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Section 1
Pelvic inflammatory disease (PID) is a clinical syndrome that results from the ascension of microorganisms from the cervix and vagina to the upper genital tract. PID is a serious complication of chlamydia and gonorrhea, two of the most common reportable infectious diseases and sexually transmitted diseases (STDs) in the US and around the world
Section 2
Women with PID may present with a variety of clinical signs and symptoms that range from unnoticeable or subtle and mild to severe. PID can go unrecognized by women and their health care providers when the symptoms are mild. Despite lack of symptoms, histologic evidence of endometritis has been demonstrated in women with subclinical PID.1 When present, signs and symptoms of PID are nonspecific, so other reproductive tract illnesses and diseases of both the urinary and the gastrointestinal tracts should be considered when evaluating a sexually active woman with lower abdominal pain. Pregnancy (including ectopic pregnancy) must also be excluded, as PID can occur concurrently with pregnancy.
Section 3
Women develop PID when certain bacteria, such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), move upward from a woman’s vagina or cervix into her reproductive organs. PID can lead to infertility and permanent damage of a woman’s reproductive organs.
Section 4
A number of different microorganisms can cause or contribute to PID. The sexually transmitted pathogens C. trachomatis and N. gonorrhoeae have been implicated in a third to half of PID cases.2-8 However, endogenous microorganisms, including gram positive and negative anaerobic organisms and aerobic/facultative gram positive and negative rods and cocci, found at high levels in women with bacterial vaginosis, also have been implicated in the pathogenesis of PID. Newer data suggest that Mycoplasma genitalium may also play a role in PID and may be associated with milder symptoms although studies have failed to demonstrate a significant increase in PID following detection of M. genitalium in the lower genital tract. Because of the polymicrobial nature of PID, broad-spectrum regimens that provide adequate coverage of likely pathogens are recommended.
Tubo-ovarian abscess (TOA) is a serious short-term complication of PID that is characterized by an inflammatory mass involving the fallopian tube, ovary, and, occasionally, other adjacent pelvic organs. The microbiology of TOAs is similar to PID and the diagnosis necessitates initial hospital admission. Treatment includes broad-spectrum antibiotics with or without a drainage procedure, with surgery often reserved for patients with suspected rupture or who fail to respond to antibiotics. Women infected with human immunodeficiency virus (HIV) may be at higher risk for TOA. Mortality from PID is less than 1% and is usually secondary to rupture of a TOA or to ectopic pregnancy.
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