Pelvic Inflammatory Disease

Basics

Pelvic inflammatory disease (PID) is an acute, community-acquired, sexually transmitted infection of the upper genital tract, including the uterus, fallopian tubes, ovaries, or adjacent structures
Occurs in 4.4% of women of reproductive age
85% of cases caused by sexually transmitted pathogens or bacterial vaginosis pathogens
15% of cases due to colonization of respiratory or enteric pathogens
Most frequent gynecologic cause for ED visits (350,000 per year)
Represents a spectrum of infection:
- No single diagnostic gold standard
- Requires low clinical threshold for considering the diagnosis and starting empiric antibiotic therapy
- Delayed care is associated with worse long-term outcomes including chronic pelvic pain and increased risk of ectopic pregnancy
Likely missed often and responsible for many cases of tubal-factor infertility
Progressive disease can lead to tubo-ovarian abscess (TOA)
Fitz-Hugh–Curtis syndrome is a capsular inflammation of the liver associated with PID:
- Sharp right upper quadrant abdominal pain
- Worse with inspiration, movement, or coughing
Chronic PID:
- Symptoms > 30 d
- Mycobacterium tuberculosis
- Actinomyces

Risk factors:
- Age <25 yr
- Earlier sexual activity:
  - 8 times higher if sexually active at age 12 yr vs. 18 yr
- Multiple or symptomatic sexual partners
- Prior sexually transmitted infection
- Previous episode of PID
- Lesbian/bisexual relationships:
  - Prevalence is 2 times higher
- Nonbarrier contraception
- Oral contraception
- African American ethnicity
Most common causes of PID are:
- Chlamydia trachomatis
- Neisseria gonorrhoeae
Other organisms include:
- Groups A and B streptococci
- Staphylococci
- Gram-negative rods (commonly Klebsiella spp., Escherichia coli, and Proteus spp.)
- Anaerobes

There's more to see -- the rest of this topic is available only to subscribers.