How should I assess suspected PID?

The following symptoms in the history suggest PID:

• Lower abdominal or pelvic pain, most commonly bilateral but sometimes unilateral
• Deep dyspareunia
• Abnormal vaginal discharge, which is usually purulent
• Abnormal vaginal bleeding, most commonly post-coital or menorrhagia
• Fever (although temperature often normal)

The following findings on examination are suggestive of PID:

• Lower abdominal tenderness
• Adnexal or uterine tenderness or cervical excitation on bimanual examination
• Abnormal discharge on speculum examination^{2, 4}

PID can be asymptomatic. Even when present, signs and symptoms have low sensitivity and specificity so have a low threshold for diagnosis and empirical treatment.