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“Pelvic inflammatory disease is a sexually transmitted disease with potentially serious sequelae usually managed badly by doctors with little interest in the condition.”
It is a decade since this bleak view of pelvic inflammatory disease (PID) management in the United Kingdom appeared in the BMJ.1 Since then a theme to emerge in sexually transmitted disease (STD) research has been increased awareness of genital chlamydial infection, which causes a substantial proportion of PID cases. In the United Kingdom, this culminated in the Chief Medical Officer's expert advisory group on genital chlamydial infection which recognised PID as an important source of preventable reproductive morbidity in women.2 However, little is known of PID epidemiology in England and Wales. The burden of disease and risk factors associated with PID are poorly understood but need to be investigated to inform public health action and clinical practice.3 This paper aims to critically review current knowledge of PID epidemiology with special reference to the United Kingdom and explore the epidemiological research needed to provide an evidence base for PID public health intervention.
A literature search was carried out on Medline using the key words “pelvic inflammatory disease” and was repeated using authors known to have published studies concerned with PID and Chlamydia trachomatis. The literature was also trawled for data presentations.
Aetiology of PID
PID is the clinical syndrome associated with upper genital tract inflammation caused by the spread of micro-organisms from the lower to the upper genital tract. PID can be caused by genital mycoplasmas, endogenous vaginal flora (anaerobic and aerobic bacteria), aerobic streptococci, Mycobacterium tuberculosis, and sexually transmitted infections (STI) such as C trachomatis or Neisseria gonorrhoeae.4 An association between PID and bacterial vaginosis has also been demonstrated in the absence of C trachomatis and N gonorrhoeae.5, 6 …