General term for infection of the upper female genital tract, including the uterus, Fallopian tubes, and ovaries

Aetiology

• Usually results from ascending infection from endocervix
  • Endometritis, salphingitis, tubo-ovarian abscess
  • Chlymydia, gonorrhoea, gardenella, anaerobes

Clinical features

Symptoms

• Lower abdominal pain
• Deep dyspareunia
• Dysuria
• Abnormal vaginal bleeding (postcoital, intermenstrual or menorrhagia)
• Abnormal vaginal discharge (especially if purulent or with an unpleasant odour)

Signs

• On vaginal examination, there may be tenderness of uterus/adnexae or cervical excitation (on bimanual palpation)
• There may be a palpable mass in the lower abdomen, with an abnormal vaginal discharge noted
• In severe cases - fever above 38°C (but may be apyrexial)

Investigations

• Full STI screen
• Urine dipstick +/- MSU: to exclude UTI
• Pregnancy test
• Transvaginal US: if severe disease or diagnostic uncertainty
• Laparoscopy: indicated only in severe cases where there is diagnostic uncertainty