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<< Pelvic Inflammatory Disease: Diagnosis and Treatment in the Emergency Department (Pharmacology CME)

Etiology And Pathophysiology

Pelvic inflammatory disease refers to a group of inflammatory disorders of the female upper genital tract comprising endometritis, salpingitis, and oophoritis.11 It is caused primarily by an infection that spreads from the vagina or cervix to the upper genital tract, and is most common in sexually active women under the age of 30.1,14 It can be complicated by peritonitis, pyosalpinx, tubo-ovarian abscess (TOA), and perihepatitis (ie, Fitz-Hugh-Curtis syndrome). Long-term complications include ectopic pregnancy, infertility, chronic pelvic pain, and recurrent infection.

Classically, PID is attributed to an untreated sexually transmitted infection (STI) of the lower genital tract due to Neisseria gonorrhoeae or Chlamydia trachomatis. N gonorrhoeae and C trachomatis were previously associated with up to 80% of PID.15 Although the rates of N gonorrhoeae- and C trachomatis-associated PID have remained high in younger and lower-income patients, recent studies have reported the rate of N gonorrhoeae- and C trachomatis-associated PID to be as low as 15%.16 

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