Pelvic Inflammatory Disease and Other Upper Genital Infections

Abstract

Pelvic inflammatory disease (PID) refers to an acute or subclinical infection of the upper genital tract and can be further classified by the anatomic structures affected. It is caused by an ascending infection to the uterus, fallopian tubes, ovaries, and peritoneum of the pelvic cavity. The most common inciting pathogens are Chlamydia trachomatis and Neisseria gonorrhoeae, though PID is considered and treated as a polymicrobial infection. PID should be considered in the differential diagnosis in people with a uterus, especially of reproductive age, who present with acute pelvic pain. Sexual activity is the most important risk factor for PID, and a thorough sexual history should be obtained. Barrier contraception is protective. PID is diagnosed clinically based on symptoms and pelvic exam. Testing for sexually transmitted infections should be performed and can aid in the diagnosis. A high index of suspicion should be used for diagnosis and early empiric treatment with antibiotics to reduce sequelae caused by inflammatory scarring of the fallopian tubes. Specific antibiotic regimens have been recommended by the Centers for Disease Control and Prevention (CDC), most recently updated in 2021. Mild or moderate PID can be treated as an outpatient with close follow-up. Careful consideration should be made for inpatient admission in those who fail outpatient management and those with severe disease or tubo-ovarian abscess (TOA). Long-term sequelae include increased risk of ectopic pregnancy, infertility, and chronic pelvic pain.