Introduction

Pelvic inflammatory disease (PID) comprises a spectrum of infections of the female upper reproductive tract. It is a common and serious sexually transmitted disease, generally initiated by ascending infection from the cervix and vagina. The inflammatory processes falling within the rubric of PID may include salpingitis, endometritis, and tubo-ovarian abscess, and extend to produce pelvic peritonitis, and perihepatitis. The annual rate of PID in industrialized countries has been reported to be as high as 10-20 per 1000 women of reproductive age, with over one million cases estimated to occur per year in the United States. 1 These numbers clearly underestimate the true incidence because of both atypical and wide variability of symptoms and the relatively poor reliability of the clinical diagnosis. Long term sequellae, including tubal factor infertility (TFI), ectopic pregnancy, and chronic pain, may occur in as many as 25 percent of patients. The annual direct and indirect costs of the acute disease and its sequella are projected to rise to $10 billion/year by 2000.

Patients with PID frequently present to emergency departments with non-specific complaints and findings. Early diagnosis and aggressive treatment may provide rapid clinical and microbiologic improvement, identify co-existent disease, decrease transmission, and minimize the likelihood of serious sequellae.

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