Pelvic inflammatory disease: Clinical update

Pelvic inflammatory disease (PID), with an estimated 10 million new cases annually, is currently the leading cause of infertility in the United States. Acute PID refers to the acute syndrome (unrelated to pregnancy or surgery) attributed to the ascent of microorganisms from the vagina and endocervix to the endometrium, fallopian tubes, and/or contiguous structure. The clinical picture of PID ranges from acute overwhelming febrile illness, which is life threatening, to chronic diffuse abdominal discomfort, which is easily mistaken for a genitourinary or gastrointestinal complaint. For simplicity, the term PID will be used rather than the specific involved site, such as endometrium, endometritis, etc. This paper provides a review of the pathophysiology of PID and a clinical update on diagnosis and treatment, with a great degree of emphasis placed on the Chlamydia organism, because of the prevalence of this bacteria in the United States and throughout the world. Attention will be focused on the life cycle, incidence, clinical appearance, and suggested therapeutic guidelines.