Update on pelvic inflammatory disease

Abstract

Pelvic inflammatory disease (PID) is the major cause of tubal infertility, the risk of which increases markedly after recurrences, which are common. It also increases the risk of ectopic pregnancy. Diagnosis is difficult and treatment may not prevent tubal damage and scarring so prevention or prompt treatment of sexually transmissible infection (STI) that often precedes it is a priority. The diagnosis of PID is usually based on a history of pelvic pain and evidence of cervical and adnexal tenderness but symptoms are often non-specific or absent. There is poor correlation between clinical and laparoscopic findings. In a recent study only 20% of women with pelvic pain (and only 55% of those considered, clinically, to have PID) had laparoscopic evidence of active salpingitis. Identifying the microbiological causes is also difficult; the predominant pathogens are Chlamydia trachomatis (by far the most common), Neisseria gonorrhoeae, Mycoplasma genitalium and/or mixed endogenous vaginal bacteria (the latter especially when PID is associated with genital trauma e.g., pregnancy termination or complications). Investigations of suspected PID should include urine nucleic acid tests for major STI pathogens and endocervical cultures for predominant facultative bacteria, including N. gonorrhoeae . However, cervical microbiology does not always reflect tubal flora and therapy is usually empirical.