Urinary tract infection (cystitis or pyelonephritis)

Urinary tract infection (cystitis or pyelonephritis)




  1. Differential diagnosis

Ectopic pregnancy


Urinary tract infection (cystitis or pyelonephritis)

Renal calculus

Adnexal torsion



  1. Additional diagnostic procedures

Human chorionic gonadotropin (b-HCG): to rule out ectopic pregnancy

Endometrial biopsy: abnormal histology in 90% of patients with laparoscopic evidence of salpingitis

Endocervical ultrasonography

Detects tuboovarian abscesses

May detect early salpingitis if tubal dilation, intratubal fluid, and tubal wall thickening found


Gold standard for diagnosis of acute salpingitis

Should be considered when the diagnosis of PID is unsure


  1. Diagnostic considerations

Clinical diagnosis of PID is difficult and imprecise.

Clinical diagnosis of symptomatic PID has a positive predictive value of 65% to 90% when compared with laparoscopy as the standard.

No single historical, physical, or laboratory finding is both sensitive and specific for the diagnosis of PID.

  1. 2015 CDC diagnostic criteria for PID

Empiric treatment of PID should be initiated based on the presence of all of the following minimum criteria:

Lower abdominal pain

Adnexal tenderness

Cervical motion tenderness

The following additional routine criteria may be used to increase the specificity of the diagnosis of PID in women with severe clinical signs:

Oral temperature greater than 38.3° C

Abnormal cervical or vaginal discharge

White blood cells (WBCs) in vaginal secretion on saline microscopy

Elevated ESR

Elevated C-reactive protein

Laboratory documentation of cervical infection with N. gonorrhoeae or Q, trachomatis


Elaborate criteria for diagnosing PID are as follows:


Laparoscopic abnormalities consistent with PID

Histopathologic evidence of endometritis pn endocervical biopsy

Tuboovaran abscess, fluid-filled tubes with or without free pelvic fluid on transvaginal sonography


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