Pelvic inflammatory disease.

This article reviews current knowledge on the diagnosis, pathogenesis, epidemiology, treatment, and prognosis of pelvic inflammatory disease (PID). Since PID has important implications for future health and fertility, its diagnosis and management are of utmost importance. A recent study of the accuracy of clinical diagnosis of PID indicated that, even when as many as 7 reliable symptoms and signs were present, there was still possibility for diagnostic error. This has led some to advocate diagnostic laparoscopy. In older women, IUD users, and women who have recently delivered or undergone pelvic surgery, endogenous organisms are more likely to be the initial infecting agents. Treatment of PID should be begun before the results of microbiological investigations are available and should cover a wide spectrum of organisms. The author's preference is a combination of penicillin or ampicillin in high dose, gentamicin, and rectal metronidazole. Follow up treatment with tetracycline or erythromycin is needed to eradicate chlamydial infection. The author also prefers to remove an IUD in place once antibiotic cover has been established. The longterm prognosis in such cases is not good, especially after nongonococcal PID. 25% of a group of 415 PID patients followed for 10 years had reinfections and 18% suffered chronic pelvic pain. 21% were involuntarily infertile, and tubal occlusion rates rose from 13% after 1 attack to 75% in those who had been infected 3 or more times. When PID patients did become pregnant, ectopic pregnancy was 6 times more common than in a group of matched controls.