Etiology
PID is a polymicrobial infection. Sexually transmitted organisms, especially Neisseria gonorrhoeae and Chlamydia trachomatis, are implicated in many cases; however, microorganisms that comprise the vaginal flora (e.g., anaerobes, Gardnerella vaginalis, Haemophilus influenzae, enteric gram-negative rods, and Streptococcus agalactiae) also have been associated with PID.[1]Chlamydia trachomatis is thought to be the most common cause of PID and is associated with 14% to 35% of cases.[7][8] In addition, cytomegalovirus (CMV), Mycoplasma hominis,Mycoplasma genitalium, and Ureaplasma urealyticum might be the etiologic agents in some cases of PID.
Pathophysiology
Infection begins in the cervix and, if untreated, may ascend to the upper genital tract. Epithelial damage, usually caused by Neisseria gonorrhoeae and Chlamydia trachomatis, may allow opportunistic entry of other microorganisms.[9] Spread to the upper genital tract can also be caused by instrumentation of the cervix such as dilation and curettage, termination of pregnancy, or insertion of an IUD.[9] Infection is thought to be caused by disruption of the protective cervical barrier and direct introduction of bacteria into the endometrial cavity from the vagina or cervix.[10]
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