Pelvic inflammatory disease is a common sequel to sexually transmitted infection. The diagnosis is suspected in sexually active females presenting with lower abdominal pain. We report a case in a female using a menstrual cup with low risk factors and atypical presentation of peritonitis. A computer tomography abdominal scan identified dilated large bowel loops and free fluid in the abdomen. A diagnostic laparoscopy revealed hyperaemic uterus and ovaries and turbid fluid in all four quadrants of the abdomen. Culture of the fluid was positive for chlamydia trachomatis. This is an unusual presentation of peritonitis in a patient, using a menstrual cup, with a latent sexually transmitted infection. Although uncommon, the use of a menstrual cup is a potential source of bacterial growth requiring a thorough gynaecological history in young female patients presenting with atypical abdominal pain.

Authors: Sujen Jayakody, Krishanth Naidu, Sivakumar Gananadha

Key Words: Menstrual cup, pelvic inflammatory disease, peritonitis