From the Guidelines
PID, or Pelvic Inflammatory Disease, is a serious infection of the female reproductive organs typically caused by sexually transmitted bacteria that spread from the vagina to the uterus, fallopian tubes, and ovaries. This condition comprises a spectrum of inflammatory disorders of the upper female genital tract, including any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis, as described in the guidelines by the Centers for Disease Control and Prevention 1. The infection develops when bacteria move upward from the vagina or cervix into the reproductive organs, often after untreated sexually transmitted infections like chlamydia or gonorrhea.
Some key points about PID include:
- Sexually transmitted organisms, especially N. gonorrhoeae and C. trachomatis, are implicated in many cases, but microorganisms that comprise the vaginal flora, such as anaerobes, G. vaginalis, H. influenzae, enteric Gram-negative rods, and Streptococcus agalactiae, also can cause PID 2.
- PID can cause permanent damage, including chronic pelvic pain, ectopic pregnancy, and infertility, if not properly treated.
- Regular STI screening is important for sexually active individuals to prevent PID, as stated in the 1998 guidelines for treatment of sexually transmitted diseases 2.
- Treatment requires prompt antibiotic therapy, usually with a combination regimen, and hospitalization may be necessary for severe cases.
It is essential to note that the guidelines for PID diagnosis and treatment have been updated over the years, but the core principles remain the same, with a focus on prompt antibiotic therapy and prevention of long-term complications, as emphasized in the 2002 guidelines 1.
From the Research
Definition of PID
- Pelvic inflammatory disease (PID) is an infection of the uterus, fallopian tubes, and adjacent pelvic structures that is not associated with surgery or pregnancy 3.
- PID affects 4% to 12% of women of reproductive age 4.
- The clinical spectrum of PID ranges from subclinical endometritis to severe salpingitis, pyosalpinx, tubo-ovarian abscess, pelvic peritonitis, and perihepatitis 3.
Causes of PID
- The most important causative micro-organisms are Chlamydia trachomatis, Neisseria gonorrhoeae, and micro-organisms associated with bacterial vaginosis 3.
- Other bacteria such as Mycoplasma genitalium can also cause PID 5.
Treatment of PID
- The main intervention for acute PID is broad-spectrum antibiotics administered intravenously, intramuscularly, or orally 4.
- Current treatment guidelines call for broad-spectrum antimicrobial coverage, including regimens such as ceftriaxone plus doxycycline, with or without metronidazole 6.
- Alternative regimens, such as azithromycin-based regimens, have been studied, but their effectiveness compared to standard treatments is still being researched 5.
- The choice of treatment regimen may depend on the specific causative micro-organism and the presence of antimicrobial resistance-associated mutations 5.