Treatment of acute pelvic inflammatory disease.

Richard L Sweet

doi:10.1155/2011/561909

Abstract

Pelvic inflammatory disease (PID), one of the most common infections in nonpregnant women of reproductive age, remains an important public health problem. It is associated with major long-term sequelae, including tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. In addition, treatment of acute PID and its complications incurs substantial health care costs. Prevention of these long-term sequelae is dependent upon development of treatment strategies based on knowledge of the microbiologic etiology of acute PID. It is well accepted that acute PID is a polymicrobic infection. The sexually transmitted organisms, Neisseria gonorrhoeae and Chlamydia trachomatis, are present in many cases, and microorganisms comprising the endogenous vaginal and cervical flora are frequently associated with PID. This includes anaerobic and facultative bacteria, similar to those associated with bacterial vaginosis. Genital tract mycoplasmas, most importantly Mycoplasma genitalium, have recently also been implicated as a cause of acute PID. As a consequence, treatment regimens for acute PID should provide broad spectrum coverage that is effective against these microorganisms.

Highlights

Pelvic inflammatory disease (PID) is a spectrum of upper genital tract infections that includes endometritis, salpingitis, tuboovarian abscess, and/or pelvic peritonitis [1]
Preliminary work by our group has suggested that the microorganisms (e.g., N. gonorrhoeae, C. trachomatis, and bacterial vaginosis) associated with subclinical PID are the same putative agents recovered from women with clinically apparent acute PID [14]
In previous studies we have shown that ongoing subclinical PID is frequently present in women with untreated lower genital tract infections [14], and that persistent endometrial infection with C. trachomatis [26] and anaerobes [22] may lead to subsequent tubal damage and increased infertility among women with inadequately treated acute PID

Summary

Introduction

Pelvic inflammatory disease (PID) is a spectrum of upper genital tract infections that includes endometritis, salpingitis, tuboovarian abscess, and/or pelvic peritonitis [1]. PID is one of the most frequent and important infections that occur among nonpregnant women of reproductive age and remains a major public health problem [4,5,6,7,8]. Among women, it is the most significant complication of sexually transmitted diseases/infections. Subclinical PID has been recognized as an important entity which is common among women with lower genital tract infections, especially Chlamydia trachomatis, Neisseria gonorrhoeae, and bacterial vaginosis (BV) [14, 15]. The polymicrobic etiology of PID is well established and has led to utilization of broad spectrum antimicrobial regimens for treatment of acute PID [1, 2, 17, 18]

Etiology of PID

Treatment Concepts

Antimicrobial Treatment Regimens

Findings

Conclusion