Pelvic inflammatory disease: bacteriology and sequelae.

Pelvic inflammatory disease (PID) is defined as the acute clinical syndrome associated with ascending spread of micro-organisms from the lower to the upper female genital tract. The causative organisms can be divided into exogenous (mostly sexually transmittable) and endogenous agents. During the past three decades' epidemic of sexually transmitted diseases (STDs), STD agents have accounted for 60-80% of PIDs in women below the age of 25. After PID a total of 17.4% of the women become infertile because of post-PID tubal damage. Multiple infections, increasing age at the first infection, and severe infections are followed by a more unfavourable fertility prognosis. The risk of an ectopic pregnancy increases 7-10-fold after PID. In areas with high prevalence of STDs, use of IUDs among women in the high risk age group for PID (15-24 years) seems to increase the risk of acquiring the disease but has no influence on the clinical course of the infection. Use of combined oral contraceptive pills decreases both the risk of acquiring PID and the risk of infertility after the infection.