Pelvic inflammatory disease

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

Causative organisms

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

Features

• lower abdominal pain
• fever
• deep dyspareunia
• dysuria and menstrual irregularities may occur
• vaginal or cervical discharge
• cervical excitation

Investigation

• screen for Chlamydia and Gonorrhoea

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

• infertility - the risk may be as high as 10-20% after a single episode
• chronic pelvic pain
• ectopic pregnancy