Infectious DiseasesTier 2Disease (DEADMAN)

Genito-urinary conditions - pelvic inflammatory disease

Description

Pelvic inflammatory disease is ascending infection of the upper female genital tract (endometritis, salpingitis, tubo-ovarian abscess) - most commonly from chlamydia or gonorrhoea ascending from the lower genital tract, though often polymicrobial

A common and clinically significant STI complication given its association with long-term reproductive morbidity (infertility, ectopic pregnancy risk) if inadequately treated, particularly with recurrent episodes

Ascending infection from the cervix/vagina causes inflammation and subsequent scarring of the fallopian tubes - tubal scarring is the mechanistic link to the long-term infertility and ectopic pregnancy risk associated with PID, with risk increasing with each subsequent episode

Clinical diagnosis (pelvic/lower abdominal pain, cervical motion tenderness, adnexal tenderness) with a low threshold for empirical treatment given the reproductive consequences of delayed treatment - waiting for microbiological confirmation before starting treatment is not recommended given this risk-benefit balance
Pelvic ultrasound helps identify tubo-ovarian abscess when clinically suspected (more severe presentation, palpable mass, failure to improve on treatment)

Empirical broad-spectrum antibiotic therapy covering chlamydia, gonorrhoea, and anaerobes should be started promptly on clinical suspicion, given the reproductive harm of delay
Tubo-ovarian abscess may require drainage in addition to antibiotics, particularly if large or not responding to antibiotics alone
Partner notification and treatment is essential given the STI aetiology in most cases

Infertility and ectopic pregnancy risk (the key long-term complications, increasing with recurrent episodes), tubo-ovarian abscess, Fitz-Hugh-Curtis syndrome (perihepatic adhesions from PID)

Empirical treatment should start on clinical suspicion without waiting for microbiological confirmation, given that delayed treatment - not treatment of a case that later proves culture-negative - is what drives the tubal scarring responsible for long-term infertility and ectopic pregnancy risk

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