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Pelvic inflammatory disease: a common cause of morbidity

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Pelvic inflammatory disease (PID) refers to infection and inflammation of the upper genital tract. It may involve the endometrium, fallopian tubes and/or ovaries, as well as the surrounding peritoneum.

Most cases of PID result from a vaginal or cervical sexually transmitted infection (STI); this may be asymptomatic. Subsequently there is direct ascent of micro-organisms from the vagina or cervix to the upper genital tract.1,2

Fitz-Hugh-Curtis syndrome can result in PID, where infection spreads along the upper peritoneum to the liver capsule, causing perihepatic 'violin string' adhesions.

PID is a common cause of morbidity and accounts for one in 60 GP consultations by women under 45 years of age.1

Causes and risk factors

It is thought that Chlamydia trachomatis and Neisseria gonorrhoeae are responsible for most cases of PID.3 Other potential pathogens include Gardnerella vaginalis, Mycoplasma hominis and Trichomonas vaginalis.

HIV infection has been found to be associated with an increased incidence of C trachomatis. Women with HIV have an increased risk of progression to PID and tubo-ovarian abscess formation.1

Sexually active women in their teens or early twenties are at increased risk of PID, as are women from lower socio-economic backgrounds.4

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