Pelvic inflammatory disease: a contemporary approach

Pelvic inflammatory disease (PID) results from an ascending polymicrobial infection of unclear pathogenesis. One in 10 women in the United States has PID during her reproductive years. Medical costs of managing the disease and its sequelae are over $5 billion per year. One out of four women with PID has serious sequelae, including infertility, ectopic pregnancy or chronic pelvic pain. Patients with PID present with a spectrum of clinical symptoms and signs, none of which conclusively makes the diagnosis. The diagnosis of PID relies on a high index of suspicion, coupled with empiric therapeutic intervention and careful follow-up. Revised guidelines from the Centers for Disease Control and Prevention include recommendations for the use of broad-spectrum antibiotics, which are initiated before culture results are obtained. Indications for hospitalization are more liberal now than under the previous CDC recommendations. Prompt recognition, patient compliance with recommended therapy and treatment of the sexual partner decrease the risk of sequelae. Family physicians can make significant contributions to the health care of women through skillful management of PID.