What are the complications of Pelvic Inflammatory Disease (PID)?

From the Guidelines

Pelvic inflammatory disease (PID) can lead to severe and long-lasting complications, including chronic pelvic pain, ectopic pregnancy, and tubal infertility, which can occur in up to 20% of women with PID 1. The most significant complications of PID include:

• Chronic pelvic pain
• Ectopic pregnancy, with a sevenfold increased risk after one episode of PID 1
• Tubal infertility, affecting approximately 12% of women after a single episode, 25% after two episodes, and over 50% after three or more episodes 1
• Dyspareunia, pyosalpinx, tubo-ovarian abscess, and pelvic adhesions, which can require subsequent surgical intervention 1 These complications can have a major effect on a woman's reproductive health and are associated with great emotional stress 1. Early recognition and treatment of PID are crucial to prevent these complications and minimize their impact on a woman's quality of life 1. Key factors to consider in the management of PID include:
• Prompt antibiotic treatment to reduce the risk of long-term complications 1
• Close follow-up to monitor for signs of complications and adjust treatment as needed 1
• Patient education on the importance of completing the full treatment course and follow-up care to prevent recurrent PID and minimize its consequences 1

From the Research

PID Complications

• Untreated PID can lead to chronic pelvic pain, infertility, ectopic pregnancy, and intra-abdominal infections 2, 3
• The infection can cause inflammation of the fallopian tubes, leading to infertility and ectopic pregnancy 3
• PID can also cause chronic pelvic pain and intra-abdominal infections 2, 3

Diagnosis and Treatment

• The diagnosis of PID is based on clinical suspicion and empiric treatment is recommended in sexually active young women or women at risk for sexually transmitted infections 2
• Mild to moderate disease can be treated in an outpatient setting with a single intramuscular injection of a recommended cephalosporin followed by oral doxycycline for 14 days 2
• Hospitalization for parenteral antibiotics is recommended in patients who are pregnant or severely ill, in whom outpatient treatment has failed, those with tubo-ovarian abscess, or if surgical emergencies cannot be excluded 2

Antibiotic Regimens

• Azithromycin versus doxycycline: there was no clear evidence of a difference between the two drugs in rates of cure for mild-moderate PID, but azithromycin may be more effective than doxycycline for curing mild-moderate PID 4, 5, 6
• Quinolone versus cephalosporin: there was no clear evidence of a difference between the two drugs in rates of cure for mild-moderate PID 4, 5
• Nitroimidazole versus no use of nitroimidazole: there was no conclusive evidence of a difference between the nitroimidazoles group and the group receiving other drugs with activity over anaerobes 4, 5

Prevention

• Prevention of PID includes screening for C. trachomatis and N. gonorrhoeae in all women younger than 25 years and those who are at risk or pregnant, plus intensive behavioral counseling for all adolescents and adults at increased risk of sexually transmitted infections 2