Diagnostic Methods

Minimum Criteria

CDC recommends empiric treatment for PID if either of these minimum criteria are met:

• Uterine or adnexal tenderness (bilateral or unilateral), or
• Cervical motion tenderness occurring in the absence of any other explanation.

Acute adnexal tenderness may be the most sensitive sign of upper genital tract infection.

Under some circumstances, a clinician may choose to treat with even less specific findings. The general recommendation is to err on the side of over treatment, given the high incidence of adverse outcomes with untreated PID.

Additional Criteria

There are additional criteria which will increase the specificity of the diagnosis (but will decrease sensitivity). These include the following:

• Temperature >38.3°C (101°F)
• Abnormal cervical or vaginal mucopurulent discharge
• Presence of abundant numbers WBCs on saline microscopy of vaginal secretions
• Elevated erythrocyte sedimentation rate (ESR)
• Elevated C-reactive protein (CRP)
• Gonorrhea or chlamydia test positive

Most women with PID have either mucopurulent cervical discharge or evidence of WBCs on a saline wet prep of vaginal secretions. If no WBCs are found on the wet prep, the diagnosis of PID is unlikely.

(Click on image for larger view)

For more specific criteria for diagnosing PID, consult the 2006 CDC STD Treatment Guidelines.

Page 5 of 13