Pelvic Inflammatory Disease

In Chapter 13 we discussed pelvic inflammatory disease (PID), an infection of the fe­male genital tract, including the endometrium, Fallopian tubes, and the lining of the pelvic area. Here we look at the role of STIs in the development of pelvic inflammatory disease. Pelvic inflammatory disease can be caused by many different agents, but the two that have been most often implicated are Chlamydia trachomatis and Neisseria gonorrhoeae (J. Ross, 2001). It is estimated 10% to 20% of women with gonorrhea or chlamydia de­velop PID (Centers for Disease Control and Prevention, 2005d). Long-term complica­tions of PID include ectopic and tubal pregnancies, chronic pelvic pain, and infertility. About 20% of women with PID become infertile, 20% develop chronic pelvic pain, and 10% who conceive have an ectopic pregnancy (Metters et al., 1998; J. Ross, 2001).

Although the exact rates of PID are unknown, it has been estimated that there are 1 million U. S. cases of PID each year, and 1 out of every 7 women of reproductive age is found to have at least one episode of PID by the age of 35 (Handsfield, 1992). However, many cases of PID remain unrecognized, either because it is asymptomatic or because the healthcare system or the patient misses it (Centers for Disease Control and Prevention, 2005d). Women who are diagnosed with PID tend to be young, be unmar­ried, have multiple sexual partners, have had an STI in the past, engage in sexual inter­course at a young age, be members of a minority group (Cates et al., 1990), and/or use douches (Aral et al., 1991).

Symptoms of PID include acute pelvic pain, fever of 101° or higher, and an abnor­mal vaginal discharge. Treatment for PID includes antibiotics for 14 days, which effec­tively eliminates the symptoms of PID (Ross, 2001). If the symptoms continue or worsen, hospitalization may be necessary. Sexual partners should be evaluated if they en­gaged in sexual contact 60 days prior to the PID diagnosis to rule out infections with gonorrhea and chlamydia (Centers for Disease Control and Prevention, 2002a).