Pelvic Inflammatory Disease

220 Pages·1997·4.97 MB·English

by  David A. Eschenbach (auth.), Daniel V. Landers M.D., Richard L. Sweet M.D. (eds.)

Pelvic Inflammatory Disease
Springer Science+Business Media, LLC
Daniel V. Landers, M.D.
Richard L. Sweet, M.D.
Editors
Pelvic
Inflammatory
Disease
With 13 Illustrations
Springer
Daniel V. Landers, M.D. Richard L. Sweet, M.D.
Associate Professor and Director Professor and Chairman
Division of Reproductive Infectious Department of Obstetrics,
Diseases and Immunology Gynecology, and Reproductive
Department of Obstetrics, Sciences
Gynecology, and Reproductive University of Pittsburgh School of
Sciences Medicine
University of Pittsburgh School of Magee-Women's Hosptial
Medicine Pittsburgh, PA 15213-3180, USA
Magee-Women's Hospital
Pittsburgh, PA 15213-3180, USA
Library of Congress Cataloging-in-Publication Data
Pelvic inflammatory disease / [edited by] Daniel V. Landers, Richard
L. Sweet,
p. cm.
Includes bibliographical references and index.
ISBN 978-1-4612-6863-5 ISBN 978-1-4612-0671-2 (eBook)
DOI 10.1007/978-1-4612-0671-2
1. Pelvic inflammatory disease. I. Landers, Daniel V. II. Sweet,
Richard L.
[DNLM: 1. Adnexitis. WP155 P3925 1996]
RG411.P452 1996
618—dc20
DNLM/DLC
for Library of Congress 96-11917
CIP
Printed on acid-free paper.
© 1997 Springer Science+Business Media New York
Originally published by Springer-Verlag New York, Inc. in 1997
Softcover reprint of the hardcover 1 st edition 1997
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987654321
ISBN 978-1-4612-6863-5
This book is dedicated to alt the women who have
in the past, do in the present, or will in the future,
suller the pain and consequences 01 pelvic inflam
matory disease.
Preface
Pelvic Inflammatory Disease (PID) continues to be a major public health
concem, with over one million cases diagnosed annually in the United
States, at a cost of over $4 billion. In addition, PID is the most frequent
cause of hospitalization among reproductive age women. The disease is
usually associated with sexually transmitted organisms and organisms that
constitute the flora of the vagina, specifically anaerobic and facultative
organisms. In young women, approximately two thirds of PID is caused by,
or associated with, chlamydia and/or gonorrhoeae. Recent evidence has
demonstrated that bacterial vaginosis also plays an important role in the
pathogenesis of PID.
The morbidity associated with acute PID, however, does not reside solely
with the acute illness. Long-term consequences even after a single episode
of PID result from fallopian tube damage and inc1ude tubal-factor infertil
ity, ectopic pregnancy, and chronic pelvic pain. Although Swedish studies
have demonstrated infertility in 16% of PID patients, studies from Canada
and the Uni ted States reported a higher rate of infertility following acute
PID. Women are also at a seven- to tenfold increased risk for ectopic
pregnancy following PID.
Of increasing concem is the growing body of data indicating that a
substantial proportion of cases of PID are unrecognized and, therefore,
untreated. The term "unrecognized PID" is suggested for those upper
genital tract infections that are asymptomatic or are not associated with the
c1assic signs and symptoms suggestive of acute PID. The diagnosis of unrec
ognized PID is established in women with inflammation of the upper genital
tract (endometrium andlor fallopian tubes) in the absence of abdominal
pain. Most importantly, unrecognized PID causes similar long-term
sequelae to acute symptomatic PID, specifically ectopic pregnancy forma
tion and tubal factor infertility. Risk factors for and clinical predictors of
unrecognized PID have yet to be elucidated, making this a fertile area for
future research efforts. Identification of risk factors/markers for the devel
opment of PID have been the focus of increasing attention. Age is an
important risk factor for PID and is inversely related to PID rates. Of
vii
viii Preface
particular concem are ado1escent females who are at significant risk of
developing acute salpingitis.
Contraception practices significantly affect the risk for PID. Women
using oral contraceptive agents or barrier methods, such as condoms and
diaphragms, appear to have protection from upper genital tract infection.
On the other hand, use of the intrauterine contraceptive device (lUD) and
lack of contraception increase the risk of PID. In addition, vaginal douching
has been implicated in the development of PID along with sex during
menses.
Establishing factors to predict upper genital tract infection would have
substantial implications for the health of reproductive-aged women. More
over, reliable predictors of unrecognized PID may alert the c1inician to be
more aggressive in treatment and follow-up of these patients. This may
result in timely treatment of PID, which would be an important factor in
reducing the consequences of PID. Among women in the United States
today, PID remains among the most significant and consequential repercus
sion of the STD epidemic. This book is aimed at providing a comprehensive
resource book on PID by leading authors and researchers in the field.
Daniel V. Landers
Richard L. Sweet
Contents
Preface ..................................................... vü
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
1 Epidemiology of Pelvic Inftammatory Disease 1
David A. Eschenbach
2 Risk Factors for Pelvic Inftammatory Disease and
Associated Sequelae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Nancy S. Padian and A. Eugene Washington
3 Microbial Etiology of Pelvic Inftammatory Disease . . . . . . . . . . 30
Richard L. Sweet
4 Diagnosis of Pelvic Inftammatory Disease . . . . . . . . . . . . . . . . . . 60
Pal W(Jlner-Hanssen
5 Treatment of Acute Pelvic Inflammatory Disease . . . . . . . . . . . 76
Richard L. Sweet
6 Tubo-Ovarian Abscess Complicating Pelvic
Inflammatory Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Daniel V. Landers
7 Pelvic Inftammatory Disease in Pregnancy . . . . . . . . . . . . . . . .. 107
Joseph G. Pastorek II
8 Pelvic Inflammatory Disease in the Adolescent Female. . . . .. 116
Vivien Igra, Jonathan Ellen, and Mary-Ann Shafer
9 Pelvic Inflammatory Disease and HIV- 1 Infection . . . . . . . . . .. 139
Abner P. Korn and Daniel V. Landers
ix
x Contents
10 Prevention of Pelvic Inftammatory Disease . . . . . . . . . . . . . . . .. 146
Julius Schachter
11 Long-term Sequelae of Pelvic Inftammatory Disease:
Tubal Factor Infertility, Ectopic Pregnancy,
and Chronic Pelvic Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 152
Joan M. Chow and Julius Schachter
12 Histopathology of Genital Tract Infection with C. trachomatis
and N. gonorrhoeae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 170
Nancy Kiviat
13 Behavioral Aspects of Pelvic Inftammatory Disease . . . . . . . .. 181
Stuart N. Seidman and Sevgi Okten Aral
Index...................................................... 205
Contributors
Sevgi Okten Aral, Ph.D.
Associate Director for Science, Division of STD Prevention, Centers for
Disease Control, Atlanta, GA 30333, USA
Joan M. Chow, Dr. P.H.
Assistant Research Epidemiologist, Department of Laboratory Medicine,
San Francisco General Hospital, San Francisco, CA 94110, USA
Jonathan Ellen, M.D.
Division of Adolescent Medicine, University of California at San Francisco,
San Francisco, CA 94143, USA
David A. Eschenbach, M.D.
Professor and Chief, Division of Gynecology, Department of Obstetrics
and Gynecology, University of Washington, Seattle, WA 98195, USA
Vivien Igra, M.D.
Division of Adolescent Medicine, University of California at San Francisco,
San Francisco, CA 94143, USA
Nancy Kiviat, M.D.
Professor of Pathology and Director, Cytopathology Laboratory, Univer
sity of Washington, Seattle, WA 98195, USA
Abner P. Korn, M.D.
Associate Clinical Professor, University of California at San Francisco, and
Director, Division of Gynecology, San Francisco General Hospital, San
Francisco, CA 94110, USA
Daniel V. Landers, M.D.
Associate Professor and Director, Division of Reproductive Infectious
Diseases and Immunology, Department of Obstetrics, Gynecology, and
Reproductive Sciences, University of Pittsburgh School of Medicine,
Magee-Women's Hospital, Pittsburgh, PA 15213-3180, USA
xi