Complications

Short term complications of PID include:

• abscess formation in fallopian tube, ovary or in the pelvic cavity
• generalised peritonitis - in case of pelvic abscess (1)
• Fitz-Hugh-Curtis syndrome - a right upper quadrant pain associated with perihepatitis seen in around 10-20% of patients with PID (2)

Long term complications

• recurrent disease - repeated episodes of PID are common, probably because of impaired local host defences
• chronic pelvic pain - this is a common sequelae to PID and may indicate structural damage to the fallopian tubes following resolution of the disease, or an erroneous diagnosis
• ectopic pregnancy - eight times more likely for a subsequent pregnancy to be ectopic
• infertility due to tubal occlusion: - single episode - 12.8% risk - three or more episodes - 75 % risk
• adhesions of the surrounding organs

Up to 70% of women investigated for infertility due to tubal occlusion demonstrate serum antibodies to C. trachomatis compared to 25% of those infertile for other reasons; 30-80% of those infertile from tubal blockage have no history of clinical disease.

Overall, 25% of women who experience a single episode of PID suffer subsequent pain, infertility or ectopic pregnancy.

Reference:

• 1. Department of Public Health and Epidemiology, University of Birmingham. The clinical effectiveness and cost effectiveness of antibiotic regimens for pelvic inflammatory disease
• 2. The International Union against Sexually Transmitted Infections 2008. European Guideline for the Management of Pelvic Inflammatory Disease