Acute PID is difficult to diagnose because of the wide variation in symptoms and signs associated with this condition. The condition might be detected later if you have trouble getting pregnant or if you develop chronic pelvic pain. One or more of the following additional criteria can be used to enhance the specificity of the minimum clinical criteria and support a diagnosis of PID:Most women with PID have either mucopurulent cervical discharge or evidence of WBCs on a microscopic evaluation of a saline preparation of vaginal fluid (i.e., wet prep). Consequently, a diagnosis of PID usually is based on imprecise clinical findings (Data indicate that a clinical diagnosis of symptomatic PID has a PPV for salpingitis of 65%–90% compared with laparoscopy (Many episodes of PID go unrecognized. Despite the complications, PID can be treated early to prevent difficulties in getting pregnant. Recommended regimens can be found in the In certain cases, clinicians may recommend hospitalization to treat PID. Laparoscopy can be used to obtain a more accurate diagnosis of salpingitis and a more complete bacteriologic diagnosis. Even women with mild or asymptomatic PID might be at risk for infertility (Presumptive treatment for PID should be initiated in sexually active young women and other women at risk for STDs if they are experiencing pelvic or lower abdominal pain, if no cause for the illness other than PID can be identified, and if one or more of the following minimum clinical criteria are present on pelvic examination:The requirement that all three minimum criteria be present before the initiation of empiric treatment could result in insufficient sensitivity for the diagnosis of PID. Copper-containing and levonorgestrel-releasing IUDs are available in the United States. The risk for PID associated with IUD use is primarily confined to the first 3 weeks after insertion (Centers for Disease Control and Prevention. After deciding whether to initiate empiric treatment, clinicians should also consider the risk profile for STDs.More elaborate diagnostic evaluation frequently is needed because incorrect diagnosis and management of PID might cause unnecessary morbidity. The decision to hospitalize adolescents with acute PID should be based on the same criteria used for older women.Several randomized trials have demonstrated the efficacy of parenteral regimens (Because of the pain associated with intravenous infusion, doxycycline should be administered orally when possible.

Azithromycin has demonstrated short-term clinical effectiveness in one randomized trial when used as monotherapy (500 mg IV daily for 1–2 doses, followed by 250 mg orally daily for 12–14 days) or in combination with metronidazole (To minimize disease transmission, women should be instructed to abstain from sexual intercourse until therapy is completed, symptoms have resolved, and sex partners have been adequately treated (See Women should demonstrate clinical improvement (e.g., defervescence; reduction in direct or rebound abdominal tenderness; and reduction in uterine, adnexal, and cervical motion tenderness) within 3 days after initiation of therapy. In early observational studies, women with HIV infection and PID were more likely to require surgical intervention. Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. Many women with PID have subtle or nonspecific symptoms or are asymptomatic. Pelvic Inflammatory Disease is an infection caused by untreated sexually transmitted diseases (STDs) or other infections. This infection can lead to pelvic inflammatory disease and infertility. For example, the presence of signs of lower-genital–tract inflammation (predominance of leukocytes in vaginal secretions, cervical exudates, or cervical friability), in addition to one of the three minimum criteria, increases the specificity of the diagnosis. Pelvic inflammatory disease is a polymicrobial infection of the upper genital tract. For the clindamycin/gentamicin regimen,  oral therapy with clindamycin (450 mg orally four times daily) or doxycycline (100 mg twice daily) can be used to complete the 14 days of therapy. In addition, these cephalosporins are less active than cefotetan or cefoxitin against anaerobic bacteria.Ampicillin/sulbactam plus doxycycline has been investigated in at least one clinical trial and has broad-spectrum coverage (Intramuscular/oral therapy can be considered for women with mild-to-moderately severe acute PID, because the clinical outcomes among women treated with these regimens are similar to those treated with intravenous therapy (*The recommended third-generation cephalsporins are limited in the coverage of anaerobes.

Male partners of women who have PID caused by The cross reactivity between penicillins and cephalosporins is <2.5% in persons with a history of penicillin allergy (Pregnant women suspected to have PID are at high risk for maternal morbidity and preterm delivery. However, when tubo-ovarian abscess is present, clindamycin (450 mg orally four times daily) or metronidazole (500 mg twice daily) should be used to complete at least 14 days of therapy with doxycycline to provide more effective anaerobic coverage than doxycycline alone.Limited data are available to support use of other parenteral second- or third-generation cephalosporins (e.g., ceftizoxime, cefotaxime, and ceftriaxone).