russian TAZOVYKH ORGANOV VOSPALITEL'NYE BOLEZNI, ADNEKSIT, АДНЕКСИТ, ТАЗОВЫХ ОРГАНОВ ВОСПАЛИТЕЛЬНЫЕ БОЛЕЗНИ
Czech Pánevní zánětlivé onemocnění, Pánevní zánětlivé onemocnění NOS, Zánět v pánvi, Zánětlivé onemocnění orgánů malé pánve, Pánevní zánět, Blíže neurčené zánětlivé onemocnění ženských pánevních orgánů a tkání, pánev - zánětlivé nemoci, pánevní zánět, pánevní zánětlivá onemocnění
Korean 상세불명의 여성 골반의 염증성 질환
Swedish Bäckeninflammation
Croatian UPALNE BOLESTI ZDJELICE, ZDJELICA, UPALNA BOLEST
Polish Choroba zapalna miednicy
Hungarian Kismedencei gyulladás, kismedencei gyulladásos betegség k.m.n., PID (kismedencei gyulladásos betegség), pelvikus gyulladás, kismedencei gyulladásos betegség, pelvikus gyulladásos betegség, Női kismedencei szervek és szövetek nem meghatározott gyulladásos betegsége, PID
Norwegian Bekkenbetennelse, Bekkeninflammasjon, Pelvioperitonitt
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Gonococcal Perihepatitis (C0341816)

Concepts Disease or Syndrome (T047)
MSH C537936
SnomedCT 186941004, 237042003
English Fitz-Hugh-Curtis synd-gonococ, gonococcal perihepatitis (diagnosis), gonococcal perihepatitis, Perihepatitis gonococcal, Perihepatitis Syndrome, Fitz-Hugh-Curtis syndrome, Gonococcal Perihepatitis, Gonococcal peri-hepatitis, Fitz-Hugh-Curtis syndrome - gonococcal, Gonococcal perihepatitis, Gonococcal perihepatitis (disorder)
Italian Periepatite gonococcica
Japanese 淋菌性肝周囲炎, ﾘﾝｷﾝｾｲｶﾝｼｭｳｲｴﾝ
Czech Gonokoková perihepatitida
Hungarian gonococcalis perihepatitis
Spanish perihepatitis gonocócica (trastorno), perihepatitis gonocócica, síndrome de Fitz-Hugh-Curtis - gonocócico, Perihepatitis gonocócica
Portuguese Perihepatite gonocócica
Dutch gonokokkenperihepatitis
French Péri-hépatite gonococcique
German Perihepatitis durch Gonokokken
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Chlamydial perihepatitis (C0341817)

Concepts Disease or Syndrome (T047)
SnomedCT 237043008
English Fitz-Hugh-Curtis synd-chlamyd, chlamydial perihepatitis, chlamydial perihepatitis (diagnosis), Fitz-Hugh-Curtis syndrome - chlamydial, Chlamydial perihepatitis, Chlamydial perihepatitis (disorder)
Spanish perihepatitis por clamidias (trastorno), perihepatitis por clamidias, síndrome de Fitz-Hugh-Curtis - por clamidias
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Fitz-Hugh-Curtis syndrome (C0549148)

Concepts Disease or Syndrome (T047)
SnomedCT 237041005, 186940003, 26790000
English Fitzhugh Curtis syndrome, Fitz-Hugh and Curtis syndrome, Fitz-Hugh-Curtis syndrome, curtis fitzhugh syndrome, fitzhugh curtis syndrome, fitzhugh-curtis syndrome, fitz-hugh-curtis syndrome, Fitz-Hugh-Curtis syndrome (disorder), Fitz-Hugh (etiology), Fitz-Hugh (manifestation)
Spanish Síndrome de Fitz-Hugh-Curtis, síndrome de Fitz - Hugh - Curtis, síndrome de Fitz-Hugh-Curtis (trastorno), síndrome de Fitz-Hugh-Curtis
Portuguese Síndrome de Fitz-Hugh-Curtis
Dutch Fitz-Hugh-Curtis syndroom
French Syndrome de Fitz-Hugh-Curtis
German Fitz-Hugh-Curtis Syndrom
Hungarian Fitz-Hugh-Curtis syndroma
Czech Fitz-Hugh-Curtisův syndrom
Italian Sindrome di Fitz-Hugh-Curtis
Japanese ﾌｨｯﾂﾋｭｰｶｰﾁｽｼｮｳｺｳｸﾞﾝ, フィッツ・ヒュー・カーチス症候群
Derived from the NIH UMLS (Unified Medical Language System)

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