Pelvic inflammatory disease

Pelvic inflammatory disease is an acute ascending polymicrobial infection of the female gynaecological tract that is frequently associated with Neisseria gonorrhoeae or Chlamydia trachomatis.

Symptoms and physical findings vary widely and may include lower abdominal tenderness, adnexal tenderness, and cervical motion tenderness. Fever and cervical or vaginal discharge may also be present.

Diagnosis may be difficult because symptoms range from absent to severe and may be non-specific. Possible laboratory findings include abundant white blood cells on saline microscopy of vaginal secretions, elevated erythrocyte sedimentation rate, elevated C-reactive protein, and laboratory documentation of cervical infection with Neisseria gonorrhoeae or Chlamydia trachomatis. Laparoscopy is the definitive procedure but is invasive and is not recommended for routine diagnosis.

Antibiotic treatment should be initiated in patients who are sexually active and who have pelvic pain, cervical motion tenderness, or adnexal or uterine tenderness for which no other cause can be found. Patients may need hospitalisation and parenteral antibiotics.

Complications include tubo-ovarian abscess and subsequent infertility or ectopic pregnancy due to scarred or obstructed fallopian tubes.

Pelvic inflammatory disease (PID) comprises a spectrum of inflammatory disorders of the upper female genital tract, including any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis. Sexually transmitted organisms, especially Neisseria gonorrhoeae and Chlamydia trachomatis, are implicated in many cases; however, micro-organisms that comprise the vaginal flora (e.g., anaerobes, Gardnerella vaginalis, Haemophilus influenzae, enteric gram-negative rods, and Streptococcus agalactiae) have also been associated with PID. In addition, cytomegalovirus (CMV), Trichomonas vaginalis, Mycoplasma hominis, Mycoplasma genitalium, and Ureaplasma urealyticum might be associated with some cases of PID.[1]Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8344968 Symptoms include fever, vomiting, back pain, dyspareunia, and bilateral lower abdominal pain, as well as symptoms of lower genital tract infection such as abnormal vaginal odour, itching, bleeding, or discharge. In some instances, symptoms are mild or even absent.