Tanya S. Ghatan

Pelvic inflammatory disease (PID) refers to an infection of the upper female genital tract. The infection involves the uterus, fallopian tubes, ovaries, and may evolve into a larger pelvic infection. It may include any combination of endometritis, salpingitis, tubo-ovarian abcess, and peritonitis. Many different organisms are implicated in PID, but the majority are associated with Neisseria gonorrhoeae and Chlamydia trachomatis.

PID can be a serious complication of sexually transmitted diseases, especially those of gonorrhea and chlamydia. The centers for disease control and prevention (CDC) reports approximately 1 million women in the United States experience an acute episode of PID each year.

Long-term consequences from damage to the fallopian tissues and surrounding tissues include infertility, ectopic pregnancy, pelvic abcesses, and chronic pelvic pain. Over 100 000 women experience infertility annually as a result of PID.

Risks factors are the same as for any sexually transmitted disease, but a previous episode of PID places a woman at greater risk for developing a second episode. Sexually active women of childbearing age are those at greatest risk, with those under 25 years at the greatest risk. The cervix of teenage girls and young women is not fully developed, which increases the risk of infection. The number of lifetime sexual partners as well as multiple partners increases the risk.

Use of intrauterine devices is associated with an elevated PID risk immediately after insertion compared with women utilizing other methods of contraception; however, this does not persist after placement. This risk is reduced by STD screening and treatment prior to placement.

PID may present differently, with some women experiencing no symptoms to very mild ones, and others having very severe symptoms. The degree of damage done to the reproductive system does not correlate to the severity of symptoms. Lower abdominal pain, fever, vaginal discharge, painful intercourse, dysuria, and irregular bleeding are common symptoms.

PID can cause significant and permanent damage to the fallopian tubes and reproductive organs of infected patients. Timely treatment can help to prevent complications. Bacteria in the fallopian tubes can cause infection resulting in scar tissue formation and subsequent blockage of the tubes. Approximately 10% of women with PID sufer from infertility, with the risk of infertility increasing with subsequent episodes.

In addition to infertility, scarring damage to the fallopian tubes may result in ectopic pregnancies. Ectoptic pregnancies can be life-threatening if not recognized and treated in a timely fashion.

Long-term chronic pelvic pain is another known complication, which results from scarring in the pelvis involving the fallopian tubes and other structures.

PID can be a subtle infection that is difficult to diagnose. It is frequently missed due to mild or subtle symptoms. There is no single test for PID. Diagnosis is usually clinical and occurs in the office or emergency room. For this reason, a low-threshold diagnosis should be maintained.

Outpatient

Empiric treatment in sexually-active young women and those at risk should be initiated if they are experiencing pelvic or lower abdominal pain, no other cause can be identified, and if cervical motion tenderess, uterine tenderness, or adnexal tenderness are present.