Current views on the concept of pelvic inflammatory disease.

Abstract

This article reviews the current literature on the etiology clinical manifestations sequelae and management of pelvic inflammatory disease (PID). PID is now regarded as a complex clinical syndrome with a polymicrobial etiology. Both exogenous (largely sexually transmissible) and endogenous microorganisms have been identified in PID. 60-80% of PID cases in women under 25 years of age involve neisseria gonorrhoeae chlamydia trachomatis or Mycoplasma hominis. PID cases caused by endogenous agents such as aerobic and anaerobic streptococci are clinically more severe than cases associated with sexually transmitted diseases. The microbial etiology of the tubal infection cannot be determined in 20% of cases suggesting 1 or more as yet unidentified microorganism. 75% of PID cases involve women under 24 years of age 75% of whom are nulliparous. The annual incidence of PID among women 15-24 years of age in the US and Europe is 20/1000 women. The classical signs of PID (e.g. elevated erythrocyte sedimentation rate febrile illness palpable adnexal swelling) are present in less than 20% of cases. Use of laparoscopy verifies the diagnosis of PID and enables specimen collection for microbiological examinations. The most common diagnostic problem is differentiation between acute salpingitis and lower genital tract infection. Prospective studies after PID have indicated that 20% of women have repeat infections. The infertility ate increases significantly with the number of tubal infections. Overall it is estimated that 25% of women with PID will experience chronic abdominal pain ectopic pregnancy and/or infertility. Conservative treatment with rest and antibiotics is recommended in acute PID episodes. Surgery is indicated in life-threatening disease abscesses and cases that fail to respond to conservative treatment. Since 75% of PID cases are associated with sexually transmitted diseases control of these infections is central to PID prevention.