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 examination2, 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.