Pelvic Inflammatory Disease - Chronic Pelvic Pain and Recurrent Abdominal Pain

Pelvic inflammatory disease (PID) is a spectrum of inflammatory disorders involving the upper genital tract of the female reproductive system and may include any combination of endometritis, parametritis, oophoritis, salpingitis, and tubo-ovarian abscess (see PID chapter for a more complete discussion). PID is a polymicrobial disease involving sexually transmitted infections, predominately Neisseria gonorrhea and Chlamydia trachomatis and/or anaerobic and facultative organisms. Risk factors for the development of PID include sexual activity and age. Fifteen to 19-year-old women have the highest hospitalization rates for PID and incidence currently about 1% and rising.

The mainstay of PID treatment continues to be broad-spectrum antibiotics that will cover the most likely pathogens. Patients who do not respond to parenteral antibiotics may require diagnostic laparoscopy to rule out the possibility of appendicitis, adnexal torsion, or other surgical emergencies. Tubo-ovarian abscesses that do not respond to antibiotics can be removed laparoscopically or can be drained with CT guidance. CPP can result from PID due to adhesion formation, tubo-ovarian abscesses, and hydrosalpinx. Conservative surgical intervention may be required to alleviate patient symptoms, restore normal pelvic architecture, and preserve, albeit diminished, fertility.