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Investigation in primary care

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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  • in all women with suspected PID, swabs for Chlamydia trachomatis and Neisseria gonorrhoea should be taken from the endocervix (and urethra) as a minimum (1)
    • a negative swab result does not exclude PID (2).
  • endocervical or vaginal pus cells on a wet-mount vaginal smear
    • although the presence of cells is non specific the absence of cells indicates that PID is unlikely (95%) (2)
  • other tests such as a pregnancy test (to exclude ectopic pregnancy) (3), urinalysis and urine culture may help exclude other causes of lower abdominal pain

Tests generally undertaken in secondary care environment may also include:

  • FBC (leucocytosis), ESR (raised), CRP (raised); useful in assessing disease severity (3) but can be normal in mild or moderate disease (1)
  • other tests which may be useful include - LFTs (raised in perihepatitis) and blood cultures (if pyrexial)

Advice may be required from microbiology and genito-urinary medicine (GUM) departments concerning current diagnostic methods for causes of PID. (1)


1. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.

2. 2018 United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease. British Association for Sexual Health and HIV (BASHH - 2018, last updated 2019)

3. Curry A et al. Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention. Am Fam Physician. 2019 Sep 15;100(6):357-364.

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