Pelvic Inflammatory Disease

Abstract

1. Jonathan R. Pletcher, MD* 2. Gail B. Slap, MD* 1. 2. *Section of Adolescent Medicine, Division of General Pediatrics, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA. 1. Pelvic inflammatory disease (PID) is a polymicrobial infection, usually initiated by endocervical infection with Neisseria gonorrhoeae or Chlamydia trachomatis . 2. More than 25% of women affected with PID suffer one of several serious sequelae, including tubal infertility, tubo-ovarian abscess, chronic pelvic pain, or ectopic pregnancy. 3. PID is diagnosed primarily through clinical assessment, with laboratory and radiographic studies supporting or confirming it. 4. Treatment of PID includes broad-spectrum antibiotic coverage for anaerobic bacteria as well as for the causative organisms. 5. Primary and secondary prevention is paramount in reducing the social, emotional, and economic burden of PID and its sequelae. Pelvic inflammatory disease (PID) is an ascending polymicrobial genital tract infection that occurs in sexually active females. It includes an array of inflammatory disorders, including endometritis, parametritis, salpingitis, oophoritis, tubo-ovarian abscess (TOA), peritonitis, and perihepatitis. Neisseria gonorrhoeae and Chlamydia trachomatis are usually the causative agents of PID, but microflora from the vagina and the bowel also may contribute to its pathogenesis. The serious medical and social consequences of PID, including chronic pain, ectopic pregnancy, and infertility, demand improved efforts at prevention, recognition, and management. Given the declining age of sexual initiation in the United States, strategies designed to curtail PID and its sequelae begin in the pediatrician’s office. PID affects 1 million American women annually at an estimated annual cost of $4.2 billion. Sexually active adolescents account for 20% to 30% of cases and face a tenfold increase in risk compared with adults. PID results in more than 600,000 hospital admissions yearly and leads to serious long-term complications in 25% of women who are infected. The likelihood of sequelae is particularly high among adolescents because of late presentation, delayed diagnosis, and inadequate treatment. The increased risk of PID during adolescence reflects both the biologic susceptibility of the immature cervix and the high prevalence …