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Pelvic inflammatory disease (PID) comprises a spectrum of infections of the female upper reproductive tract. It is a common and serious disease initiated by ascending infection from the cervix and vagina. PID includes salpingitis, endometritis, myometritis, parametritis, oophoritis, and tubo-ovarian abscess and may extend to produce pelvic peritonitis and perihepatitis (Fitz-Hugh–Curtis syndrome). Worldwide, it is difficult to estimate the incidence and prevalence of PID due to difficulties experienced in access to care, lack of diagnostics and laboratory facilities, and underfunding and overstretching of public health services. Although no specific data are available for PID incidence, the World Health Organization in 1999 (most recent available data) estimated that 340 million new cases of curable sexually transmitted infections occur annually throughout the world in adults aged 15 to 49 years, most commonly in sub-Saharan Africa and Southeast Asia. Women in resource-poor countries experience an increased rate of complications and long-term sequelae. Worldwide, sexually transmitted infections rank in the top five disease categories for which adults seek care (http://www.who.org and http://www.who.int/mediacentre/factsheets/fs110/en/). The annual rate of PID in industrialized countries has been reported to be as high as 10 to 20 per 1000 women of reproductive age, with as many as 1 million cases estimated to occur per year in the U.S. From 1995 to 2001, approximately 769,859 cases were reported in the U.S. Of these, 91% were diagnosed in ambulatory care settings.1,2 PID is the most common serious infection in women aged 16 to 25 years. The increased risk in younger women is attributed to the greater frequency of high-risk behaviors in this group, including intercourse with multiple sexual partners, less consistent condom use, increased coincident alcohol and drug use, and delay or reduction in seeking care.3 An increased rate of PID, approximately 2.3 times the rate seen in white women overall, is reported in lower socioeconomic classes in the U.S. This is attributed to early initiation of sexual activity, relations with multiple sexual partners, and delay in seeking medical care. Due to the subjective method of diagnosis of PID, racial and socioeconomic biases may influence both how likely it is that this diagnosis is assigned and which subjects are included in the large, urban EDs and sexually transmitted disease clinics often utilized as data collection sites for major studies. The numbers cited also probably underestimate the true incidence of PID because of wide variation in symptoms, relatively poor reliability of the clinical diagnosis, and incomplete and nontimely conventional reporting methods. Long-term sequelae, including tubal factor infertility, implantation failure after in vitro fertilization, ectopic pregnancy, and chronic pain, may occur in as many as 25% of patients, ultimately affecting 11% of reproductive-aged women.4 Mortality due to PID is estimated to occur in 0.29 patients per 100,000 cases in women aged 15 to 44 years. The most common cause of death is rupture of a tubo-ovarian abscess, and the mortality associated with rupture remains at 5% to 10%, even with current treatment methods. The annual direct ...

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