Treatment of Acute Pelvic Inflammatory Disease

Abstract

The optimum strategy for minimizing the sequelae is prevention of pelvic inflammatory disease (PID) by preventing lower genital tract infections such as cervicitis with Neisseria gonorrhoeae or Chlamydia trachomatis and bacterial vaginosis (BV) (i.e., primary prevention).1 A secondary approach, when primary prevention fails, relies on early detection and prompt treatment of lower genital tract infections. Unfortunately accomplishing either of these two strategies requires effective sexually transmitted disease (STD) control programs, which to date are sorely lacking in the United States. Thus, in the United States prevention of these sequelae relies on prompt diagnosis and treatment of acute PID. This so-called tertiary prevention approach is further complicated by the wide spectrum of clinical presentation of PID, ranging from asymptomatic (“silent”) to minimally symptomatic (“atypical” or “unrecognized”) to clinical PID (“typical”). Whether patients are truly asymptomatic or unrecognized because they present with minimal or atypical signs and symptoms of PID has been uncertain. Recently, Wølner-Hanssen2 provided data demonstrating that patients listed as having silent PID truly did have symptoms suggestive of PID when questioned extensively.