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PID (pelvic inflammatory disease) is infection of the upper part of the female reproductive system (i.e. uterus, fallopian tubes, and the ovaries), and inside of the pelvis.

• The disease is caused by bacteria that spreads from the vagina and the cervix
• Infection by N. gonorrhoeae or Chlamydia t. is implicated in 82% of cases. Often, multiple different bacteria are involved

• Asymptomatic, often
• Pain:
  • Lower abdominal pain → PID should be considered in all women of childbearing age who have lower abdo pain
  • Cervical motion tenderness
  • Uterine tenderness
  • Adnexal tenderness
  • Dyspareunia (pain with sex)
• Vaginal discharge (new or different)
• Fever
• Dysuria (burning with urination)
• Irregular menstruation
• Rarely:
  • Arthritis
  • Skin lesion
  • Inflammation of the eyes
  • Inflammation of the urethra

• Clinical Dx, w/ Sx
• Finding pus involving the fallopian tubes during surgery, for a definitive Dx
• U/S

• Similar to those of STI's generally, including:
  • Numerous number of sexual partners
  • Drug use
• Vaginal douching

• Prevention, including:
  • Sexual abstinence, or having few sexual partners
  • Using condoms
  • Screen women at-risk for chlamydia, followed by Tx
• A woman's sexual partner should also be Tx
• In those w/ mild to moderate Sx, a single injection of the antibiotic ceftriaxone, along with 2 weeks of oral doxycycline and possibly oral metronidazole
• For those who don't improve after 3 days, or who have severe disease, IV abx should be used

Untreated PID can result in long term complications, including:

• Infertility → due to scarring of reproductive organs
• Ectopic pregnancy → due to scarring of reproductive organs
• Chronic pelvic pain  → due to scarrying of reproductive organs
• Cancer
• Endometritis
• Salpingitis
• Tubo-ovarian abscess
• Pelvic peritonitis
• Periappendicitis
• Perihepatitis
• In pregnant women, the disease can pass from mother to child, and causes 50% of infants to be born with the disease. This can cause:
  • Spontaneous abortion
  • Premature birth
  • Conjunctivitis, which may lead to blindness
  • Pneumonia

• Without Tx, 10% of Pt's with chlamydia, and 40% with gonorrhea, will develop PID

• Globally, there are 106 million cases of chlamydia, and 106 million cases of gonorrhea. The number of cases of PID however, is unclear
• It affects 1.5% of young women yearly
• In the 1970's, a IUD known as the Dalkon shield, led to increased rates of PID. However, current IUD's aren't associated with this problem after the 1st month

• Chlamydia
• Gonorrhea