Pelvic inflammatory disease is one of the frequent causes of infertility and consists of inflammation of the upper genital tract of women of childbearing age – it includes inflammation of the ovaries (oophoritis), of the fallopian tubes (salpingitis), of the endometrium (endometritis), of the periuterine tissues (parametritis), of the pelvic peritoneum (pelvic peritonitis). Usually the infection ascends from the endocervix. In two-thirds of cases, pelvic inflammatory disease affects women under the age of 25. Gram-negative bacteria of the species Chlamydia trahomatis and Neisseria gonorrhoeae are considered the main etiological agents of the infection. Sexually transmitted bacteria of the Mycoplasma genitalium species, as well as anaerobes of the genus Peptostreptococcus, etc., are also found among the causative agents of pelvic inflammatory disease. The causative agent of bacterial vaginosis, Gardnerella vaginalis, is also among the etiological causes of pelvic inflammatory disease. Since pelvic inflammatory disease develops among women suffering from sexually transmitted infections such as gonorrhea and chlamydial infection, among the factors that increase the risk of its development are: frequent change of sexual partners, multiple sexual contacts with different partners, unprotected intercourse , young age, low socioeconomic status, intravenous drug use, smoking, presence of an intrauterine device. In addition to risks, there are also protective factors, among which are the use of barrier methods of contraception (condoms) and oral contraceptives. The pathophysiological mechanism of infection of the upper genital tract consists in the disruption of the barrier function of the endocervix performed by epithelial cells and cervical mucus. It is believed that the ascension of the infectious agent occurs during the proliferative phase of the menstrual cycle, when the cervical mucus is less viscous and allows its passage. On the other hand, gonococci and chlamydia destroy the connections between epithelial cells. There is also a genetic predisposition to pelvic inflammatory disease – genetic polymorphism in genes for Toll-like receptors increases the risk of infection of the upper genital tract. Pelvic inflammatory disease can be acute, subacute, chronic and subclinical. In a large percentage of cases, the diagnosis is missed due to the asymptomatic course. In an acute course, the following symptoms are characteristic: Severe abdominal pain, usually bilateral; Pain when moving the cervix during bimanual palpation; Pain in the area of ​​the adnexa during bimanual palpation; Increased body temperature above 38 degrees; Pain during urination (dysuria) and during intercourse (dyspareunia); Dysfunctional uterine bleeding; Vaginal discharge with a mucopurulent character; Leukocytosis, increased C-reactive protein, accelerated ESR; Isolation of gonococci or chlamydia. According to the spread of the infectious-inflammatory process, several stages of pelvic inflammatory disease are distinguished:I stage – patients with acute salpingitis without peritonitis; II stage – acute salpingitis with peritonitis; III stage – presence of tubo-ovarian abscess; IV stage – rupture of the tubo-ovarian abscess. As complications of pelvic inflammatory disease, ectopic pregnancy, infertility, chronic pelvic pain or tubo-ovarian abscess may occur. Diagnosing pelvic inflammatory disease is not an easy task, especially in asymptomatic cases. Leukocytosis, elevated C-reactive protein, and accelerated ESR are nonspecific markers and do not have much diagnostic value. Laparoscopy has the greatest diagnostic value, but since the method is invasive and expensive, it is not routinely applied. Another diagnostic method is the ultrasound examination, which is applied routinely, but in the early stage of pelvic inflammatory disease, it has no great diagnostic value. The method is useful in suspected tubo-ovarian abscess or hydrosalpinges. Testing for gonorrhea and chlamydia is mandatory. Computed tomography or nuclear magnetic resonance can be applied as additional methods and in case of diagnostic difficulties, the latter being preferable due to its high sensitivity and lack of ionizing radiation. In terms of differential diagnosis, acute appendicitis, ectopic pregnancy, endometriosis, ovarian cyst rupture, urinary tract infections should be excluded. Treatment of pelvic inflammatory disease should begin empirically with medications covering aerobes and anaerobes. The goals of treatment are short-term, related to controlling the infectious-inflammatory process and clinical manifestations, and long-term, aimed at preventing complications such as infertility, chronic pelvic pain, etc. As a first line of treatment, a combination of parenteral third-generation cephalosporin, oral doxycycline and, if necessary, metronidazole to cover anaerobes is administered. Quinolones are used as a second line of treatment, but they should be avoided in pelvic inflammatory disease caused by gonococci because of the high resistance of gonococci to them.Testing for gonorrhea and chlamydia is mandatory. Computed tomography or nuclear magnetic resonance can be applied as additional methods and in case of diagnostic difficulties, the latter being preferable due to its high sensitivity and lack of ionizing radiation. In terms of differential diagnosis, acute appendicitis, ectopic pregnancy, endometriosis, ovarian cyst rupture, urinary tract infections should be excluded. Treatment of pelvic inflammatory disease should begin empirically with medications covering aerobes and anaerobes. The goals of treatment are short-term, related to controlling the infectious-inflammatory process and clinical manifestations, and long-term, aimed at preventing complications such as infertility, chronic pelvic pain, etc. As a first line of treatment, a combination of parenteral third-generation cephalosporin, oral doxycycline and, if necessary, metronidazole to cover anaerobes is administered. Quinolones are used as a second line of treatment, but they should be avoided in pelvic inflammatory disease caused by gonococci because of the high resistance of gonococci to them.Testing for gonorrhea and chlamydia is mandatory. Computed tomography or nuclear magnetic resonance can be applied as additional methods and in case of diagnostic difficulties, the latter being preferable due to its high sensitivity and lack of ionizing radiation. In terms of differential diagnosis, acute appendicitis, ectopic pregnancy, endometriosis, ovarian cyst rupture, urinary tract infections should be excluded. Treatment of pelvic inflammatory disease should begin empirically with medications covering aerobes and anaerobes. The goals of treatment are short-term, related to controlling the infectious-inflammatory process and clinical manifestations, and long-term, aimed at preventing complications such as infertility, chronic pelvic pain, etc. As a first line of treatment, a combination of parenteral third-generation cephalosporin, oral doxycycline and, if necessary, metronidazole to cover anaerobes is administered. Quinolones are used as a second line of treatment, but they should be avoided in pelvic inflammatory disease caused by gonococci because of the high resistance of gonococci to them.