Introduction

Pelvic inflammatory disease (PID) is a term used to describe infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries and the surrounding peritoneum. It is usually the result of ascending infection from the endocervix.

Epidemiology

  • Incidence: 300.00 cases per 100,000 person-years
  • Peak incidence: 20-30 years
Condition Relative
incidence
Endometriosis3.33
Pelvic inflammatory disease1
Acute appendicitis0.37
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Pathophysiology

Causative organisms
  • Chlamydia trachomatis - the most common cause
  • Neisseria gonorrhoeae
  • Mycoplasma genitalium
  • Mycoplasma hominis

Clinical features

Features

Investigations

Investigation
  • a pregnancy test should be done to exclude an ectopic pregnancy
  • high vaginal swab
    • these are often negative
  • screen for Chlamydia and Gonorrhoea

Management

Management
  • due to the difficulty in making an accurate diagnosis, and the potential complications of untreated PID, consensus guidelines recommend having a low threshold for treatment
  • oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole
  • RCOG guidelines suggest that in mild cases of PID intrauterine contraceptive devices may be left in. The more recent BASHH guidelines suggest that the evidence is limited but that ' Removal of the IUD should be considered and may be associated with better short term clinical outcomes'

Complications

Complications
  • perihepatitis (Fitz-Hugh Curtis Syndrome)
    • occurs in around 10% of cases
    • it is characterised by right upper quadrant pain and may be confused with cholecystitis
  • infertility - the risk may be as high as 10-20% after a single episode
  • chronic pelvic pain
  • ectopic pregnancy