Clinical Review

Extracts from “Clinical Evidence”: Pelvic inflammatory disease

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7287.658 (Published 17 March 2001) Cite this as: BMJ 2001;322:658
  1. Jonathan Ross, consultant in genitourinary medicine ([email protected])
  1. Birmingham Specialist Community Health NHS Trust, Whittall Street Clinic, Birmingham B4 6DH

    Background

    Definition Pelvic inflammatory disease (PID) is inflammation and infection of the upper genital tract in women, typically involving the fallopian tubes, ovaries, and surrounding structures.

    Interventions

    Unknown effectiveness:

    Empirical antibiotic treatment

    Different durations of antibiotic treatment

    Oral versus parenteral antibiotics

    Incidence/prevalence The exact incidence of PID is unknown because the disease cannot be diagnosed reliably from clinical symptoms and signs.13 Direct visualisation of the fallopian tubes by laparoscopy is the best single diagnostic test, but it is invasive and not used routinely in clinical practice. PID is the most common gynaecological reason for admission to hospital in the United States, accounting for 49 per 10 000 recorded hospital discharges. However, since most PID is asymptomatic, this figure almost certainly underestimates true prevalence. 1 4

    Aetiology/risk factors Factors associated with PID mirror those for sexually transmitted infections: young age, reduced socioeconomic circumstances, African or Afro-Caribbean ethnic origin, lower educational attainment, and recent new sexual partner. 2 5 6 Most cases seem to result from ascending infection from the cervix. Initial epithelial damage caused by bacteria (especially Chlamydia trachomatis and Neisseria gonorrhoeae) allows the opportunistic entry of other organisms. …

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