Pelvic inflammatory disease.

Two studies compared and showed equal efficacy of the two intravenous treatment regimens recommended by the Centers for Disease Control: cefoxitin plus doxycycline and aminoglycoside plus clindamycin. The increased risk of pelvic inflammatory disease (PID) among users of an intrauterine device was confirmed in a reanalysis of the Oxford Family Planning Study. However, a prospective study showed that prophylactic, single-dose oral doxycycline significantly reduced the risk of post-insertion gonococcal, but not chlamydial, PID. According to Canadian investigators, laparoscopy is not very specific for PID diagnosis when tubal and endometrial histopathology is used as the gold standard. Two studies showed that vaginal douching is significantly associated with PID and with ectopic pregnancy. The risk of PID increased with frequency of douching. Data from the Women's Health Study suggest increased risk of PID among cigarette smokers. However, the risk of PID was unrelated to the number of cigarettes smoked.     

Pelvic inflammatory disease.

Pelvic inflammatory disease is a common serious complication of the sexually transmitted pathogens Neisseria gonorrhoeae and Chlamydia trachomatis. There are more than 800,000 cases of pelvic inflammatory disease annually accounting for approximately 200,000 hospital admissions for acute and chronic infections. Early accurate diagnosis and treatment are essential to prevent the serious sequelae including ectopic pregnancy, tubal disease infertility, chronic pain, and disability requiring multiple hospitalizations and surgery. Although clinical models to aid in the diagnosis and management of pelvic inflammatory disease have been developed by numerous investigators, all have lacked the sensitivity and specificity to be helpful to the clinician. Laparoscopy, considered by many to be the "gold standard" for diagnosis, is underutilized, and the definition of pelvic infection differs between investigators. Improved patient compliance and safety may be seen if single-agent therapy for acute pelvic inflammatory disease becomes a reality. In a small prospective randomized study, oral ofloxacin was as effective as cefoxitin plus doxycycline for outpatient treatment of chlamydial and gonococcal pelvic inflammatory disease. Treatment of tuboovarian abscess appears to be successful with single agent and combination therapy. Risk factors for developing postabortion endometritis continue to be identified, and the most efficacious prophylactic antibiotic regimen has not been determined to date.     

Pelvic inflammatory disease in adolescents: high incidence and recurrence rates in an urban teen clinic

STUDY OBJECTIVE: To determine pelvic inflammatory disease (PID) incidence and recurrence rates in an urban teen clinic. DESIGN/SETTING: A retrospective chart review of female patients seen as outpatients over an 18-month period at an urban teen clinic. 192 patients were diagnosed with PID, and the charts of these patients were reviewed in depth. MAIN OUTCOME MEASURES: PID incidence and recurrence rates. RESULTS: A PID incidence of 9.7% was identified. Of the adolescent females diagnosed with PID, 47% had recurrent PID. Of the females with recurrent PID, 27% had three or more episodes. Only 36% of adolescent females diagnosed with PID ever reported that their partners had been treated. CONCLUSIONS: This study suggests a higher incidence of PID as well as PID recurrence in the present clinic-based adolescent population than previously reported. More accurate monitoring of incidence and recurrence rates in well-defined populations of adolescents should be conducted with the hope of identifying effective avenues of intervention.     

Pelvic inflammatory disease: medical treatment

Pelvic inflammatory disease (PID) refers to infection of the uterus (endometritis), fallopian tubes (salpingitis) and adjacent pelvic structures (tubo-ovarain complex, pelvic peritonitis). PID causes major medical, social, and economic problems. Long-term sequelae, especially tubal factor infertility and extra uterine pregnancy are common and their management is extremely costly. Medical treatment of PID should be immediate because sequelae are more frequent if the treatment is delayed or inadequate.     

Pelvic inflammatory disease and tubo-ovarian abscess

Pelvic inflammatory disease is a disease that has reached nearly epidemic proportions in the United States. The gold standard of diagnosis remains laparoscopy, and treatment is usually with broad-spectrum antibiotics and surgery.     

Pelvic endometriosis and tubal inflammatory disease

The incidence of tubal inflammatory disease in women with endometriosis who had undergone surgery was compared with that in women who had undergone similar operative procedures but who did not have endometriosis and with that in a group of clinically healthy women undergoing tubal sterilisation. The incidence of tubal inflammatory lesions was much higher in all women who had undergone surgery than in those undergoing sterilisation, but there was no difference in the incidence of tubal lesions between those women with endometriosis and those not suffering from this disease. Women with endometriosis and tubal inflammatory disease did not have a significantly lower mean gravidity than did those with healthy tubes. It is concluded that there is no specific association between endometriosis and tubal inflammation and that tubal inflammatory disease is unlikely to be a significant factor contributing to infertility in endometriosis.     

Pelvic inflammatory disease in the postmenopausal woman.

OBJECTIVE: Review available literature on pelvic inflammatory disease in postmenopausal women. DESIGN: MEDLINE literature review from 1966 to 1999. RESULTS: Pelvic inflammatory disease is uncommon in postmenopausal women. It is polymicrobial, often is concurrent with tuboovarian abscess formation, and is often associated with other diagnoses. CONCLUSION: Postmenopausal women with pelvic inflammatory disease are best treated with inpatient parenteral antimicrobials and appropriate imaging studies. Failure to respond to antibiotics should yield a low threshold for surgery, and consideration of alternative diagnoses should be entertained.     

Pelvic inflammatory disease during the post-partum year

OBJECTIVE: To investigate the occurrence of, and risk factors for, pelvic inflammatory disease (PID) occurring during the post-partum year. METHODS: Demographic and clinical data for women who delivered a term infant with 5-minute Apgar score > or = 8 from 1992 through 1999 at a large urban hospital were extracted from an electronic medical record system. RESULTS: During the study period, 15 206 deliveries occurred among 12 549 women. PID was diagnosed during the post-partum year of 148 (1.0%) deliveries. In univariate analysis, young age, black race, and both pre-delivery history and post-partum diagnosis of chlamydial and gonococcal infection were associated with PID. In multivariate analysis, only young age and a positive test for gonorrhea before delivery or post-partum were independent predictors of PID. CONCLUSIONS: Pelvic inflammatory disease was diagnosed during the post-partum year in 1% of women studied. Young maternal age was an important demographic risk factor. Further investigation of post-partum STD acquisition and progression to PID is needed to determine whether women are at increased risk following delivery.     

Pelvic inflammatory disease and the intrauterine contraceptive device

The relationship between the use of intrauterine contraceptive device (IUD) and pelvic inflammatory disease (PID) was examined in 1054 patients who were seen at the Family Planning Clinic of Jos University Teaching Hospital and were followed up. The overall risk of PID developing in women wearing the IUD was minimal: 62 out of 1054 (5.9%). The rates, however, varied for the 6-month periods studied. The incidence of PID decreased as the period of usage increased. The greater number of patients developed PID less than 3 months from the date of IUD insertion. When PID occurred it was usually of mild or moderate intensity and the response to antibiotic therapy was very encouraging. There was no relationship between the parity of the patients and the development of PID. Even though there is a definite link between the use of IUD and the development of PID it does not obliterate the benefits which the use of IUD provide for the majority of its patrons; and so the use of IUD should continue.