Pelvic inflammatory disease: diagnosis and management

Acute pelvic inflammatory disease (PID) is a major gynecologic health problem in the United States, afflicting more than 1 million women each year and generating annual direct and indirect costs estimated at $4.2 billion. Family physicians can play an important role in the prevention, as well as diagnosis and treatment, of PID.

A MEDLINE search for articles published from 1985 to the present was made using the key words "pelvic inflammatory disease," "endometritis," "salpingitis," "tubo-ovarian abscess," "adnexitis," "pelvic abscess," "parametritis," and "oophoritis." The bibliographies of these articles and the author's personal files were also sources of information.

A number of risk factors have been linked to PID, including young age, age at first intercourse, multiple sex partners, the presence of bacterial vaginosis, vaginal douching, the use of an intrauterine contraceptive device, and a history of a sexually transmitted disease. The diagnosis of PID represents a major clinical challenge that requires a careful history and physical examination coupled with selective and knowledgeable use of the diagnostic tests and procedures currently available. Broad-spectrum antibiotics, which represent the cornerstone of therapy, must adequately cover the polymicrobial spectrum of pathogens implicated in this infection, which includes Neisseria gonorrhoeae, Chlamydia trachomatis, and specific cervicovaginal anaerobic and aerobic bacteria. The numerous sequelae associated with PID, which include infertility, ectopic pregnancy, and chronic pelvic pain syndromes, underscore the need for effective measures for preventing pelvic inflammatory disease.