Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infection of the female upper genital tract. Women with PID may experience both short- and long-term consequences of infection. Short-term sequelae include perihepatitis (Fitz-Hugh-Curtis syndrome) and tubo-ovarian abscess. Long-term sequelae include infertility, ectopic pregnancy, and chronic pelvic pain. PID is a significant public health problem, with an estimated one million cases each year in the United States. Millions of dollars are spent annually on diagnosis and treatment. The epidemiology of PID is complex, with several variables impacting on the risk of acquisition. Risk factors include age less than 25 years, African American race, low socioeconomic status, multiple sexual partners, a new partner within 30 days, a young age at first intercourse, use of an intrauterine contraceptive device, cigarette smoking, a history of previous PID, and lower genital tract infection with Neisseria gonorrhoeae, Chlamydia trachomatis, and bacterial vaginosis. PID is a polymicrobial infection, caused by both sexually transmitted and endogenous organisms. It almost always results from direct spread of organisms from the endocervix upward to the upper genital tract. The clinical diagnosis of PID is often difficult to make because women may present with a wide variety of signs and symptoms that may overlap with other conditions. The most common presenting symptom is lower abdominal pain. On physical examination, the minimum criteria for making a diagnosis of PID include lower abdominal, adnexal, and cervical motion tenderness. The goals of PID treatment are to control the acute infection and to prevent long-term sequelae. Antimicrobial therapy must provide empiric broad-spectrum coverage of likely etiologic pathogens.