Etiology and Diagnosis of Pelvic Inflammatory Disease: Looking Beyond Gonorrhea and Chlamydia

Abstract

Pelvic inflammatory disease (PID) is a clinical syndrome that has been associated with a wide range of potential causal pathogens. Three broad groups of organisms have been isolated from the genital tract of people with PID: sexually transmitted organisms such as Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis; bacterial vaginosis (BV)-associated species and genera such as Atopobium vaginae, Sneathia, and Megasphaera; and genera and species usually associated with the gastrointestinal or respiratory tracts such as Bacteroides, Escherichia coli, Streptococcus, or Haemophilus influenza. Although PID is often considered to be synonymous with gonorrhea or chlamydia, these pathogens are found in only one quarter to one third of people with PID, suggesting that broader screening and diagnostic and treatment strategies need to be considered to reduce the burden of PID and its associated sequelae.

Keywords: bacterial vaginosis; chlamydia; gonorrhea; pelvic inflammatory disease; sexually transmitted infections.

Figure 1.

Proportion of people with pelvic inflammatory disease with Neisseria gonorrhoeae or Chlamydia trachomatis detected in the lower (vagina/cervix) vs upper (endometrium, tubes, cul-de-sac) genital tract in studies published between 1970 and 2020. References for studies included here are in Table 1 and Supplemental References. DFA, direct fluorescence antibody; NAAT, nucleic acid amplification test; UGT, upper genital tract.