Pelvic inflammatory disease natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

The overall prognosis of PID is good. Timely, appropriate treatment often prevents serious complications such as ectopic pregnancy, infertility, hydrosalpinx, and chronic pelvic pain.

Natural history

If left untreated, PID may lead to infertility in approximately 16% of affected women.^[1] It may progress to adjacent organ involvement or even peritonitis.

Prognosis

The overall prognosis of PID is good if patients are treated within 3 days of the onset of symptoms onset, though clinical improvement cannot guarantee protection against infertility.^[2]

Factors that predict poor prognosis include:^[3]

Advanced age
History of previous open gynecological surgery
Any cystic lesion identified by ultrasonography
High CRP levels

Complications

Chronic pelvic pain

Chronic pelvic pain is defined as lower abdominal pain that lasts for at least 6 months and causes functional disability. Approximately 1 in 3 of women affected by PID will experience chronic pelvic pain.^[4]
Recurrent PID is the strongest predictor for the development of chronic pelvic pain due to the scars and adhesions that result from repeated inflammation.^[5]

Infertility

PID may cause permanent damages to the fallopian tubes, this damages include loss of ciliary action, fibrosis, and occlusion that may result in infertility.^[6]
Risk factors for infertility include:
1. Chlamydial infection^[7]
2. Delayed PID treatment^[8]
3. Frequent PIDs^[9]
4. Severity of infection^[10]

Ectopic pregnancy

Tubal damage due to PID may result in anatomical distortion, which can predispose the patient to ectopic pregnancy.^[1]

Hydrosalpinx

Tubal damage may lead to tubal blockade, sterile fluid accumulation, and/or fallopian tube enlargement, which may cause pain or infertility.^[11]

Fitz Hugh Curtis syndrome

Inflammation and adhesion formation in the liver capsule (perihepatitis) may cause right upper quadrant abdominal pain and tenderness.^[12]

References

↑ ^1.0 ^1.1 Weström L, Joesoef R, Reynolds G, Hagdu A, Thompson SE (1992). “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. 19 (4): 185–92. PMID 1411832.
↑ Ross J (2004). “Pelvic inflammatory disease”. Clin Evid (11): 2121–7. PMID 15652102.
↑ Terao M, Koga K, Fujimoto A, Wada-Hiraike O, Osuga Y, Yano T, Kozuma S (2014). “Factors that predict poor clinical course among patients hospitalized with pelvic inflammatory disease”. J. Obstet. Gynaecol. Res. 40 (2): 495–500. doi:10.1111/jog.12189. PMID 24118399.
↑ Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Songer T, Lave JR, Hillier SL, Bass DC, Kelsey SF (2002). “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. 186 (5): 929–37. PMID 12015517.
↑ Haggerty CL, Peipert JF, Weitzen S, Hendrix SL, Holley RL, Nelson DB, Randall H, Soper DE, Wiesenfeld HC, Ness RB (2005). “Predictors of chronic pelvic pain in an urban population of women with symptoms and signs of pelvic inflammatory disease”. Sex Transm Dis. 32 (5): 293–9. PMID 15849530.
↑ Cates W, Joesoef MR, Goldman MB (1993). “Atypical pelvic inflammatory disease: can we identify clinical predictors?”. Am. J. Obstet. Gynecol. 169 (2 Pt 1): 341–6. PMID 8362945.
↑ Svenstrup HF, Fedder J, Kristoffersen SE, Trolle B, Birkelund S, Christiansen G (2008). “Mycoplasma genitalium, Chlamydia trachomatis, and tubal factor infertility–a prospective study”. Fertil. Steril. 90 (3): 513–20. doi:10.1016/j.fertnstert.2006.12.056. PMID 17548070.
↑ Hillis SD, Joesoef R, Marchbanks PA, Wasserheit JN, Cates W, Westrom L (1993). “Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility”. Am. J. Obstet. Gynecol. 168 (5): 1503–9. PMID 8498436.
↑ Weström L (1980). “Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries”. Am. J. Obstet. Gynecol. 138 (7 Pt 2): 880–92. PMID 7008604.
↑ Lepine LA, Hillis SD, Marchbanks PA, Joesoef MR, Peterson HB, Westrom L (1998). “Severity of pelvic inflammatory disease as a predictor of the probability of live birth”. Am. J. Obstet. Gynecol. 178 (5): 977–81. PMID 9609570.
↑ Kawwass JF, Crawford S, Kissin DM, Session DR, Boulet S, Jamieson DJ (2013). “Tubal factor infertility and perinatal risk after assisted reproductive technology”. Obstet Gynecol. 121 (6): 1263–71. doi:10.1097/AOG.0b013e31829006d9. PMC 4292839. PMID 23812461.
↑ Brunham RC, Gottlieb SL, Paavonen J (2015). “Pelvic inflammatory disease”. N. Engl. J. Med. 372 (21): 2039–48. doi:10.1056/NEJMra1411426. PMID 25992748.

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[pmid1411832-1] 1.0 ^1.1 Weström L, Joesoef R, Reynolds G, Hagdu A, Thompson SE (1992). “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. 19 (4): 185–92. PMID 1411832.

[pmid15652102-2] Ross J (2004). “Pelvic inflammatory disease”. Clin Evid (11): 2121–7. PMID 15652102.

[pmid24118399-3] Terao M, Koga K, Fujimoto A, Wada-Hiraike O, Osuga Y, Yano T, Kozuma S (2014). “Factors that predict poor clinical course among patients hospitalized with pelvic inflammatory disease”. J. Obstet. Gynaecol. Res. 40 (2): 495–500. doi:10.1111/jog.12189. PMID 24118399.

[pmid12015517-4] Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Songer T, Lave JR, Hillier SL, Bass DC, Kelsey SF (2002). “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. 186 (5): 929–37. PMID 12015517.

[pmid15849530-5] Haggerty CL, Peipert JF, Weitzen S, Hendrix SL, Holley RL, Nelson DB, Randall H, Soper DE, Wiesenfeld HC, Ness RB (2005). “Predictors of chronic pelvic pain in an urban population of women with symptoms and signs of pelvic inflammatory disease”. Sex Transm Dis. 32 (5): 293–9. PMID 15849530.

[pmid8362945-6] Cates W, Joesoef MR, Goldman MB (1993). “Atypical pelvic inflammatory disease: can we identify clinical predictors?”. Am. J. Obstet. Gynecol. 169 (2 Pt 1): 341–6. PMID 8362945.

[pmid17548070-7] Svenstrup HF, Fedder J, Kristoffersen SE, Trolle B, Birkelund S, Christiansen G (2008). “Mycoplasma genitalium, Chlamydia trachomatis, and tubal factor infertility–a prospective study”. Fertil. Steril. 90 (3): 513–20. doi:10.1016/j.fertnstert.2006.12.056. PMID 17548070.

[pmid8498436-8] Hillis SD, Joesoef R, Marchbanks PA, Wasserheit JN, Cates W, Westrom L (1993). “Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility”. Am. J. Obstet. Gynecol. 168 (5): 1503–9. PMID 8498436.

[pmid7008604-9] Weström L (1980). “Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries”. Am. J. Obstet. Gynecol. 138 (7 Pt 2): 880–92. PMID 7008604.

[pmid9609570-10] Lepine LA, Hillis SD, Marchbanks PA, Joesoef MR, Peterson HB, Westrom L (1998). “Severity of pelvic inflammatory disease as a predictor of the probability of live birth”. Am. J. Obstet. Gynecol. 178 (5): 977–81. PMID 9609570.

[pmid23812461-11] Kawwass JF, Crawford S, Kissin DM, Session DR, Boulet S, Jamieson DJ (2013). “Tubal factor infertility and perinatal risk after assisted reproductive technology”. Obstet Gynecol. 121 (6): 1263–71. doi:10.1097/AOG.0b013e31829006d9. PMC 4292839. PMID 23812461.

[pmid25992748-12] Brunham RC, Gottlieb SL, Paavonen J (2015). “Pelvic inflammatory disease”. N. Engl. J. Med. 372 (21): 2039–48. doi:10.1056/NEJMra1411426. PMID 25992748.

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