Pelvic inflammatory disease, laparoscopy, and the expenditure of health care dollars.

Pelvic inflammatory disease. Attention is directed to the medical consequences of (PID) such as recurrent/chronic infection chronic pain ectopic pregnancy infertility and mortality. Risk factors for PID are also discussed as well as clinical diagnosis the use of laparoscopy in the diagnosis of PID laparoscopic grading intraoperative laparoscopic treatment pelviscopic surgery and the expenditure of health care dollars on PID. Pelvic inflammatory disease a nonspecific clinical term is used to describe acute and/or chronic inflammation involving the upper female genital tract with particular reference to the uterus fallopian tubes ovaries and pelvic peritoneum. Inflammation of the upper genital tract can result from conditions such as endometriosis or extensions of intraabdominal infection but in most instances infectious PID is considered a sexually derived disease resulting from sexually transmitted organisms. Sexually transmitted disease that predominatly involve the vulva vagina and urethra are not included under the term PID. The precise incidence of PID is unknown either in the US or in other parts of the world. During the 1970-75 period it is estimated that an average of 210000 females above 10 years of age were hospitalized annually with a diagnosis of PID. Data for the 1975-81 period document an increase in the estimate of hospitalizations for PID to more than 267000 women per year. Coital sexual activity generally is regarded to be the underlying basis for PID except in rare instances. In the decade between 1974-84 numerous papers associated the onset of PID with the use of an IUD. The majority of these reports failed to study concomitantly the sexual behavior of patients who had requested an IUD for the sole reason of prevention of pregnancy. At this time the IUD is considered the only contraceptive method that fails to afford some protection against the ascent of bacteria from the cervix to the upper generative tract at midcycle. There are no universally accepted criteria for the diagnosis of PID despite the use of a variety of diagnostic aids. Recently developed American data suggested that the standard in-hospital medical therapy of clinically diagnosed PID may not be economically beneficial in that the money is being spent to treat a condition with an average rate of inaccurate diagnosis of 38%. At this time laparoscopy represents the most nearly definitive means to confirm or reject the diagnosis of PID. On the basis of the available data in the literature and the conclusions reported by Method who demonstrated no economic disadvantage to the use of laparoscopy in all women clinically suspected of having PID it is believed that laparoscopy should be used routinely in the diagnosis of PID in women hospitalized with a provisional diagnosis of this condition.