The diagnosis of PID can often be challenging, since a wide variety of symptoms, which may be mild, are often seen. Although only 50% sensitive and specific, the diagnosis is usually made clinically.
In women at risk for PID who have no apparent alternative diagnosis, the CDC has suggested several findings on physical examination that are suggestive of PID:
–    Uterine tenderness
–    Adnexal tenderness
–    Cervical motion tenderness
Use of these criteria makes it very unlikely that a case of PID will go undetected.
Additional criteria that support the diagnosis of PID are the following:
–    Temperature greater than 101°F
–    Abnormal mucopurulent cervical or vaginal discharge (Most women with PID will have visible mucopurulent discharge or vaginal secretions with white blood cells. If neither of these finding is present, serious consideration should be given to an alternate diagnosis.1)
–    White blood cells in vaginal secretions
–    Elevated erythrocyte sedimentation rate
–    Elevated C-reactive protein
–    Positive tests for N. gonorrhoeae or C. trachomatis (However, negative endocervical N. gonorrhoeae or C. trachomatis tests do not rule out infection of the upper genital tract.)
Several other tests may be helpful in supporting a diagnosis of PID, and these include laparoscopy, endometrial biopsy, transvaginal ultrasonography, and magnetic resonance imaging. Laparoscopy is very useful, but it is not always readily available, and it is difficult to justify in mild cases. Imaging studies such as ultrasonography or magnetic resonance imaging may be used to look for distinct abnormalities: fallopian tubes that are thickened or fluid-filled; free pelvic fluid; or a tubo-ovarian complex. Power Doppler ultrasonography to detect fallopian tube hyperemia is a newer technology that may prove useful.

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