Clinical manifestations and diagnosis of pelvic inflammatory disease.

Pelvic inflammatory disease (PID) is defined as the clinical syndrome attributed to the ascending spread of microorganisms unrelated to pregnancy and surgery from the vagina and cervix to the endometrium fallopian tube and/or contiguous structures. Incidence of PID has been established as 10/1000 women per year in ages 15-39; in a modern urban area the rate is 1/60 women. The mechanisms determining the spread are unknown. Exposure to sexually transmitted diseases is 1 risk factor for PID and promiscuous sexual relations increase the risk as does the use of an IUD; use of oral contraceptives decreases the risk. 3000 laparoscopies performed on women with genital infections is discussed. Only 3% of patients with PID were seriously ill at admission. Women with chlamydia associated PID often consult their physicians after having had abdominal pain for over 7 days; in mild and moderately severe PID cases nausea and vomiting are fairly infrequent (10%) and a febrile illness was recorded in 40% of PID cases in this study. An erythrocyte sedimentation rate exceeding 15 mm in the 1st hour of admission was seen in 75% of the PID patients and in 50% of those with lower genital tract infection. When examining peritoneal fluid obtained by cul-de-sac puncture it was found that the white blood count (WBC) contents of such fluid exceeded 30000/cu m in PID cases but were 1000 or less in cases without pelvic infection. Diagnosis is most easily performed using some of the following: direct microscopy of a wet mount of the vaginal contents laparoscopy WBC and isoamylases analysis and ultrasonography. In this series 12% had other intrapelvic pathology for PID the most common conditions being pelvic endometriosis corpus luteum hematoma and ectopic pregnancy.