other cause of illness can be determined, and if cervical motion tenderness, uterine tenderness or adnexal tenderness are present on pelvic examination. 16 In addition to those minimum criteria, the following findings can be used to support a diagnosis of PID: oral temperature &gt;101F, abnormal cervical or vaginal mucopurulent discharge, presence of abundant numbers of white blood cells on saline microscopy of vaginal secretions, elevated erythrocyte sedimentation rate, elevated C-reactive protein, and laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis . 16 The CDC surveillance case definition for PID differs from the clinical case definition. A female who has lower abdominal pain and who has not been diagnosed as having an established cause other than PID must have lower abdominal tenderness, tenderness with motion of the cervix, and adnexal tenderness to be considered a surveillance case of PID. 17 In addition to the previous 3 criteria, at least 1 of the following findings must also be present: meets the surveillance case definition of C. trachomatis infection or gonorrhea; temperature &gt;100.4F (&gt;38.0C); leukocytosis &gt;10,000 white blood cells/mm 3 ; purulent material in the peritoneal cavity obtained by culdocentesis or laparoscopy; pelvic abscess or inflammatory complex detected by bimanual examination or by sonography; patient is a sexual contact of a person known to have gonorrhea, chlamydia, or nongonococcal urethritis. 17 We examined all cases of PID among San Francisco residents reported to the San Francisco Department of Public Health with a date of diagnosis between January 1, 2004 and