What are the diagnostic (clinical) criteria for PID?

PID is a clinical diagnosis. The minimum criteria are pelvic/lower abdominal pain with pelvic organ tenderness - specifically cervical motion tenderness, uterine tenderness, or adnexal tenderness on bimanual examination, in a sexually active woman (with no other explanation).

Supporting features include fever, abnormal discharge, raised inflammatory markers, and proven gonorrhoea/chlamydia.

Clinical relevance. Knowing the clinical criteria for PID (pain + pelvic organ tenderness) allows prompt empirical diagnosis and treatment.

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Diagnostic criteria for PID

PID is diagnosed clinically, with a low threshold to treat.

Minimum (clinical) criteria

• Lower abdominal/pelvic pain, AND
• Pelvic organ tenderness on bimanual examination - cervical motion (excitation) tenderness, uterine tenderness, or adnexal tenderness,
• in a sexually active (usually young) woman, with no other identified cause.

Additional supporting criteria

• Fever (>38C).
• Abnormal cervical or vaginal discharge.
• Raised inflammatory markers (CRP, WCC, ESR).
• Laboratory confirmation of cervical gonorrhoea or chlamydia.

Definitive criteria (rarely needed)

• Laparoscopic evidence, endometrial biopsy (endometritis), or imaging of a tubo-ovarian abscess.

Key point

• Because the consequences of missing PID are serious, empirical treatment is started on the clinical criteria without waiting for confirmation; always exclude pregnancy/ectopic.