What are the key clinical features to consider when diagnosing Pelvic Inflammatory Disease (PID) in a primary care setting?

Key clinical features to consider when diagnosing Pelvic Inflammatory Disease (PID) in primary care include:

• Lower abdominal or pelvic pain, which is a common presenting symptom.
• Adnexal tenderness and cervical motion tenderness on examination, indicating inflammation of the upper genital tract.
• Systemic symptoms such as fever or malaise may be present but are not always required for diagnosis.
• Vaginal discharge, which may be abnormal and suggestive of infection.
• Consideration of risk factors such as recent or current sexually transmitted infections (STIs), including chlamydia and gonorrhoea.
• Exclude pregnancy and ectopic pregnancy by offering a pregnancy test, as symptoms can overlap.
• Absence of other causes of pelvic pain should be considered, but due to lack of definitive diagnostic criteria, a low threshold for empirical treatment is recommended.

Empirical antibiotic treatment should be started promptly once PID is suspected, ideally after STI screening but without delaying treatment. Women with severe symptoms, systemic illness, or complications require urgent hospital referral.

These features align with the British Association for Sexual Health and HIV (BASHH) guidelines and NICE CKS recommendations for primary care management of PID ¹,².