Pelvic inflammatory disease and infertility.

The epidemiology pathogenesis clinical manifestations diagnosis and treatment of pelvic inflammatory disease (PID) are reviewed. PID the most morbid and difficult to diagnose of the sexually transmitted diseases in women refers to infection of any site(s) in the upper genital tract. It leads to infertility ectopic pregnancy chronic pelvic pain and recurrent infection. It affects a disproportionate number of young nulliparas because of biological and social factors as well as IUD users. Most PID arises from N. gonorrhea and/or C. trachomatis primary infections. 15% of primary cases follow transuterine procedures. 1% come from an endogenous focus such as appendicitis. Usually those of STD origin start as a cervical infection later the infection ascends into the endometrium tubes and peritoneum accompanied by bacterial vaginitis organisms. Chlamydial infections typically have a slow onset and mild symptoms but are much more likely to cause infertility and ectopic pregnancy than gonococcal disease. Women with bilateral uterine or adnexal tenderness and abnormal vaginal discharge should be evaluated with a vaginal wet mount an endocervical gram stain endocervical culture and endocervical specimen. Treatment should include at least 2 antibiotics doxycycline and cefoxitin or clindamycin and gentamicin for the older woman whose infection is dominated by anaerobes. Hospitalization is recommended when fertility is important or compliance is doubtful. All partners in the last 30 days should be traced examined and treated.