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 the bacteria 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 for PID, 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
- Young age
- History of minor gynecologic operation 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
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 aims to preserve fertility, prevent long-term consequences, and relieve acute clinical symptoms. The recommended treatment regimens include:
- A single intramuscular injection of a recommended cephalosporin followed by oral doxycycline for 14 days for mild to moderate disease 3
- Metronidazole 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
- Treatment does not change in patients with intrauterine devices or those with HIV 3
- Sex partner treatment is recommended; expedited partner treatment is recommended where legal 3
Differential Diagnosis and Caveats
It is essential to consider other potential causes of pelvic pain and to exclude surgical emergencies. The diagnosis and treatment of PID should be guided by established guidelines, such as those from the US Centers for Disease Control and Prevention (CDC) 1. Antibiotic therapy should be started early and given for an adequate period to reduce the risk of complications, including coverage for anaerobic organisms in most cases 4.