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Pelvic inflammatory disease (PID) includes an array of infectious processes that damage the endometrium, fallopian tubes, ovaries, and pelvic peritoneum. Sexually transmitted infections (STIs) cause most PID cases, but organisms associated with bacterial vaginosis (BV) have also been implicated. Approximately 15% of untreated chlamydial infections progress to PID; this percentage may be higher with gonococcal infections.1 Delayed diagnosis contributes to inflammatory sequelae, including infertility, ectopic pregnancy, and chronic pelvic pain.2,3 Approximately one in six women with salpingitis develops infertility.2,3 The cost of having PID has previously been estimated at $1,995 per patient, not including expenses for future evaluation and treatment of complications.4 Based on the National Health and Nutrition Examination Survey 2013–2014 data, 4.4% of women (2.5 million) 18 to 44 years of age in the United States reported a history of PID.5 Although studies suggest an overall decline in rates of PID, cases of gonorrhea and chlamydia are increasing.6 This is especially worrisome with the rise of antibiotic-resistant Neisseria gonorrhoeae.
WHAT IS NEW ON THIS TOPIC:
Pelvic Inflammatory Disease
Because of emerging resistance, routine use of quinolones is no longer recommended for pelvic inflammatory disease to provide empiric coverage for gonorrhea.
Intrauterine devices pose no increased risk of pelvic inflammatory disease beyond the first 20 days postinsertion.
Intrauterine devices do not need to be removed if the patient with pelvic inflammatory disease is clinically improving within 48 to 72 hours of initiation of antibiotics.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| The diagnosis of PID should be made clinically in the absence of other obvious causes in an at-risk woman with unexplained pelvic pain and cervical motion, uterine, or adnexal tenderness.8 | C | Consensus guideline from the Centers for Disease Control and Prevention |
| Empiric antibiotic treatment should be offered at the time of presentation to patients with PID symptoms.8 | C | Consensus guideline |
| Women with mild to moderate PID may be treated in an outpatient setting without increased risk of sequelae.3,26 | B | Multicenter RCT showing no differences in reproductive outcomes between inpatient and outpatient treatment in mild to moderate PID |
| Patient-delivered or expedited partner therapy for STIs should be offered where legal to decrease rates of reinfection.8,32 | B | Consensus guideline and RCT of expedited therapy showing reduction in... |