Pelvic Inflammatory Disease (PID)

Overview

Pelvic inflammatory disease (PID) is a serious infection of the upper female reproductive tract that includes the uterus, fallopian tubes, ovaries, and surrounding pelvic structures. This condition represents one of the most significant causes of reproductive health problems in women of childbearing age, affecting over one million women annually in the United States alone. PID typically develops when bacteria from the vagina or cervix spread upward into the normally sterile upper reproductive organs, causing inflammation and infection that can lead to severe complications if left untreated.

The condition is most commonly caused by sexually transmitted infections (STIs), particularly chlamydia and gonorrhea, though other bacteria can also be responsible. PID can range from mild, subclinical infection to severe, life-threatening illness. The infection can affect different parts of the reproductive system, including endometritis (infection of the uterine lining), salpingitis (infection of the fallopian tubes), oophoritis (infection of the ovaries), and peritonitis (infection of the pelvic peritoneum). Each of these conditions can occur independently or in combination, contributing to the varied presentation of PID.

Early recognition and treatment of PID are crucial because the condition can lead to serious long-term complications including infertility, ectopic pregnancy, chronic pelvic pain, and pelvic adhesions. Approximately 10-15% of women with PID will become infertile as a result of the infection, and the risk increases with each subsequent episode. The inflammation and scarring caused by PID can permanently damage the fallopian tubes, making it difficult or impossible for eggs to travel from the ovaries to the uterus. Understanding the signs, symptoms, risk factors, and treatment options for PID is essential for women's reproductive health and overall well-being.

Symptoms

PID symptoms can vary significantly from mild discomfort to severe illness, and some women may have no symptoms at all, making the condition particularly dangerous.

Primary Pelvic Symptoms

Urogenital Symptoms

• Abnormal vaginal discharge (yellow, green, or foul-smelling)
• Painful urination (dysuria)
• Irregular vaginal bleeding between periods
• Lower abdominal pain and pressure
• Pain during sexual intercourse (dyspareunia)
• Heavy or prolonged menstrual periods

Systemic Symptoms

• Vomiting and nausea
• Nausea and loss of appetite
• Fever and chills
• Fatigue and weakness
• General feeling of illness (malaise)

Associated Pain Symptoms

• Lower back pain
• Pain during bowel movements
• Pain that worsens during menstruation
• Pain radiating to thighs
• Bloating and abdominal distension

Symptom Severity Levels

Mild PID

• Subtle pelvic discomfort
• Mild abnormal discharge
• No fever or systemic symptoms
• Often goes unnoticed (silent PID)
• Can still cause serious complications

Moderate PID

• Noticeable pelvic pain
• Obvious changes in vaginal discharge
• Pain with intercourse
• Low-grade fever
• Mild systemic symptoms

Severe PID

• Intense pelvic and abdominal pain
• High fever (>101°F/38.3°C)
• Severe nausea and vomiting
• Signs of sepsis
• May require hospitalization

Silent PID

Up to 75% of PID cases may be asymptomatic or have very mild symptoms:

• No obvious pain or discomfort
• Subtle changes in discharge
• Slight irregularities in menstrual cycle
• Diagnosed only during routine exams
• Same risk of complications as symptomatic PID

Complications-Related Symptoms

Tubo-ovarian Abscess

• Severe pelvic pain
• High fever with chills
• Palpable pelvic mass
• Signs of sepsis

Peritonitis

• Severe abdominal pain
• Abdominal rigidity
• Rebound tenderness
• High fever
• Rapid heart rate

Chronic PID Symptoms

• Persistent pelvic pain
• Chronic fatigue
• Depression and anxiety
• Sexual dysfunction
• Difficulty conceiving
• Recurrent infections

Emergency Warning Signs

Seek immediate medical attention if experiencing:

• Severe abdominal or pelvic pain
• High fever (>101°F/38.3°C)
• Persistent vomiting
• Signs of shock (dizziness, rapid pulse)
• Severe weakness or fainting
• Inability to walk due to pain

Causes

PID is primarily caused by bacterial infections that ascend from the lower reproductive tract to the upper reproductive organs.

Primary Bacterial Causes

Sexually Transmitted Infections (STIs)

• Chlamydia trachomatis: Most common cause (40-60% of cases)
• Neisseria gonorrhoeae: Gonorrhea bacteria (20-40% of cases)
• Mycoplasma genitalium: Emerging important cause
• Trichomonas vaginalis: Parasitic infection

Non-STI Bacteria

• Gardnerella vaginalis: Associated with bacterial vaginosis
• Haemophilus influenzae: Respiratory bacteria
• Peptostreptococcus: Anaerobic bacteria
• Bacteroides species: Intestinal bacteria
• Escherichia coli: From intestinal tract
• Streptococcus agalactiae: Group B strep

Polymicrobial Infections

• Multiple bacteria often involved simultaneously
• STI bacteria may facilitate other bacterial infections
• Mixed aerobic and anaerobic bacteria
• More severe infections with multiple organisms
• Harder to treat with single antibiotic

Routes of Infection

Ascending Infection (Most Common)

• Bacteria travel from vagina through cervix
• Ascend through uterus to fallopian tubes
• Can spread to ovaries and peritoneum
• Facilitated by disrupted cervical barrier

Hematogenous Spread

• Bacteria travel through bloodstream
• Less common route of infection
• Can occur with tuberculosis
• May seed multiple organs

Lymphatic Spread

• Through lymphatic vessels
• Uncommon route
• Can occur with severe infections

Predisposing Factors

Cervical Barrier Disruption

• Menstruation (blood provides nutrients for bacteria)
• Douching (disrupts normal flora)
• Sexual intercourse during menstruation
• Recent cervical procedures
• IUD insertion

Hormonal Factors

• Estrogen levels affect cervical mucus
• Oral contraceptives may increase risk
• Pregnancy hormones can alter susceptibility
• Menopause changes tissue vulnerability

Specific Risk Scenarios

Medical Procedures

• Intrauterine device (IUD) insertion
• Endometrial biopsy
• Dilation and curettage (D&C)
• Hysterosalpingography
• Abortion procedures
• Childbirth complications

Sexual Behaviors

• Unprotected sexual intercourse
• Multiple sexual partners
• Partner with STI
• New sexual partner
• Sex during menstruation

Bacterial Vaginosis Connection

• Disrupts normal vaginal flora
• Creates environment favorable to pathogenic bacteria
• Increases risk of STI acquisition
• Often coexists with PID
• May facilitate ascending infection

Recurrent PID Causes

• Incomplete treatment of initial infection
• Reinfection from untreated partner
• Antibiotic-resistant bacteria
• Structural damage from previous PID
• Ongoing risk behaviors
• Immunocompromised state

Special Populations

Adolescents

• Immature cervical epithelium
• Increased susceptibility to STIs
• Behavioral risk factors
• Delayed diagnosis common

Postmenopausal Women

• Rare but can occur
• Often related to procedures
• May have atypical presentation
• Usually non-STI bacteria

Risk Factors

Several factors increase a woman's risk of developing pelvic inflammatory disease:

Sexual and Reproductive History

High-Risk Sexual Behaviors

• Multiple sexual partners
• Unprotected sexual intercourse
• Sexual partner with STI
• New sexual partner within last 60 days
• Partner with multiple sexual partners
• History of sexually transmitted infections
• Sex work or partner who engages in sex work

Previous STI History

• Previous chlamydia or gonorrhea infection
• History of PID
• Previous pelvic infections
• Bacterial vaginosis
• Trichomonas infection

Age and Demographics

• Young age: Highest risk ages 15-25
• Adolescents: Immature cervical epithelium
• Sexual debut: Early age of first intercourse
• Unmarried status: Single or divorced women
• Urban residence: Higher STI prevalence areas

Contraceptive and Medical Factors

Contraceptive Methods

• Intrauterine device (IUD) use, especially first 20 days after insertion
• No contraceptive use (unprotected sex)
• Some studies suggest oral contraceptives may increase risk
• Non-barrier contraceptive methods

Medical Procedures

• Recent gynecological procedures
• Endometrial biopsy
• Dilation and curettage (D&C)
• Hysterosalpingography
• Induced abortion
• Childbirth with complications

Behavioral Risk Factors

• Douching (disrupts normal vaginal flora)
• Substance abuse, particularly injection drug use
• Alcohol abuse affecting judgment
• Poor personal hygiene
• Sexual intercourse during menstruation
• Inconsistent condom use

Biological and Health Factors

Immune System

• Immunocompromised conditions
• HIV infection
• Diabetes mellitus
• Chronic corticosteroid use
• Chemotherapy or radiation therapy
• Autoimmune disorders

Gynecological Factors

• Bacterial vaginosis
• Cervical ectropion
• Cervicitis
• Menstrual irregularities
• Heavy menstrual bleeding

Socioeconomic and Environmental

• Low socioeconomic status
• Limited access to healthcare
• Lack of health insurance
• Poor health literacy
• Living in high STI prevalence areas
• Inadequate STI screening and treatment

Partner-Related Risk Factors

• Male partner with urethritis
• Partner recently treated for STI
• Partner with multiple sexual partners
• Partner who refuses STI testing
• Partner with history of STIs
• Inconsistent partner condom use

Timing-Related Risks

• First 20 days after IUD insertion
• During and immediately after menstruation
• After gynecological procedures
• Postpartum period
• After miscarriage or abortion

Protective Factors

Factors That Reduce Risk

• Consistent condom use
• Monogamous relationship with uninfected partner
• Regular STI screening
• Abstinence from sexual activity
• Hormonal contraceptives (may have some protective effect)
• Good personal hygiene

Recurrence Risk Factors

• Incomplete treatment of previous PID
• Untreated sexual partners
• Continued high-risk behaviors
• Structural damage from previous PID
• Antibiotic-resistant bacteria
• Non-adherence to treatment

Population-Specific Risks

Adolescents

• Biological susceptibility
• Behavioral factors
• Limited healthcare access
• Delayed diagnosis

Women in Correctional Facilities

• High STI prevalence
• Limited healthcare access
• Risk behaviors before incarceration

Diagnosis

Diagnosing PID can be challenging because symptoms may be subtle or absent. Early and accurate diagnosis is crucial to prevent serious complications.

Clinical Assessment

Medical History

• Detailed sexual history
• Menstrual and reproductive history
• Previous STIs or PID episodes
• Recent gynecological procedures
• Current symptoms and timeline
• Partner symptoms or STI history
• Contraceptive use
• Recent antibiotic use

Physical Examination

• General appearance and vital signs
• Abdominal examination for tenderness
• Pelvic examination (external and internal)
• Bimanual examination
• Assessment for lymphadenopathy
• Signs of systemic illness

Pelvic Examination Findings

Key Clinical Signs

• Cervical motion tenderness: Pain with gentle movement of cervix
• Uterine tenderness: Pain on bimanual examination
• Adnexal tenderness: Pain in ovary/fallopian tube areas
• Abnormal discharge: Mucopurulent cervical discharge
• Pelvic mass: May indicate abscess

Diagnostic Criteria

CDC Clinical Criteria (2021)

Minimum criteria (all must be present):

• Sexually active woman at risk for STIs
• Pelvic or lower abdominal pain
• No other cause identified
• One or more of: cervical motion tenderness, uterine tenderness, adnexal tenderness

Additional Supportive Criteria

• Oral temperature >101°F (38.3°C)
• Abnormal cervical or vaginal mucopurulent discharge
• Elevated erythrocyte sedimentation rate
• Elevated C-reactive protein
• Laboratory evidence of cervical infection

Laboratory Tests

Essential Tests

• Pregnancy test: Rule out ectopic pregnancy
• Nucleic acid amplification tests (NAAT): Chlamydia and gonorrhea
• Wet mount microscopy: Vaginal discharge examination
• Gram stain: Cervical discharge
• Complete blood count: Look for elevated WBC

Additional Laboratory Studies

• Erythrocyte sedimentation rate (ESR)
• C-reactive protein (CRP)
• Blood cultures (if sepsis suspected)
• HIV testing (if risk factors present)
• Syphilis screening
• Hepatitis B and C testing

Imaging Studies

Transvaginal Ultrasound

• First-line imaging modality
• Evaluate for tubo-ovarian abscess
• Assess for ovarian cysts
• Identify fluid in pelvis
• Rule out other pelvic pathology

CT Scan

• Used when complications suspected
• Excellent for abscess detection
• Evaluate for appendicitis
• Assess for peritonitis
• Guide drainage procedures

MRI

• Superior soft tissue contrast
• Better characterization of complex masses
• No radiation exposure
• More expensive and less available

Specialized Diagnostic Procedures

Laparoscopy

• Gold standard for PID diagnosis
• Direct visualization of pelvic organs
• Reserved for uncertain cases
• Can obtain cultures and tissue samples
• Therapeutic intervention possible

Endometrial Biopsy

• Histological evidence of endometritis
• Presence of plasma cells
• Rarely performed in acute setting
• May be useful in chronic cases

Differential Diagnosis

Gynecological Conditions

• Ectopic pregnancy
• Ovarian cysts or torsion
• Endometriosis
• Uterine fibroids
• Mittelschmerz (ovulation pain)

Non-Gynecological Conditions

• Appendicitis
• Urinary tract infection
• Irritable bowel syndrome
• Inflammatory bowel disease
• Kidney stones
• Diverticulitis

Severity Assessment

Mild PID

• Outpatient treatment appropriate
• No signs of severe illness
• Able to tolerate oral antibiotics
• No tubo-ovarian abscess

Severe PID

• High fever or signs of sepsis
• Tubo-ovarian abscess
• Pregnancy
• Unable to tolerate oral medications
• Failed outpatient treatment

Challenges in Diagnosis

• Subclinical disease common
• Non-specific symptoms
• Overlap with other conditions
• Patient reluctance to disclose sexual history
• Lack of definitive diagnostic test
• Provider comfort with sensitive topics

Point-of-Care Testing

• Rapid STI tests available
• Can provide same-day results
• Allows immediate treatment initiation
• Improves patient compliance
• Reduces loss to follow-up

Treatment Options

Treatment of PID involves prompt antibiotic therapy to eliminate infection, prevent complications, and preserve fertility. Treatment should begin as soon as the diagnosis is suspected.

Antibiotic Therapy

Outpatient Treatment (Mild to Moderate PID)

Recommended Regimens (CDC 2021):

• Regimen A: Ceftriaxone 250mg IM + Doxycycline 100mg PO BID × 14 days + Metronidazole 500mg PO BID × 14 days
• Regimen B: Cefoxitin 2g IM + Probenecid 1g PO + Doxycycline 100mg PO BID × 14 days + Metronidazole 500mg PO BID × 14 days
• Alternative: Azithromycin 1g PO weekly × 2 weeks (if doxycycline contraindicated)

Inpatient Treatment (Severe PID)

Parenteral Regimens:

• Regimen A: Cefotetan 2g IV q12h OR Cefoxitin 2g IV q6h PLUS Doxycycline 100mg PO/IV q12h
• Regimen B: Clindamycin 900mg IV q8h PLUS Gentamicin 2mg/kg IV loading, then 1.5mg/kg IV q8h
• Alternative: Ampicillin/sulbactam 3g IV q6h PLUS Doxycycline 100mg PO/IV q12h

Indications for Hospitalization

• Tubo-ovarian abscess
• Pregnancy
• Severe illness with high fever, nausea, vomiting
• Unable to tolerate oral medications
• Failed outpatient treatment after 72 hours
• Uncertain diagnosis requiring observation
• HIV infection with low CD4 count

Supportive Care

Pain Management

• NSAIDs (ibuprofen, naproxen) for anti-inflammatory effect
• Acetaminophen for fever and pain
• Heat therapy for pelvic pain
• Prescription analgesics if needed
• Avoid aspirin in young women

General Measures

• Bed rest during acute phase
• Adequate hydration
• Pelvic rest (no intercourse, tampons, douching)
• Follow-up within 72 hours of starting treatment
• Complete entire antibiotic course

Partner Treatment

• Essential component: All recent sexual partners must be treated
• Timeframe: Partners within 60 days of symptom onset
• Treatment: Same regimen for chlamydia and gonorrhea
• Testing: Partners should be tested for STIs
• Abstinence: No intercourse until both partners complete treatment

Treatment of Complications

Tubo-ovarian Abscess

• Hospitalization required
• IV antibiotic therapy
• Serial imaging to monitor response
• Drainage if no response to antibiotics
• Surgical intervention if rupture occurs

Abscess Drainage Options

• Transvaginal ultrasound-guided drainage
• CT-guided percutaneous drainage
• Laparoscopic drainage
• Laparotomy (if other methods fail)

Surgical Treatment

Indications for Surgery

• Ruptured tubo-ovarian abscess
• Large abscess not responding to medical therapy
• Persistent symptoms despite adequate treatment
• Uncertain diagnosis requiring exploration
• Life-threatening complications

Surgical Options

• Laparoscopic drainage and irrigation
• Salpingectomy (removal of fallopian tube)
• Salpingo-oophorectomy
• Hysterectomy (in severe, recurrent cases)
• Adhesiolysis for chronic pain

Follow-up Care

Short-term Follow-up (72 hours)

• Clinical improvement expected
• Assess symptom response
• Check medication compliance
• Address side effects
• Consider hospitalization if not improving

Long-term Follow-up

• Complete antibiotic course
• Partner treatment verification
• STI retesting in 3 months
• Annual chlamydia/gonorrhea screening
• Contraceptive counseling
• Fertility assessment if desired

Treatment Monitoring

Signs of Improvement

• Decreased pelvic pain
• Resolution of fever
• Improved appetite
• Less vaginal discharge
• Improved well-being

Treatment Failure Indicators

• Worsening symptoms after 72 hours
• Persistent high fever
• Increasing abdominal pain
• Development of abscess
• Signs of sepsis

Special Considerations

Pregnancy

• Requires hospitalization
• Modified antibiotic regimens
• Avoid doxycycline and fluoroquinolones
• Close maternal-fetal monitoring

HIV-Positive Women

• May require longer treatment courses
• Higher risk of treatment failure
• More aggressive monitoring
• Consider hospitalization for severe cases

Adolescents

• Same treatment regimens as adults
• Address confidentiality concerns
• Partner notification challenges
• Comprehensive STI education

Prevention of Recurrence

• Consistent condom use
• Partner treatment and testing
• Regular STI screening
• Limit number of sexual partners
• Avoid douching
• Prompt treatment of future STIs

Prevention

Prevention of PID focuses primarily on preventing sexually transmitted infections and maintaining good reproductive health practices.

Primary Prevention

Safe Sexual Practices

• Consistent condom use: Latex or polyurethane condoms for all sexual contact
• Mutual monogamy: Both partners tested and infection-free
• Partner reduction: Limit number of sexual partners
• Partner communication: Discuss STI history and testing
• Delay sexual activity: Later age of sexual debut
• Sexual abstinence: Most effective prevention method

STI Prevention and Testing

• Regular STI screening for sexually active women
• Annual chlamydia screening for women under 25
• Screening for women over 25 with risk factors
• Partner testing and treatment
• Pre-exposure counseling and education
• Vaccination (hepatitis B, HPV)

Behavioral Modifications

Personal Hygiene Practices

• Avoid douching (disrupts normal vaginal flora)
• Proper genital hygiene
• Wipe front to back after urination
• Change tampons/pads regularly
• Avoid scented feminine products
• Urinate after sexual intercourse

Risk Reduction Strategies

• Avoid sexual intercourse during menstruation
• Limit alcohol and substance use affecting judgment
• Seek immediate treatment for symptoms
• Complete all prescribed antibiotic courses
• Ensure partner treatment for STIs

Medical Prevention

Contraceptive Considerations

• Hormonal contraceptives may provide some protection
• Barrier methods (condoms, diaphragms) reduce STI risk
• IUD insertion requires STI screening
• Consider postponing IUD if high STI risk

Procedural Precautions

• STI testing before gynecological procedures
• Prophylactic antibiotics when indicated
• Sterile technique during procedures
• Post-procedure monitoring

Healthcare Provider Interventions

Screening and Early Detection

• Risk assessment at routine visits
• Age-appropriate STI screening
• Contact tracing and partner notification
• Expedited partner therapy when appropriate
• Point-of-care testing when available

Patient Education

• Comprehensive sexual health education
• Risk factor discussion
• Symptom recognition training
• Importance of partner treatment
• Follow-up care instructions

Secondary Prevention

Early Treatment of STIs

• Prompt diagnosis and treatment
• Treatment of asymptomatic infections
• Partner treatment and notification
• Test of cure when indicated
• Rescreening after treatment

High-Risk Population Strategies

• Enhanced screening for adolescents
• Targeted interventions in high-prevalence areas
• Community-based prevention programs
• School-based health education
• Correctional facility screening

Community and Public Health Measures

• STI surveillance and reporting
• Public health partner services
• Community education campaigns
• Healthcare provider training
• Policy development and implementation
• Research on prevention strategies

Special Population Prevention

Adolescent Prevention

• Age-appropriate sexual education
• Parent-adolescent communication
• Confidential healthcare services
• Peer education programs
• School-based health services

Women with Previous PID

• Enhanced monitoring and follow-up
• Aggressive treatment of new STIs
• Regular fertility assessment
• Counseling on recurrence risk
• Long-term health monitoring

Vaccine Prevention

• HPV vaccination to prevent cervical changes
• Hepatitis B vaccination
• Research on chlamydia vaccines
• Future gonorrhea vaccine development

Technology and Innovation

• Mobile health apps for education
• Telemedicine for consultation
• Online STI testing services
• Electronic health records for tracking
• Social media for health promotion

Global Prevention Efforts

• WHO prevention guidelines
• International surveillance networks
• Resource-limited setting adaptations
• Cultural competency in prevention
• Research collaboration

When to See a Doctor

PID requires prompt medical attention to prevent serious complications. Recognizing when to seek care can preserve fertility and prevent life-threatening complications.

Seek Emergency Medical Care Immediately

• Severe pelvic or abdominal pain
• High fever (>101°F/38.3°C) with chills
• Persistent vomiting or inability to keep fluids down
• Signs of sepsis (rapid heart rate, low blood pressure, confusion)
• Fainting or severe dizziness
• Severe weakness or difficulty walking
• Suspected ruptured abscess
• Pregnancy with pelvic pain

Schedule Urgent Medical Appointment

• Pelvic pain lasting more than a few hours
• Abnormal vaginal discharge with odor
• Painful urination with pelvic pain
• Irregular vaginal bleeding
• Pain during sexual intercourse
• Lower abdominal pain with fever
• Worsening of any pelvic symptoms

Schedule Routine Medical Appointment

• New or multiple sexual partners
• Partner diagnosed with STI
• History of STIs requiring screening
• Annual gynecological examination
• Concerns about reproductive health
• Contraceptive counseling
• Preconception planning

High-Risk Situations Requiring Immediate Evaluation

Recent Sexual Exposure

• Unprotected sex with new partner
• Partner recently treated for STI
• Sexual assault or non-consensual sex
• Condom failure with high-risk partner

Recent Medical Procedures

• IUD insertion within last 3 weeks
• Recent abortion or miscarriage
• Endometrial biopsy or D&C
• Any gynecological procedure with new symptoms

Warning Signs During Treatment

• Symptoms worsening after 72 hours of antibiotics
• New fever developing during treatment
• Severe side effects from medications
• Unable to complete antibiotic course
• Partner refuses treatment
• New symptoms developing

Age-Specific Considerations

Adolescents

• Any pelvic pain in sexually active teen
• First episode of sexual activity
• Concerns about confidentiality
• Questions about sexual health
• Irregular menstrual periods with pain

Older Reproductive Age Women

• New onset pelvic pain
• Changes in menstrual pattern
• Post-menopausal bleeding with pain
• Difficulty conceiving

Partner-Related Concerns

• Partner has symptoms of STI
• Partner diagnosed with chlamydia or gonorrhea
• Partner refuses STI testing
• Multiple partners or partner infidelity
• Partner with history of STIs

What to Prepare for Your Visit

Information to Gather

• Complete menstrual and sexual history
• List of current medications
• Detailed symptom timeline
• Partner information and symptoms
• Previous STI test results
• Recent medical procedures

Questions to Ask Your Doctor

• Do I have PID and what caused it?
• What antibiotics do I need and for how long?
• Does my partner need treatment?
• When can I resume sexual activity?
• What are the long-term effects?
• How will this affect my fertility?
• When should I follow up?
• What symptoms should worry me?

Specialists You May Need to See

• Gynecologist: Reproductive health specialist
• Infectious disease specialist: Complex or resistant infections
• Reproductive endocrinologist: Fertility concerns
• Emergency physician: Acute, severe symptoms
• Primary care physician: Initial evaluation and follow-up

Follow-up Care Requirements

Short-term Follow-up

• Return visit within 72 hours if not improving
• Complete entire antibiotic course
• Partner treatment verification
• Symptom monitoring

Long-term Follow-up

• STI retesting in 3 months
• Annual screening for sexually active women
• Fertility assessment if desired
• Pap smear follow-up
• Contraceptive management

When NOT to Delay Care

• Don't wait for symptoms to worsen
• Don't try to self-treat with over-the-counter medications
• Don't delay due to embarrassment
• Don't assume symptoms will resolve on their own
• Don't wait for partner to get tested first

Emergency Department vs. Office Visit

Emergency Department

• Severe pain or high fever
• Signs of sepsis or shock
• Pregnancy with pelvic pain
• Unable to reach regular doctor

Scheduled Office Visit

• Mild to moderate symptoms
• Routine screening
• Follow-up care
• Partner evaluation

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