- N. gonorrhoeae
This bacteria causes many cases of PID in populations with high incidence rates of gonorrhea (i.e., inner city).
Acute PID is developed in 10% to 20% of women with endocervical gonorrhea.
This organism is an important cause of PID.
It is the predominant etiologic agent among patients of middle and upper socioeconomic status with PID in the United States.
More than 50% of PID cases are caused by N. gonorrhoeae, C. trachomatis, or both.
Polymicrobial infection: Other microorganisms exist as causative agents for the disease, including facultative and anaerobic bacteria such as the following:
Mycobacterium tuberculosis is an important cause of chronic PID in developing countries.
SIGNS AND SYMPTOMS
Lower abdominal pain: usually bilateral, most common presenting symptom
Abnormal vaginal discharge
Abnormal uterine bleeding
Dysuria: 20% of patients
Nausea and vomiting: may suggest peritonitis
Right upper quadrant tenderness (perihepatitis): 5% of PID cases
Elevated acute phase reactants: erythrocyte sedimentation rate (ESR), C-reactive protein
Gram stain of endocervical exudate: greater than 30 PMNs per high-power field (HPF) correlates with chlamydial or gonococcal infection
Endocervical cultures for N. gonorrohoeae and C. trachomatis
Fallopian tube aspirate or peritoneal exudate culture if laparoscopy performed