The presenting symptoms depend on the extent to which the infection has spread.

• Endometritis: Pts present with midline abdominal pain and abnormal vaginal bleeding. Lower-quadrant, adnexal, or cervical motion or abdominal rebound tenderness is less severe in women with endometritis alone than in women who also have salpingitis.
• Salpingitis: Symptoms evolve from mucopurulent cervicitis to endometritis and then to bilateral lower abdominal and pelvic pain caused by salpingitis. Nausea, vomiting, and increased abdominal tenderness may occur if peritonitis develops.
• Perihepatitis (Fitz-Hugh-Curtis syndrome): 3-10% of women present with pleuritic upper abdominal pain and tenderness in the RUQ due to perihepatic inflammation. Most cases are due to chlamydial salpingitis.
• Periappendicitis: ~5% of pts can have appendiceal serositis without involvement of the intestinal mucosa as a result of gonococcal or chlamydial salpingitis.