Pelvic inflammatory disease

Direct association between abscesses and the infectious pathogens that cause PID. Abscesses may form if the condition is untreated.

Treatment with antibiotics effective against PID.[50]Chappell CA, Wiesenfeld HC. Pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and tuboovarian abscess. Clin Obstet Gynecol. 2012 Dec;55(4):893-903. http://www.ncbi.nlm.nih.gov/pubmed/23090458?tool=bestpractice.com Follow-up imaging to ensure abscess resolution. In severe cases, surgical drainage may be required.

Up to 18% of patients will develop infertility as a result of tubal damage.[51]Farhi J, Ben-Haroush A. Distribution of causes of infertility in patients attending primary fertility clinics in Israel. Isr Med Assoc J. 2011 Jan;13(1):51-4. https://www.ima.org.il/FilesUploadPublic/IMAJ/0/38/19450.pdf http://www.ncbi.nlm.nih.gov/pubmed/21446238?tool=bestpractice.com Likelihood varies according to adequacy of treatment and severity of infection before treatment. Repeat episodes of PID are associated with an exponential increase in the risk of infertility.[22]British Association for Sexual Health and HIV (BASHH). UK national guideline for the management of pelvic inflammatory disease. Jan 2019 [internet publication]. https://www.bashhguidelines.org/current-guidelines/systemic-presentation-and-complications/pid-2019

Infertility in women

Patients may develop chronic pelvic pain as a result of tubal damage. Likelihood varies according to adequacy of treatment and severity of infection before treatment. Repeated episodes of PID are associated with an increased risk of permanent tubal damage.

Chronic pelvic pain

Ectopic pregnancy occurs in 1% of those who conceive.

Ectopic pregnancy

Comprises right upper quadrant abdominal pain associated with perihepatitis. Characterized by "violin string" perihepatic adhesions seen at laparoscopy. Treatment is the same as for PID.