(BQ) Part 2 book “ABC of sexually transmitted infections” has contents: Pelvic inflammatory disease and pelvic pain, sexually transmitted infections in pregnancy, other conditions that affect the female genital tract, genital ulcer disease, and other contents. | 8 Pelvic inflammatory disease and pelvic pain Helen Mitchell Acute pelvic inflammatory disease (PID) is most commonly caused by infection ascending from the vagina or cervix, which causes inflammation of the upper genital tract. This can result in any combination of salpingitis, endometritis, oophoritis, parametritis, pelvic peritonitis, and tubo-ovarian abscess formation. The organisms commonly responsible for acute PID depend on the local prevalence of sexually transmitted infections (STIs). Chlamydia trachomatis is the most common treatable bacterial STI in the United Kingdom and is implicated in more than 50% of cases of acute PID. Ten to 20% of cases are associated with Neisseria gonorrhoeae, this rate will be higher in areas with higher local prevalence. Studies have shown that 8-39% of women with C trachomatis related genital infection will develop acute PID. In addition, it is estimated that for every overt case of chlamydial pelvic infection there are three covert (asymptomatic) cases. The role of Mycoplasma genitalium and Ureaplasma urealyticum in acute pelvic infection is still unclear, but they have been implicated in the pathogenesis of acute endometritis and chorioamnionitis associated with pre-term labour. Other organisms connected with acute pelvic infection include anaerobes, Bacteroides fragilis, peptostreptococci, Escherichia coli, and Lancefield group B haemolytic streptococci. Bacterial vaginosis is associated with ascending infection and acute PID after induced abortion and post partum. Clinical diagnosis of PID The most common presenting symptoms are lower abdominal pain and abnormal vaginal discharge. Other symptoms associated with PID include intermenstrual and post-coital bleeding, dysuria, deep dyspareunia, and fever. Low backache and rectal discomfort may also be present. Right upper quadrant pain from perihepatitis is a feature of the uncommon Fitz-Hugh-Curtis syndrome in association with C trachomatis related PID. The history for .
