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week no. 9 ending March 2 , 1985
Texas Preventable Disease
contents:
Pelvic Inflammatory Disease
BUREAU OF EPIDEMIOLOGY 1100 West 49th Street, Austin, Texas 78756 (512-458-7207)
PELVIC INFLAMMATORY DISEASE
Pelvic inflammatory disease (PID) is a common complication of gonorrhea that affects
many women in Texas; approximately 15% of women in the US with gonorrhea will develop
PID as a result of their gonococcal infections. Although the disease is caused by
several kinds of bacteria, this discussion will be limited to gonococcal pelvic
inflammatory disease (GPID) with occasional reference to other etiologies.
PID is an infection related to the ascending spread of micro-organisms from the
vagina or endocervix in situations unrelated to pregnancy, the puerperium, or
surgical procedures. The clinical spectrum of PID ranges from minimal symptoms to
severe, life-threatening involvement of intra-abdominal tissues and organs. Since
the primary pathology frequently involves the fallopian tubes, the term salpingitis
is often used. PID may be more than salpingitis because the uterus, ovaries, pelvic
peritoneum, and other contiguous structures may also be infected.
As with many sexually transmitted diseases, young females with multiple sexual
partners are at high risk for pelvic inflammatory disease. Minority women,
especially black women, perhaps because of less access to medical care, are also at
risk of pelvic inflammatory disease. The risk of PID in women who use an intrauterine
device (IUD) is four times greater than in women who do not use IUDs. PID also
predisposes women to future episodes of PID with the same, different, or a combina-
tion of bacteria.
CLINICAL PRESENTATION AND DIAGNOSIS
Clinical manifestations of PID develop within 48 hours or up to several weeks after
the patient is infected, usually at the time of the next menstrual period. Although
patients present with physical signs and symptoms localized to the abdominal and
pelvic areas (low abdominal pain or tenderness, adnexal tenderness, tenderness on
cervical motion, tender adnexal mass, or purulent endocervical discharge), some may
present with the severe symptoms of the early-onset form of PID (fever, chills,
nausea, vomiting, and anorexia). Approximately 25% of PID patients who become re-
infected with gonorrhea and fail to seek treatment or who receive inappropriate
treatment will develop severe sequelae, such as tubo-ovarian abscesses, ectopic
pregnancy, infertility, chronic pelvic or abdominal pain, and recurrent menstrual
pain and irregularities.
The diagnosis of PID is made on the basis of the clinical presentation of the
disease. An evaluation of presence of risk factors for PID, exposure to an STD,
presence of symptoms and signs outlined above, and positive laboratory tests will
determine the existence of PID. Laboratory tests suggestive of PID include: a
positive culture for Neisseria gonorrhoeae or Chlamydia trachomatis from the
endocervix or cul-de-sac, high leukocyte count with a shift to the left, and a high
Texas Department of Health
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