CLINICAL PEARLS AND PITFALLS One in eight sexually active adolescent girls will develop PID PID can lead to chronic pelvic pain, ectopic pregnancy, and infertility Acute presentation of PID is variable and patients may be well appearing despite serious consequences of untreated disease Current Evidence PID is a polymicrobial inflammatory condition of the female upper genital tract caused by an ascending sexually transmitted infection that variably involves the endometrium, fallopian tubes, ovaries, adjacent structures, and pelvic peritoneum An estimated one in eight sexually active adolescent girls develops PID before reaching 20 years of age Young age, a large number of sexual partners, and nonbarrier contraceptive methods are risk factors for infection with N gonorrhoeae and C trachomatis, the microorganisms responsible for initiating most cases of acute PID Other risk factors include cigarette smoking, recent douching, bacterial vaginosis, previous gynecologic surgery, and HIV infection Patients with PID are at risk of serious acute and chronic complications such as tuboovarian abscesses, infertility, and chronic pelvic pain It has been estimated that 20% of women with PID will have chronic pelvic pain Half of all ectopic pregnancies are thought to be the result of tubal damage produced by PID Women with a history of PID have a 10-fold risk of infertility with repeated bouts substantially increasing the likelihood of infertility Clinical Considerations Clinical Recognition Although the constellation of symptoms and signs associated with PID— abdominal pain, irregular uterine bleeding, abnormal vaginal discharge, and lower abdominal and pelvic tenderness—is well known, no single symptom or sign or a combination of symptoms and signs is both sensitive and specific Clinical findings that improve the specificity of the diagnosis of PID (i.e., increase the likelihood that the diagnosis is correct) so only at the expense of sensitivity (i.e., exclude patients who in fact have PID) Criteria for the diagnosis of PID suggested by the CDC are shown in Table 92.2 Because the diagnosis of PID is imprecise, and the potential for damage to the reproductive health of the patient is great, providers should maintain a low threshold for the diagnosis of PID