Abstract
OBJECTIVE: Review available literature on pelvic inflammatory disease in postmenopausal women. DESIGN: MEDLINE literature review from 1966 to 1999. RESULTS: Pelvic inflammatory disease is uncommon in postmenopausal women. It is polymicrobial, often is concurrent with tuboovarian abscess formation, and is often associated with other diagnoses. CONCLUSION: Postmenopausal women with pelvic inflammatory disease are best treated with inpatient parenteral antimicrobials and appropriate imaging studies. Failure to respond to antibiotics should yield a low threshold for surgery, and consideration of alternative diagnoses should be entertained.
Highlights
Design: MEDLINE literature review from 1966 to 1999
Postmenopausal women with pelvic inflammatory disease are best treated with inpatient parenteral antimicrobials and appropriate imaging studies
Failure to respond to antibiotics should yield a low threshold for surgery, and consideration of alternative diagnoses should be entertained
Summary
Postmenopausal women with pelvic inflammatory disease are best treated with inpatient parenteral antimicrobials and appropriate imaging studies. Z The pathophysiology involves the ascending spread of pathogens initially found within the endocervix, with the most common etiologic agents being the sexually transmitted microorganisms Neisseria gonorrhoeae and Chlamydia trachomatis These bacteria are identified in 60-75% of premenopausal women with PID.[3] Other responsible microorganisms include respiratory pathogens, such as Haemophilus influenzae4,s and Streptococcus pyogenes,s and bacterial vaginosis-associated microorganisms (Prevotella, Peptostreptococcus).[3,6] Cervical factors play a role in the development of PID. The columnar epithelium of the endocervix is commonly found everted in women of reproductive age, and this is accentuated with use of oral contraceptive pills Both N. gonorrhoeae and C. trachomatis attach preferentially to these columnar endocervical cells. The cervical transformation zone is anatomically located within
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