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A longitudinal study of pelvic inflammatory disease
C M Stacey1, P E Munday, D Taylor-Robinson
1Jefferiss Wing, St Mary's Hospital, Paddington, London, UK.
Objective:
To study the microbiology and long term prognosis of pelvic inflammatory disease (PID).
Design:
A prospective study of women with laparoscopically confirmed PID.
Setting:
Teaching hospital in central London.
Subjects:
23 women with PID.
Outcome Measures:
Microbiological investigations at the time of diagnosis and at follow up; subsequent fertility and the occurrence of pelvic pain.
Results:
PID diagnosed by laparoscopy was regarded as moderate to severe in 15 cases. Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum or a combination of these micro-organisms were detected most frequently in the cervix, less often in the endometrium and least in the tubes, C. trachomatis being the micro-organism found most commonly in the tubes. There was serological evidence of acute chlamydial infection in 13 of 20 cases in which paired sera were available and a serological response to M. hominis in 9 of 12 cases in which it was possible to evaluate the results. On the basis of microbiological and serological results, C. trachomatis appeared to be the most important aetiological agent in 10 cases, N. gonorrhoeae in four cases, M. hominis in three cases and U. urealyticum in none; in five cases, two of these micro-organisms appeared to be of equal importance. After 1 to 3 years, 33% of the women were having difficulty conceiving and 56% continued to complain of pelvic pain.
Conclusion:
It is difficult to be certain of the infectious cause of PID in any given case. However, the evidence that N. gonorrhoeae and C. trachomatis are pathogens is very strong. M. hominis may be responsible for a few cases on its own or together with other micro-organisms.
Insights
Pelvic inflammatory disease (PID) is often caused by Chlamydia trachomatis and Neisseria gonorrhoeae, leading to long-term fertility issues and pelvic pain in women. Microbiological investigations are crucial for understanding PID
Area of Science:
- Gynecology
- Infectious Diseases
- Microbiology
Background:
- Pelvic inflammatory disease (PID) is a significant cause of reproductive morbidity in women.
- Understanding the causative agents and long-term consequences of PID is essential for effective management.
Purpose of the Study:
- To investigate the microbiology of PID.
- To determine the long-term prognosis of PID, including fertility and pelvic pain.
Main Methods:
- A prospective study involving 23 women with laparoscopically confirmed PID.
- Microbiological investigations were conducted at diagnosis and follow-up.
- Assessment of subsequent fertility and occurrence of pelvic pain.
Main Results:
- Chlamydia trachomatis and Neisseria gonorrhoeae were identified as key pathogens in PID.
- Microorganisms were detected more frequently in the cervix than in the endometrium or tubes.
- After 1-3 years, 33% of women experienced conception difficulties and 56% reported persistent pelvic pain.
Conclusions:
- While the exact infectious cause can be challenging to pinpoint, C. trachomatis and N. gonorrhoeae are strongly implicated in PID.
- Mycoplasma hominis may contribute to PID, either alone or in combination with other microorganisms.