Pelvic inflammatory disease.

Acute pelvic inflammatory disease (PID) is a major public health problem. An estimated 1 million cases occur annually in the United States. PID is a major cause of infertility and ectopic pregnancy. Prevention of the significant medical and economic sequelae of acute PID relies on the institution of appropriate treatment regimens that are based on the true microbiologic etiology of acute PID and take cognizance of the polymicrobic nature of this etiology. The clinician must maintain a high index of suspicion for acute PID so that early diagnosis can be made and treatment begun. Hospitalization and utilization of parenteral antimicrobial therapy will be of greatest benefit to the patient. This therapy should include combination agents that provide coverage for Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobes (including Bacteroids and anaerobic cocci), gram-negative aerobic rods, and gram-positive aerobes (including group B Streptococcus). Finally, to prevent repeated infection, it is crucial to locate the sexual partners of women with acute PID and to screen and treat them for sexually transmitted diseases. In this way, the recurrent infections, which lead to a poor prognosis for fertility, can be avoided.