Infertility as a sequela of chlamydial pelvic inflammatory disease

The sensitivity of clinical criteria for the diagnosis of pelvic inflammatory disease (PID) is low, particularly with regard to chlamydial PID. Chlamydia trachomatis infection of the fallopian tubes ranges from the clinically severe to the silent, subclinical PID which can result in tubal scarring and subsequent infertility. In the treatment of PID, therefore, this organism should be considered. The diagnosis of chlamydial PID should be based both on isolation of the agent from the infected site--the endometrium, the fallopian tubes, or the peritoneum--and, preferably, on the further demonstration of a significant antibody response to C. trachomatis as well. Cultures for C. trachomatis from the cervix and the urethra can, if positive, offer presumptive evidence of etiology. Moreover, such evidence is of importance in motivating examination and treatment of sexual partner(s).