Infection of the fallopian tubes leads to two of the most devastating consequences of PID: infertility and ectopic pregnancy.

Infection in the fallopian tubes causes a vigorous inflammatory reaction, and a combination of bacteria and white blood cells fills the tubes.

The presence of this inflammatory reaction leads to permanent scarring. This scar tissue may lead to partial or complete blockage of the tube, thereby affecting future fertility.

A study by Westrom demonstrated a 16% infertility rate after a single episode of PID.²² Risk factors associated with the development of tubal infertility include increasing numbers of PID episodes, delay in seeking care, severity of infection, and Chlamydia infection.⁴

In addition to infertility, the risk of ectopic pregnancy increases with the number of episodes and severity of disease, and is 6 to 10 times as common in women with a history of PID, compared with those patients without a history.⁴

To prevent recurrent episodes of PID and its long-term complications, patients should be counseled about the nature of the disease at the time of diagnosis.

Patients should be informed that PID is a sexually transmitted disease, educated about safe sex practices, and offered follow-up for HIV and syphilis testing.

In addition, male sex partners within the preceding 60 days of a woman’s diagnosis with PID should undergo evaluation for treatment.

PID is the most frequent gynecologic cause of emergency department visits, approaching 350,000 per year.

Controversies

Because there is no single diagnostic gold standard for PID, the question as to the utility of adjunct imaging studies is often discussed.

The utility of transvaginal ultrasound to aid in diagnosis is particularly debated.

Acute PID produces notable changes on ultrasound, including tubal wall thickness greater than 5 mm, incomplete septae within the tube, fluid in the cul-de-sac, and a “cogwheel” appearance to the tube on cross-sectional view.

However, the utility of ultrasound for diagnosis remains limited, as the absence of these findings should not diminish one’s clinical suspicion for PID.

One study of 55 women with histologically-confirmed PID who underwent transvaginal ultrasound found sensitivities of 32%-42% for findings consistent with PID.²³

As a result of these low sensitivities, transvaginal ultrasound cannot be used to rule out PID. Its use should be limited to acutely ill patients with clinically diagnosed PID in whom the diagnosis of TOA is suspected (sensitivity 93%, specificity 98%).²⁴