Acute pelvic inflammatory disease: a narrative review

Abstract

Background and objective: Pelvic inflammatory disease (PID) is an upper genital tract infection in females that is typically acquired via sexual activity. It usually is initiated by the presence of Chlamydia trachomatis and/or Neisseria gonorrhoeae and escalates into a polymicrobial infection from local genital tract flora. Research identifies various known risk factors including young age, immunopathology and others. This article reviews the epidemiology, differential diagnosis, management, and concepts of prevention for PID. Methods: An electronic search was performed on MEDLINE to identify relevant articles from 2010 to 2018. Key Content and Findings: PID continues to be a major sexually transmitted disease among adolescent and young adult females. Among the 1 million cases that are found in the United States (U.S.) each year, about one-third are in adolescent females. It is typically a polymicrobial infection that can lead to acute salpingitis, perihepatitis, endometritis, oophoritis, pelvic peritonitis and/or tubo-ovarian abscess. Diagnostic criteria and recommended treatment have been developed by the U.S. Centers for Disease Control and Prevention (CDC). Complication of PID include chronic pelvic pain, ectopic pregnancy and infertility. Conclusions: PID is a common sexually transmitted disease that is found in many adolescents and young women. The possibility of PID should be seriously considered by clinicians when evaluating a sexually active teenage or young adult female with lower abdominal pain, vaginal discharge, vaginal bleeding, urinary symptoms, post-coital bleeding and/or dyspareunia. It may be a silent infection as well. Various risk factors for PID are noted including the adolescent age group, ectropion of young adolescent females, immature immune system, multiple coital partners and others. Clinicians should follow treatment protocols established by the CDC and the World Health Organization (WHO). The problem of PID should stimulate clinicians and society to provide comprehensive sexuality education to our youth.