Exams and Tests

Pelvic inflammatory disease (PID) is often difficult to diagnose because:

• PID symptoms vary and can be mistakenly linked to other health conditions.
• There is no single test that can detect PID. It is diagnosed by the combination of your medical history, your symptoms, a physical exam, and lab test results.
• It is hard to examine the inside of the abdomen or a fallopian tube to see whether an infection is present.

Guidelines for PID care urge prompt treatment, even when only the minimal clinical criteria for the diagnosis of PID are met and even before laboratory test results are available.³ This means that you may be given antibiotic treatment right away, based on your risk factors, medical history, and physical exam. Delaying treatment for several days could increase your risks of fallopian tube damage and infertility.

Medical history

To learn about your medical history, your doctor may ask you the following questions.

• Is it possible that you are pregnant?
• Do you think you were exposed to any sexually transmitted infections (STIs)? How do you know? Did your partner tell you?
• What are your symptoms?
  • Do you have vaginal discharge? If you have discharge from the vagina, it is important to note any smell or color.
  • Do you have sores in the genital area or anywhere else on your body?
  • Do you have any urinary symptoms, including frequent urination, burning or stinging with urination, or urinating in small amounts?
• What method of birth control do you use? Do you use condoms to protect against STIs?
• Do you or your partner engage in high-risk sexual behaviors, including sex without a condom?
• Do you or your partner have other sexual contact outside of your relationship?
• Have you had an STI in the past? How was it treated?
• Have you had PID in the past? How was it treated?
• When was your last menstrual period?

Physical exam

After your medical history is taken, the initial exam for PID will include a pelvic exam.

Laboratory and imaging tests

A pregnancy test is done to rule out the possibility of a tubal (ectopic) pregnancy.

Tests for gonorrhea, chlamydia, and bacterial vaginosis are done, because they are most commonly linked to PID. These are done during your pelvic exam.

Other tests may be done to confirm the diagnosis of PID, to rule out other problems (such as appendicitis), or to find out whether the infection has spread. These tests include:

• Blood tests such as a complete blood count (CBC), sedimentation rate (ESR), or C-reactive protein test to detect signs of inflammation or infection.
• A blood or urine culture, which screens for infection.
• A pelvic or transvaginal ultrasound, which can show internal organs on a computer screen.
• Laparoscopy, which is the insertion of a lighted viewing instrument into the abdomen to look for signs of infection and scar tissue.
• Magnetic resonance imaging (MRI) or computed tomography (CT) scan, which, in rare cases, is used if symptoms aren't improving with treatment or an ultrasound has shown a possible growth or abscess that needs to be further evaluated.

Laparoscopy and ultrasound are considered the best procedures for diagnosing PID. But these tests are not done unless the diagnosis is in doubt or the results from the procedure will change the method used for treatment.

Early Detection

There is no standard screening for pelvic inflammatory disease (PID) at this time. But routine annual screening of young, sexually active women for chlamydia is thought to reduce the number of cases of PID and is recommended by experts.

Be sure to have a gynecologic exam promptly whenever you notice pelvic infection symptoms or pelvic pain. If you have been exposed to an STI, see your doctor for testing right away. If you are diagnosed with an STI, especially gonorrhea or chlamydia, you will be treated and evaluated for PID. Your partner(s) must also have treatment for the STI.

Women who have recently been infected with the human immunodeficiency virus (HIV) also should be checked for other STIs.