Clinical aspects of pelvic inflammatory disease

Pelvic inflammatory disease (PID) is a common and poorly managed condition.Untreated or inadequately treated, it leads to tubal infertility, ectopicpregnancy and chronic pelvic pain. Diagnostic difficulties are compoundedby the wide variety of clinical presentations and the insensitivity andpoor specificity of laboratory tests. Better recognition of mild andatypical disease needs a high index of suspicion whenever young, sexuallyactive women present with gynaecological symptoms. Laparoscopy supplementedby microbiological tests and fimbrial minibiopsy should be regarded as thediagnostic 'gold standard' for research studies; new studies are requiredto identify techniques which might reduce under- and over-diagnosis. Earlytreatment reduces the risk of an adverse effect on fertility. Anytherapeutic regimen selected should be effective against the commonaetiological agents Chlamydia trachomatis, Neisseria gonorrhoeae, genitalmycoplasmas and aerobic and anaerobic bacteria. Since at least 60% of casesof PID can be attributed to infection with a sexually transmitted organism,partner notification forms an essential part of management.