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, such as the use of intrauterine devices (IUDs) 2
- History of minor gynecologic operations 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
- Use of condoms to prevent sexually transmitted diseases (STDs), including HIV 4
- Consideration of contraceptive pills as a good option to decrease the rate of recurrence 4
Signs and Symptoms of PID
The diagnosis of PID is made primarily on clinical suspicion, and empiric treatment is recommended in sexually active young women or women at risk for sexually transmitted infections who have:
- Unexplained lower abdominal or pelvic pain
- Cervical motion, uterine, or adnexal tenderness on examination 3
Treatment Options for PID
Treatment of PID includes:
- Antibiotic therapy, which should be started early and given for an adequate period of time to reduce the risk of complications 5
- Coverage for anaerobic organisms should be considered in most cases 5
- 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 3
- Metronidazole is recommended for 14 days in the setting of bacterial vaginosis, trichomoniasis, or recent uterine instrumentation 3
- 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
Follow-up and Counselling after PID
Follow-up, partner treatment, and counselling are also useful to reduce the reinfection rate 4. Few weeks after PID, clinical evaluation as well as transvaginal and transabdominal sonography must be performed. The interest of systematic bacteriological tests is not proved. Hysterosalpingography and second-look laparoscopy should be considered only for women with infertility and severe infection. Counselling and risk-reduction interventions decreased significantly the rate of recurrence and sequelae in PID.