Pelvic inflammatory disease
Pelvic inflammatory disease is an ascending upper-genital-tract syndrome, often polymicrobial; early empirical treatment limits tubal inflammation and the later risks of chronic pelvic pain, infertility, ectopic pregnancy and tubo-ovarian abscess.
Definition
Pelvic inflammatory disease is infection and inflammation of the upper genital tract, including the endometrium, fallopian tubes, ovaries and adjacent pelvic tissues. It is a clinical diagnosis treated empirically to prevent tubal damage.
First principles
PID is an anatomical syndrome rather than one organism
Infection or altered vaginal flora can ascend through the cervix to the endometrium, fallopian tubes, ovaries, parametria and pelvic peritoneum. Chlamydia and gonorrhoea are important causes, but anaerobes, Mycoplasma genitalium and endogenous organisms also contribute, so a negative cervical test does not exclude PID and empirical therapy must be broad.
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