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Pelvic inflammatory disease (PID, mechanism of disease)

This is a flowchart on pelvic inflammatory disease (PID), covering the etiology, pathophysiology, and manifestations. ADDITIONAL TAGS: Infection ascends to infect the upper reproductive tract (endometrium, fallopian tubes, ovaries) and/or peritoneal cavity: Ovarian adhesions IUDs ↑ risk pathogen ascension Risk factors / SDOH Cell / tissue damage Structural factors Medicine / iatrogenic Infectious / microbial Biochem / metabolic Immunology / inflammation Signs / symptoms Tests / imaging / labs Environmental, toxin Neurology pathology Flow physiology Pathophysiology Etiology Manifestations Pathogens: Chlamydia trachomatis Neisseria gonorrhoeae Escherichia coli Ureaplasma Mycoplasma Other anaerobes Infection in the lower genital tract (vagina, cervix) Less common; consider coinfections Risk factors: Multiple sexual partners Unprotected sex History of prior STIs Imbalance of intravaginal flora (vaginal dysbiosis) Modern devices: ↑ risk is limited to the first 3 weeks after IUD placement Endometrium: endometritis Fallopian tubes: salpingitis Ovaries: oophoritis Uterine adnexa: adnexitis Surrounding pelvis: parametritis Peritoneum: peritonitis Lower abdominal pain (generally bilateral) Nausea, vomiting Fever Dysuria, urinary urgency Menorrhagia, metrorrhagia Dyspareunia Abnormal vaginal discharge (yellow/green color) Complications: Pelvic peritonitis Acute abdomen Fitz-Hugh-Curtis syndrome: inflammation of the liver capsule (perihepatitis) Violin-string-like adhesions from peritoneum to liver RUQ abdominal pain Tubo-ovarian abscess: pus collection in uterine adnexa Spread to adjacent organs (bladder, bowel) Pelvic inflammatory disease Adnexitis Fallopian tube adhesions Tubal scarring Impaired ciliary function and tubal occlusion Ectopic pregnancy Infertility Chronic pelvic pain Hydrosalpinx/pyosalpinx: fluid/pus in fallopian tubes