Abstract
Pelvic inflammatory disease accounts for 5%-20% of hospital admissions for gynecologic problems and is associated with health care costs of more than 1 billion dollars annually. This article reviews the epidemiology, polymicrobial etiology, and diagnosis of this disease state. Special consideration is given to in vivo and in vitro studies of antimicrobial therapy, including both established regimens and expanded-spectrum beta-lactam antibiotics. The adjunctive modalities reviewed include treatment of sexual contacts, removal of intrauterine devices, use of alternative contraceptive methods associated with a reduced risk of disease, and surgery. Although understanding of pelvic inflammatory disease has increased markedly, investigation of its various aspects is both necessary and ongoing. In particular, well-designed, controlled, comparative clinical trials of new treatment regimens must be performed to verify a true advantage of these therapies.
Keywords
Adnexal Effects--determinants
Adnexitis--etiology
Bacterial And Fungal Diseases
Biology
Chlamydia
Contraception
Contraceptive Agents
Contraceptive Agents
Female
Contraceptive Methods
Diseases
Family Planning
Genital Effects
Female
Genitalia
Genitalia
Female
Gonorrhea
Infections
Oral Contraceptives
Pelvic Inflammatory Disease
Physiology
Reproductive Tract Infections
Sexually Transmitted Diseases
Treatment
Urogenital System
MeSH Terms
Adolescent
Adult
Age Factors
Anti-Bacterial Agents/therapeutic use
Cephalosporins/therapeutic use
Chlamydia Infections/complications
Clinical Trials as Topic
Contraceptive Agents, Female
Female
Gonorrhea/complications
Humans
Infertility, Female/etiology
Inpatients
Intrauterine Devices/adverse effects
Laparoscopy
Outpatients
Pain
Pelvic Inflammatory Disease/complications,drug therapy,microbiology
Penicillins/therapeutic use
Pregnancy
Pregnancy, Ectopic/etiology
Recurrence
Salpingitis/etiology
Sexual Behavior
Chemicals
Anti-Bacterial Agents
Cephalosporins
Contraceptive Agents, Female
Penicillins
Authors & Affiliations
2 authors, click to expand affiliations / ORCID
Burnakis T G
Hildebrandt N B
Other Abstracts
eng
This state-of-the-art review focuses on the epidemiology, etiology, diagnosis, and treatment of pelvic inflammatory disease (PID). 5-20% of hospital admissions for gynecologic problems are secondary to PID
the condition itself is associated with health care costs of about $1.25 billion each year in the US. Special consideration is given in this article to in vivo and in vitro studies of antimicrobial therapy, including both established regimens and expanded spectrum beta-lactam antibiotics. Early treatment of PID can reduce the effects of the infection on the fallopian tubes
however, microbe-related inflammation and tubal necrosis can precede the manifestation of symptoms, especially in cases where Chlamydia is the infecting agent. The 2nd-generation cephalosporins seem to offer advantages in the treatment of PID because of an expanded spectrum that includes many of the major pathogens. In vitro tests have demonstrated considerable activity against penicillinase-producing strains of N gonorrhoeae resistant to both penicillin and 1st-generation cephalosporins. Cefoxitin is currently considered the most attractive such cephalosporin and has shown cure rates of 95-100% in the treatment of uncomplicated gonorrhea. Also reviewed in this article are adjunctive methods of treatment, including treatment of sexual contacts, removal of IUDs, use of alternate methods of contraception associated with a reduced risk of disease and surgery. Oral contraceptives are the logical alternative when a switch in contraception is indicated given the lower risk of PID incidence and severity, infertility, and ectopic pregnancy in pill users. There remains a need for well-designed, prospective, comparative studies of new treatment regimens.
