Pelvic inflammatory disease: etiology, diagnosis, and treatment.

Coincident with the epidemic of sexually transmitted diseases, the incidence of pelvic inflammatory disease has risen sharply in recent years. Pelvic inflammatory disease is a major direct cause of infertility; in addition, it leads to ectopic pregnancies and chronic inflammatory residua requiring surgical intervention. This threat to the future fertility of women is rendered more serious by the difficulty of making a correct diagnosis and the likelihood that faulty diagnosis will result in inadequate treatment. Pelvic inflammatory disease is caused not only by Neisseria gonorrhoeae but also by Chlamydia trachomatis, genital tract mycoplasmas, and mixed bacteria from the endogenous vaginal and cervical flora, especially anaerobes. Diagnostic criteria include (1) lower abdominal and pelvic pain, (2) lower abdominal tenderness, (3) elevation of erythrocyte sedimentation rate, (4) adnexal inflammatory mass, and (5) presence of leukocytes and bacteria in the peritoneal fluid. Early diagnosis and prompt treatment appear to be crucial in preventing infertility. No studies have evaluated prospectively the relative advantages of inpatient vs. outpatient management of acute pelvic inflammatory disease. The recommendations of the Centers for Disease Control (CDC; Atlanta, Ga.) for outpatient treatment and the results of a multi-hospital collaborative study using the CDC regimens are discussed. Criteria for hospitalization and parenteral antibiotic therapy are presented.