Long-term complications of pelvic inflammatory disease
- Jeffrey F Peipert, MD, PhD
Jeffrey F Peipert, MD, PhD
- Clarence E. Ehrlich Professor and Chair
- Department of Obstetrics & Gynecology
- Indiana University School of Medicine
- Tessa Madden, MD, MPH
Tessa Madden, MD, MPH
- Associate Professor of Obstetrics and Gynecology
- Washington University in St. Louis, School of Medicine
Pelvic inflammatory disease (PID) refers to infection of the female upper genital tract leading to one or more of the following: endometritis, salpingitis, oophoritis, pelvic peritonitis, and perihepatitis . Prompt diagnosis and treatment are important to reduce the risk of both short- and long-term complications. However, even with timely treatment and clinical improvement in symptoms, long-term sequelae frequently occur; this is thought to be secondary to the scarring and adhesion formation that accompany healing of infection-damaged tissues. These sequelae — chronic pelvic pain, infertility, and ectopic pregnancy — account for much of the morbidity, suffering, and cost of PID . One group estimated that a cohort of 100,000 females acquiring PID between 20 and 24 years of age would go on to have 18,600 cases of chronic pelvic pain; 16,800 cases of infertility; and 8550 ectopic pregnancies .
Long-term complications of PID will be reviewed here; other issues related to this disorder are discussed separately:
- Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
- Soper DE. Pelvic inflammatory disease. Obstet Gynecol 2010; 116:419.
- Yeh JM, Hook EW 3rd, Goldie SJ. A refined estimate of the average lifetime cost of pelvic inflammatory disease. Sex Transm Dis 2003; 30:369.
- Trent M, Haggerty CL, Jennings JM, et al. Adverse adolescent reproductive health outcomes after pelvic inflammatory disease. Arch Pediatr Adolesc Med 2011; 165:49.
- Camus E, Poncelet C, Goffinet F, et al. Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies. Hum Reprod 1999; 14:1243.
- Kawwass JF, Crawford S, Kissin DM, et al. Tubal factor infertility and perinatal risk after assisted reproductive technology. Obstet Gynecol 2013; 121:1263.
- Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol 2002; 186:929.
- Weström L. Effect of acute pelvic inflammatory disease on fertility. Am J Obstet Gynecol 1975; 121:707.
- Haggerty CL, Peipert JF, Weitzen S, et al. Predictors of chronic pelvic pain in an urban population of women with symptoms and signs of pelvic inflammatory disease. Sex Transm Dis 2005; 32:293.
- Chung SD, Chang CH, Hung PH, et al. Correlation Between Bladder Pain Syndrome/Interstitial Cystitis and Pelvic Inflammatory Disease. Medicine (Baltimore) 2015; 94:e1878.
- Cates W Jr, Joesoef MR, Goldman MB. Atypical pelvic inflammatory disease: can we identify clinical predictors? Am J Obstet Gynecol 1993; 169:341.
- Wiesenfeld HC, Hillier SL, Meyn LA, et al. Subclinical pelvic inflammatory disease and infertility. Obstet Gynecol 2012; 120:37.
- Weström L, Joesoef R, Reynolds G, et al. Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis 1992; 19:185.
- Svenstrup HF, Fedder J, Kristoffersen SE, et al. Mycoplasma genitalium, Chlamydia trachomatis, and tubal factor infertility--a prospective study. Fertil Steril 2008; 90:513.
- Ness RB, Trautmann G, Richter HE, et al. Effectiveness of treatment strategies of some women with pelvic inflammatory disease: a randomized trial. Obstet Gynecol 2005; 106:573.
- Ness RB, Soper DE, Richter HE, et al. Chlamydia antibodies, chlamydia heat shock protein, and adverse sequelae after pelvic inflammatory disease: the PID Evaluation and Clinical Health (PEACH) Study. Sex Transm Dis 2008; 35:129.
- Hillis SD, Joesoef R, Marchbanks PA, et al. Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility. Am J Obstet Gynecol 1993; 168:1503.
- Weström L. Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. Am J Obstet Gynecol 1980; 138:880.
- Lepine LA, Hillis SD, Marchbanks PA, et al. Severity of pelvic inflammatory disease as a predictor of the probability of live birth. Am J Obstet Gynecol 1998; 178:977.
- Quintar AA, Mukdsi JH, del Valle Bonaterra M, et al. Increased expression of uteroglobin associated with tubal inflammation and ectopic pregnancy. Fertil Steril 2008; 89:1613.
- Lin HW, Tu YY, Lin SY, et al. Risk of ovarian cancer in women with pelvic inflammatory disease: a population-based study. Lancet Oncol 2011; 12:900.
- Seidman JD, Sherman ME, Bell KA, et al. Salpingitis, salpingoliths, and serous tumors of the ovaries: is there a connection? Int J Gynecol Pathol 2002; 21:101.
- Risch HA, Howe GR. Pelvic inflammatory disease and the risk of epithelial ovarian cancer. Cancer Epidemiol Biomarkers Prev 1995; 4:447.
- Trautmann GM, Kip KE, Richter HE, et al. Do short-term markers of treatment efficacy predict long-term sequelae of pelvic inflammatory disease? Am J Obstet Gynecol 2008; 198:30.e1.
- Trent M, Bass D, Ness RB, Haggerty C. Recurrent PID, subsequent STI, and reproductive health outcomes: findings from the PID evaluation and clinical health (PEACH) study. Sex Transm Dis 2011; 38:879.
- Ness RB, Randall H, Richter HE, et al. Condom use and the risk of recurrent pelvic inflammatory disease, chronic pelvic pain, or infertility following an episode of pelvic inflammatory disease. Am J Public Health 2004; 94:1327.
- Wølner-Hanssen P, Eschenbach DA, Paavonen J, et al. Decreased risk of symptomatic chlamydial pelvic inflammatory disease associated with oral contraceptive use. JAMA 1990; 263:54.
- Spinillo A, Gorini G, Piazzi G, et al. The impact of oral contraception on chlamydial infection among patients with pelvic inflammatory disease. Contraception 1996; 54:163.
- Ness RB, Soper DE, Holley RL, et al. Hormonal and barrier contraception and risk of upper genital tract disease in the PID Evaluation and Clinical Health (PEACH) study. Am J Obstet Gynecol 2001; 185:121.