among women aged 15 to 49 years, the estimated global prevalence of chlamydia was 3.4%, gonorrhoea was 2%, and trichomoniasis was 4.0% (1)
PID is almost always caused by a sexually transmitted infection (STI) (2)
Chlamydia trachomatis accounts for 14–35% of cases (3)
other causative organisms include Neisseria gonorrhoeae (2–3% of cases)
however, based on the pattern of organisms isolated from the upper genital tract, the infection may often be polymicrobial (caused by more than one type of bacteria) (1)
this suggests that initial damage produced by C trachomatis or N gonorrhoeae may permit the opportunistic entry of other bacteria, including anaerobes
however, in many cases, no infection is found in the lower genital tract
risk factors for developing PID include:
sexual behaviour related factors, for example (2):
women younger than aged 25 years
early age of first coitus
recent new partner (within the previous 3 months)
multiple sexual partners.
past history of STI in the woman or her partner
Iatrogenic - for example:
termination of pregnancy.
insertion of an intrauterine device - suggested that may be not immediate and within the past 4–6 weeks, especially in women with pre-existing gonorrhoea or C. trachomatis infection (2)
hysterosalpingography.
in vitro fertilization and intrauterine insemination
in the UK, the prevalence of PID is about 2% among women between 16 and 46 years old
10% to 20% may become infertile, 40% will develop chronic pelvic pain, and 10% of those who conceive will have an ectopic pregnancy
Reference:
1. Savaris RF et al. Antibiotic therapy for pelvic inflammatory disease. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD010285. DOI:0.1002/14651858.CD010285.pub3.
2. Curry A et al. Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention. Am Fam Physician. 2019 Sep 15;100(6):357-364.
3. Price MJ, Ades AE, Welton NJ, et al. Proportion of pelvic inflammatory disease cases caused by Chlamydia trachomatis: consistent picture from different methods. J Infect Dis. 2016 Aug 15;214(4):617-24.
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