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Pelvic inflammatory disease - Management
What investigations should I do?

  • Do a pregnancy test if pregnancy is a possibility.
  • Take endocervical swabs for Chlamydia trachomatis and Neisseria gonorrhoeae.
    • If uncertain, confirm with the local laboratory which testing methods are available, the samples required, and how soon these should reach the laboratory.
    • In general, chlamydia should be tested for by taking endocervical samples, using nucleic acid amplification tests (NAATs). First-catch urine samples or vulvovaginal swabs may be accepted for NAAT testing by some laboratories.
    • Endocervical swabs for N. gonorrhoeae should be sent in transport medium to arrive at the laboratory for culture within 24 hours. NAATs may be used, but a positive NAAT should be confirmed using a second NAAT test with a different primer sequence, or with culture.
    • Adequate sample collection is important. When taking an endocervical swab, the swab should be inserted inside the cervical os and firmly rotated against the endocervix. Swabbing a collection of discharge will result in an inadequate specimen, so it is generally recommended that excess cervical secretions are cleaned away prior to taking the swab.
    • There is no need to take a urethral swab unless local guidelines suggest this.
  • If possible, look for endocervical or vaginal pus cells under a microscope on a wet-mount vaginal smear:
    • If absent, a diagnosis of pelvic inflammatory disease (PID) is unlikely.
    • Excess leucocytes are associated with PID but they are also found in women with lower genital tract infection.
  • Consider performing the following tests. If elevated they support the diagnosis of PID but are non-specific:
    • Erythrocyte sedimentation rate (ESR).
    • C-reactive protein.
    • Leucocyte count.

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