Pelvic inflammatory disease (PID) is an inflammatory condition of the pelvic cavity that may begin with cervicitis and may involve the uterus (endometritis), fallopian tubes (salpingitis), ovaries (oophoritis), pelvic peritoneum, or pelvic vascular system. Each year an estimated 750,000 cases of PID are seen; the true incidence is unknown because some cases are asymptomatic. Risk factors include early age at first intercourse, multiple sexual partners, frequent intercourse, intercourse without condoms, sex with a partner with a sexually transmitted infection (STI), a history of STI, or previous pelvic infection.

Infection, which may be acute, subacute, recurrent, or chronic and localized or widespread, is usually caused by bacteria but may be attributed to a virus, fungus, or parasite. Pathogenic organisms usually enter the body through the vagina, pass through the cervical canal into the uterus, and may proceed to one or both fallopian tubes and ovaries and into the pelvis. Infection most commonly occurs through sexual transmission but also may be caused by invasive procedures such as endometrial biopsy, surgical abortion, hysteroscopy, or insertion of an intrauterine device (IUD). The most common organisms involved are gonorrhea and chlamydia. The infection is usually bilateral.

Symptoms may be acute and severe or low-grade and subtle.

• Vaginal discharge, dyspareunia, lower abdominal pelvic pain, and tenderness that occur after menses may be seen; pain may increase during voiding or defecating.
• Systemic symptoms include fever, general malaise, anorexia, nausea, headache, and possibly vomiting.
• Intense tenderness is noted on palpation of the uterus or movement of cervix (cervical motion tenderness) during pelvic examination.

Broad-spectrum antibiotic therapy is instituted, with mild to moderate infections being treated on an outpatient basis. If the patient is acutely ill, hospitalization may be required. Indications for hospitalization include surgical emergencies, pregnancy, no clinical response to oral antimicrobial therapy, inability to follow or tolerate an outpatient oral regimen, severe illness (i.e., nausea, vomiting, or high fever), and tubo-ovarian abscess. Once hospitalized, the patient is placed on a regimen of bed rest, IV fluids, and IV antibiotic therapy; vital signs are monitored. Treatment of sexual partners is necessary to prevent reinfection.

Nursing measures include nutritional support of the patient and administration of antibiotic therapy as prescribed. Vital signs are assessed, as are characteristics of the disorder and the amount of vaginal discharge.

The nurse administers analgesic agents as prescribed for pain relief. Adequate rest and a healthy diet are encouraged. Another nursing intervention is prevention of transmission of infection to others by impeccable hand hygiene and use of barrier precautions and hospital guidelines for disposing of biohazardous articles (e.g., pads).