Pelvic Inflammatory Disease

Basics

Description

  • Pelvic inflammatory disease (PID) is an acute, inflammatory disorder of the upper genital tract, including the uterus, fallopian tubes, ovaries, or adjacent structures due to infectious etiologies, frequently polymicrobial
  • Occurs in 4.4% of women of reproductive age
  • 85% of cases caused by sexually transmitted pathogens, such as Neisseria gonorrhea and Chlamydia trachomatis
  • 15% of cases are caused by other organisms such as:
    • Mycoplasma genitalium
    • Pathogens associated with bacterial vaginosis (BV)
    • Respiratory pathogens
    • Enteric pathogens
  • Most frequent gynecologic cause for ED visits (350,000/yr)
  • Inflammatory changes involving the upper genital tract leads to scarring, adhesions, and obstruction of the fallopian tube
  • Diagnosis requires high index of suspicion:
    • 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, increased risk of ectopic pregnancy and infertility
  • Progressive disease can lead to tubo-ovarian abscess (TOA) – most common complication
  • 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

Etiology

  • 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 (more likely to have asymptomatic infection)
  • Most common causes of PID are:
    • Chlamydia trachomatis
    • Neisseria gonorrhoeae
  • Other organisms include:
    • Mycoplasma genitalium
    • Organisms associated with BV (G. vaginalis, peptostreptococcus)
    • Respiratory pathogens (H. influenza, S. pneumonia, S. aureus)
    • Enteric pathogens (E. coli, Group B strep, B. fragilis)

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