Definition: a clinical spectrum of infection (Figure 8.1) that may involve the cervix, endometrium, fallopian tubes, ovaries, uterus, broad ligaments, intraperitoneal cavity, and perihepatic region.
- Infectious inflammation of the pelvic organs may lead to tissue necrosis and abscess formation. Eventually, the process evolves into scar formation with development of adhesions to nearby structures.
- Acute PID (salpingitis) is the typical clinical syndrome.
- Chronic PID is an outdated term that refers to the long-term sequelae.
Etiology
- The pathogenesis is incompletely understood but involves a polymicrobial infection ascending from the bacterial flora of the vagina and cervix.
- Chlamydia trachomatis and/or Neisseria gonorrhoeae is detectable in >50% of women. These pathogens are probably responsible for the initial invasion of the upper genital tract, with other organisms becoming involved secondarily.
- Fifteen percent of cases follow a surgical procedure (endometrial biopsy, intrauterine device [IUD] placement) which breaks the cervical mucous barrier and directly transmits bacteria to the upper genital tract.
Risk factors
- The classic example of a high-risk patient is a menstruating teenager who has multiple sexual partners, does not use contraception and lives in an area with a high prevalence of STIs.
- Seventy-five percent of women diagnosed are <25 years.
- Premenarchal, pregnant, or postmenopausal patients are rare.
- Having multiple partners increases the risk by fivefold.
- Frequent vaginal douching increases the risk by threefold.
- Barrier (condom, diaphragm) contraception decreases the risk.
- IUD insertion is a risk factor in the first 3 weeks after placement.
- Previous PID is a risk factor for future episodes: 25% of women will develop another infection.
Epidemiology
- 1 million women in the USA (200,000 in the UK) are diagnosed annually.
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