Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease is an infection of the upper genital tract. It may involve the endometrium, fallopian tubes, pelvic peritoneum, or nearby contiguous structures. Infection commonly ascends from the lower genital tract; *Chlamydia trachomatis* and *Neisseria gonorrhoeae* are important causes, although PID may be polymicrobial. Inflammation in the uterus and adnexa produces pelvic pain and tenderness. When inflammation heals, the fallopian tubes may develop fibrosis and adhesions. That structural damage explains the major long-term consequences: impaired fertility, ectopic pregnancy, and chronic pelvic pain. A collection of infected material involving the tube and ovary is a tubo-ovarian abscess, a complication that changes outpatient treatment into a hospital-level problem. PID is therefore not just “a sexually transmitted infection with pain.” The immediate concern is controlling an ascending infection; the longer-term concern is preventing irreversible tubal injury.