Pelvic Inflammatory Disease

Pelvic inflammatory disease is an infection-induced inflammation of the female upper reproductive tract (the endometrium, fallopian tubes, ovaries, or pelvic peritoneum); it has a wide range of clinical manifestations.(1) Inflammation spreads from the vagina or cervix to the upper genital tract, with endometritis as an intermediate stage in the pathogenesis of disease.(2) The hallmark of the diagnosis is pelvic tenderness combined with inflammation of the lower genital tract; women with pelvic inflammatory disease often have very subtle symptoms and signs. 3 Many women have clinically silent spread of infection to the upper genital tract, which results in subclinical pelvic inflammatory disease.(1,4) Pelvic inflammatory disease is a major concern because it can result in long-term reproductive disability, including infertility, ectopic pregnancy, and chronic pelvic pain. After the introduction of laparoscopy in the 1960s, research on pelvic inflammatory disease proliferated through the 1970s, 1980s, and 1990s, leading to major breakthroughs in the understanding of the microbial causes of the disease and its relationship to reproductive disability, as well as enabling the standardization of antimicrobial treatment. According to a national estimate, in 2001 more than 750,000 cases of pelvic inflammatory disease occurred in the United States.(5) Over the past two decades, the rates and severity of pelvic inflammatory disease have declined in North America and western Europe.(6-9) These declines have occurred in association with public health efforts to control Chlamydia trachomatis and Neisseria gonorrhoeae infection.(6,10,11) Despite progress, however, pelvic inflammatory disease remains a problem because reproductive outcomes among treated patients are still suboptimal, subclinical pelvic inflammatory disease remains poorly controlled, and programs aimed at the prevention of pelvic inflammatory disease are not feasible in much of the developing world.