Complications

Short term complications of PID include:

• abscess formation in fallopian tube, ovary or in the pelvic cavity
• generalised peritonitis - in case of pelvic abscess
• Fitz-Hugh-Curtis syndrome - a right upper quadrant pain associated with peri-hepatitis seen in around 10-20% of patients with PID

Long term complications

• recurrent disease - repeated episodes of PID are common, probably because of impaired local host defences
• chronic pelvic pain - this is a common sequelae to PID and may indicate structural damage to the fallopian tubes following resolution of the disease, or an erroneous diagnosis
• ectopic pregnancy - eight times more likely for a subsequent pregnancy to be ectopic
• infertility due to tubal occlusion: - single episode - 12.8% risk - three or more episodes - 75 % risk
• adhesions of the surrounding organs

Up to 70% of women investigated for infertility due to tubal occlusion demonstrate serum antibodies to C. trachomatis compared to 25% of those infertile for other reasons; 30-80% of those infertile from tubal blockage have no history of clinical disease.

Overall, 25% of women who experience a single episode of PID suffer subsequent pain, infertility or ectopic pregnancy.

Reference:

1. Bartlett EC et al. Pelvic inflammatory disease. BMJ. 2013 May 23;346:f3189. doi: 10.1136/bmj.f3189.

2. Curry A et al. Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention. Am Fam Physician. 2019 Sep 15;100(6):357-364.

3. British Association for Sexual Health and HIV. UK national guideline for the management of pelvic inflammatory disease. Jan 2019 [internet publication]