Clinical Manifestations and Sequelae

Women with PID present with a vast array of clinical manifestations that range from virtually none to severe and debilitating symptoms.

Subclinical disease (asymptomatic or “silent” PID), which is thought to be present 60% of the time, is notable because it lacks symptoms. This makes diagnosis and treatment problematic. Women may experience dyspareunia, irregular bleeding, dysuria, or gastrointestinal symptoms, which they may not link to PID, and therefore, may not seek care. C. trachomatis is particularly implicated in subclinical PID.

When symptomatic, as in overt mild to moderate PID, women may complain of lower abdominal pain or pelvic pain, cramping, or dysuria. They may also exhibit signs such as intermittent or post-coital bleeding, vaginal discharge, or fever. Uterine tenderness or cervical motion pain or adnexal tenderness is most often present on pelvic exam in most cases of moderate PID.

In severe PID, women appear very ill with fever, chills, purulent vaginal discharge, nausea, vomiting, and elevated white blood cell count (WBC). Other laboratory indicators, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), may also be elevated.

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Sequelae

Approximately 25% of women with a single episode of symptomatic PID will experience sequelae, including ectopic pregnancy, infertility, or chronic pelvic pain. The risk of ectopic pregnancy is increased six- to ten-fold after PID. Tubal infertility occurs in 8% of women after one episode of PID, in 20% of women after two episodes, and in 50% of women after three episodes.

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