Pelvic inflammatory disease: a clinical syndrome with social causes

Abstract

Prevalence of pelvic inflammatory disease (PID) reflects community and individual risk factors. Cultural and behavioural factors influence community prevalence of sexually transmitted disease (STD), illegal abortion, puerperal sepsis and contraceptive usage--all of which influence risk of PID. The relative importance of these factors will vary by region. Individual risk factors for the ascent of a lower genital tract infection are still poorly understood but are thought to be behavioural and immunological. Prevention of PID must be undertaken at several levels. At primary level, it requires a reduction in community risk. At secondary level, individual risk can be modified by ensuring diagnosis and treatment of STD before damage of the upper genital tract occurs. More attention to cultural factors should increase the potential for prevention at both levels.

PIP: In many countries, pelvic inflammatory disease (PID) is a major cause of short- and long-term morbidity. The lack of epidemiological data on sexually transmitted diseases (STD) and difficulties in diagnosing PID where laparoscopy cannot be performed, however, prevent the accurate assessment of the etiology of PID by region. The prevalence of PID reflects community and individual risk factors. Cultural and behavioral factors influence the community prevalence of STDs, illegal abortion, puerperal sepsis, and contraceptive usage, all of which influence the risk of PID. At the individual level, risk factors for the ascent of a lower genital tract infection are poorly understood, but are thought to be behavioral and immunological. PID therefore needs to be prevented at several levels. Primary prevention necessitates a reduction in community risk, while prevention at the secondary level calls for the modification of individual risk by ensuring the diagnosis and treatment of STD before damage of the upper genital tract occurs. More attention to cultural factors should increase the potential for prevention at both levels. The authors discuss social factors affecting the community risk of PID in India and from African studies, and risk factors at the individual level in terms of reinfection, pregnancy history, menstruation, and treatment history. The paper concludes with discussion of the usefulness of social indicators.