Pelvic inflammatory disease (PID) is an inflammatory disorder of the female upper genital tract that can include endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis. Sexually transmitted organisms such as Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum cause many cases of PID. However, organisms that comprise the normal vaginal flora (Cardnerella vaginalis, Haemophilus influenzae, Streptococcus agalactiae, enteric gram-negative rods) have also been implicated.
Pelvic inflammatory disease has a number of severe long-term sequelae. Of women who develop PID, 20% develop infertility, 18% suffer from chronic pelvic pain, and 9% will have an ectopic pregnancy. Because of these devastating sequelae, the CDC has cautioned clinicians to maintain a low threshold for its diagnosis and treatment, and this should be especially true among sexually active young women. Preventing these sequelae is the reason that C. trachomatis screening in asymptomatic women has been implemented, as C. trachomatis causes about 40% of PID cases.
A number of risk factors for PID have been identified and should be recognized by practitioners:
- Age less than 35 years
- Non-barrier contraception
- New, multiple, or symptomatic sexual partners
- History of PID
Bilateral lower abdominal pain is the most typical symptom in PID. The pain may be mild and is sometimes present only during intercourse or menses. Other symptoms include vaginal discharge, fever, and dysuria. On examination, patients with PID may appear well or toxic. If abdominal tenderness is present, it is typically diffuse. Fever and vaginal discharge are important signs to look for.