Abstract
BackgroundPelvic inflammatory disease (PID) is the result of infection ascending through the endocervix to the uterus and fallopian tubes. Inflammation driven by infected host cells appears to be central to the development of tissue damage and associated reproductive complications. Nonsteroidal anti-inflammatory agents (NSAIDs) therefore have the potential to reduce the sequelae associated with pelvic infection.MethodsA search of four electronic reference databases, an internet search for relevant grey literature and a review of the bibliographies of identified publications was used to identify studies evaluating NSAIDs in the management of PID. A predefined search strategy was used to identify studies that included women with PID aged over 16 and diagnosed after 1980. Randomized controlled trials, nonrandomized controlled trials, and cohort studies with comparison group data were included without language restriction. Two reviewers independently assessed the studies against agreed criteria and extracted relevant data using a standardized pro forma. A meta-analysis to calculate the relative risk associated with NSAID use was planned if appropriate.ResultsForty-three studies were identified. After reviewing abstracts or full texts, two randomized controlled trials were found to meet the selection criteria for inclusion. The use of NSAIDs was reported to improve tubal patency, reduce pelvic adhesions and reduce suprapubic pain but the studies were of poor quality with a high risk of bias. Meta-analysis of the data was not performed.ConclusionsInsufficient data is available to support or refute the efficacy of NSAIDs in the prevention of short or long-term complications of PID.
Highlights
Pelvic inflammatory disease (PID) is the result of infection ascending through the endocervix to the uterus and fallopian tubes
Mycoplasma genitalium, Trichomonas vaginalis, Herpes simplex type 2, bacterial vaginosis-associated microorganisms and anaerobic organisms endogenous to the vaginal flora have been isolated from the upper genital tract, their role in the reproductive complications of pelvic infection remains unclear [3,4,5,6,7,8]
Effectiveness of nonsteroidal anti-inflammatory agent (NSAID) The studies included in this review provide insufficient data to support the use of NSAIDs in the prevention of long-term complications of PID
Summary
Pelvic inflammatory disease (PID) is the result of infection ascending through the endocervix to the uterus and fallopian tubes. Inflammation driven by infected host cells appears to be central to the development of tissue damage and associated reproductive complications. Pelvic inflammatory disease (PID) is an infectious and inflammatory disorder of the uterus, fallopian tubes and adjacent pelvic structures as a result of ascending infection from the endocervix. Mycoplasma genitalium, Trichomonas vaginalis, Herpes simplex type 2, bacterial vaginosis-associated microorganisms and anaerobic organisms endogenous to the vaginal flora have been isolated from the upper genital tract, their role in the reproductive complications of pelvic infection remains unclear [3,4,5,6,7,8]. Inflammation driven by infected host cells appears central to the development of reproductive complications. Toll-like receptor-2 acts as a mediator of the innate immune response and has a role in both the production of inflammatory mediators and the development of upper genital tract pathology [9]
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