OBJECTIVES: To study the causes of pelvic inflammatory disease (PID) in Shenyang, Northeastern China, and to assess the efficacy of the syndromic management flowchart for PID recommended by World Health Organization (WHO). METHODS: 200 outpatients with PID attending Gynaecologic Clinic of No. 1 and No. 2 hospital of China Medical University in Shenyang, and 155 control women without symptoms underwent pelvic examination, and were tested for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma hominis (MH), bacterial vaginosis (BV), Candida albicans (CA) and Trichomonas vaginalis (TV). RESULTS: In PID patients, the prevalence of MH was 26%, of BV 26%, of CT 16%, of CA 11%, of TV 4% and of NG 2.5%. In the control population, prevalences were 5.2%, 8.4%, 0%, 5.2%, 0.7%, 0% respectively. MH, BV and CT were significantly more common in PID patients than in controls (P<0.01). One hundred and thirty-seven of the 200 patients with PID (68.5%) returned for follow-up. Symptoms had resolved completely in 64 (47%), and had improved in 68 (50%). There was no improvement in five (4%). CONCLUSIONS: The management protocol for female lower abdominal pain recommended by WHO is effective in this setting.