From the Research
Introduction to Pelvic Inflammatory Disease (PID)
Pelvic Inflammatory Disease (PID) is an infection of the female upper genital tract, typically caused by Neisseria gonorrhoeae and/or Chlamydia trachomatis, although other endogenous flora can also be involved 1. It is often a sexually transmitted disease, but other etiologic routes are also noted.
Risk Factors for PID
Several risk factors have been identified, including:
- Adolescence and young adulthood
- Adolescent cervical ectropion
- Multiple sexual partners
- Immature immune system
- History of previous PID
- Risky contraceptive practices
- Use of intrauterine device (IUD)
- History of minor gynecologic operation
- Sexual activity with multiple partners and younger age 2
Prevention Methods for PID
Prevention of PID includes:
- Screening for Chlamydia trachomatis and Neisseria gonorrhoeae in all women younger than 25 years and those who are at risk or pregnant 3
- Intensive behavioral counseling for all adolescents and adults at increased risk of sexually transmitted infections 3
- Safer sex education for adolescent and young adult patients 1
- Screening for chlamydia in young sexually active women may reduce the incidence of PID 4
Signs and Symptoms of PID
The diagnosis of PID can be challenging due to the wide spectrum of disease and clinical presentation 4. Signs and symptoms may include:
- Unexplained lower abdominal or pelvic pain
- Cervical motion, uterine, or adnexal tenderness on examination
- Nonspecific signs and symptoms, which can lead to delayed diagnosis 5
Treatment Options for PID
Treatment options for PID include:
Outpatient Treatment
- A single intramuscular injection of a recommended cephalosporin followed by oral doxycycline for 14 days 3
- Metronidazole is recommended for 14 days in the setting of bacterial vaginosis, trichomoniasis, or recent uterine instrumentation 3
Inpatient Treatment
- 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 3
- Treatment does not change in patients with intrauterine devices or those with HIV 3
Additional Considerations
- Sex partner treatment is recommended; expedited partner treatment is recommended where legal 3
- Arranging follow-up of patients within 48 to 72 hours and providing clear patient education are fundamental to ensuring good patient outcomes 5
Complications and Long-Term Sequelae of PID
Untreated PID can lead to:
- Chronic pelvic pain
- Infertility
- Ectopic pregnancy
- Intra-abdominal infections
- Ruptured tubo-ovarian abscess 5