Since PID can range from the "silent" variety (no symptoms) to a full-blown infection complete with pain, fever, and abnormal blood tests, there is no "standard" diagnostic procedure. If your doctor suspects that you may have PID, he or she must be able to distinguish between the disease and emergency conditions such as an ectopic pregnancy and appendicitis. For every 100 women suspected of having PID, about three or four will actually have an ectopic pregnancy and another three or four will turn out to have appendicitis.
Most women who develop PID have abdominal pain, pelvic tenderness, and some symptoms of a lower genital tract infection such as cervicitis. To help confirm the presence of infection, your doctor will probably do a couple of blood tests. There may also be a test for human chorionic gonadotropin, a hormone that rises during pregnancy and can signal that the pain is due not to PID but to an ectopic pregnancy. You will also probably be checked for gonorrhea and chlamydia. Samples swabbed from your cervix, or birth canal, will be taken with a cotton swab and sent to a lab for examination.
If your doctor suspects the infection may be due to an adnexal abscessa pus-filled pocket of fluid and bacteria around the ovary or fallopian tubeyou may have to undergo an ultrasound examination, in which sound waves beamed into the body are used to build an image of internal organs on a computer screen.
The only completely conclusive way to diagnose PID is a surgical procedure called laparoscopy in which a special kind of viewing instrument called a laparoscope is inserted through a small incision below the navel. This type of surgery usually involves general anesthesia that puts you to sleep, but it can often be performed on an out-patient basis and does not usually require overnight hospitalization. By examining the affected organs with the laparoscope, your doctor can make a definite diagnosis. You'll usually be given antibiotics to protect you from further infection by the operation itself. The procedure generally takes less than 45 minutes and most patients can return home after resting from 2 to 6 hours.
Although laparoscopy is necessary for a definitive diagnosis of dangerous conditions such as adnexal abscess or ectopic pregnancy, most cases of PID do not call for it; and most doctors will start treatment for PID immediately if they even suspect the problem. If you have gonorrhea or chlamydia, delaying even a few days can greatly increase your chances of complications such as ectopic pregnancy or infertility. The risk of taking some unnecessary antibiotics is far less than the risk of letting PID go unchecked.
