View source for Pelvic inflammatory disease natural history, complications and prognosis

__NOTOC__
{{Pelvic inflammatory disease}}
{{CMG}}; {{AE}} {{MehdiP}}
==Overview==
The overall prognosis of PID is good. Timely, appropriate treatment often prevents serious complications such as [[ectopic pregnancy]], [[infertility]], [[hydrosalpinx]], and [[chronic pelvic pain]].

==Natural history==
If left untreated, PID may lead to [[infertility]] in approximately 16% of affected women.<ref name="pmid1411832">{{cite journal |vauthors=Weström L, Joesoef R, Reynolds G, Hagdu A, Thompson SE |title=Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results |journal=Sex Transm Dis |volume=19 |issue=4 |pages=185–92 |year=1992 |pmid=1411832 |doi= |url=}}</ref> It may progress to adjacent organ involvement or even [[peritonitis]].

==Prognosis==
The overall prognosis of PID is good if patients are treated within 3 days of the onset of symptoms onset, though clinical improvement cannot guarantee protection against [[infertility]].<ref name="pmid15652102">{{cite journal |vauthors=Ross J |title=Pelvic inflammatory disease |journal=Clin Evid |volume= |issue=11 |pages=2121–7 |year=2004 |pmid=15652102 |doi= |url=}}</ref>

Factors that predict poor prognosis include:<ref name="pmid24118399">{{cite journal |vauthors=Terao M, Koga K, Fujimoto A, Wada-Hiraike O, Osuga Y, Yano T, Kozuma S |title=Factors that predict poor clinical course among patients hospitalized with pelvic inflammatory disease |journal=J. Obstet. Gynaecol. Res. |volume=40 |issue=2 |pages=495–500 |year=2014 |pmid=24118399 |doi=10.1111/jog.12189 |url=}}</ref>
*Advanced age 
*History of previous open [[gynecological surgery]]
*Any [[cystic]] [[lesion]] identified by [[ultrasonography]]
*High [[CRP]] levels

==Complications==


===Chronic pelvic pain===
*[[Chronic pelvic pain]] is defined as [[lower abdominal pain]] that lasts for at least 6 months and causes functional disability. Approximately 1 in 3 of women affected by [[PID]] will experience chronic pelvic pain.<ref name="pmid12015517">{{cite journal |vauthors=Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Songer T, Lave JR, Hillier SL, Bass DC, Kelsey SF |title=Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial |journal=Am. J. Obstet. Gynecol. |volume=186 |issue=5 |pages=929–37 |year=2002 |pmid=12015517 |doi= |url=}}</ref>
*Recurrent PID is the strongest predictor for the development of [[chronic pelvic pain]] due to the [[scars]] and [[adhesions]] that result from repeated [[inflammation]].<ref name="pmid15849530">{{cite journal |vauthors=Haggerty CL, Peipert JF, Weitzen S, Hendrix SL, Holley RL, Nelson DB, Randall H, Soper DE, Wiesenfeld HC, Ness RB |title=Predictors of chronic pelvic pain in an urban population of women with symptoms and signs of pelvic inflammatory disease |journal=Sex Transm Dis |volume=32 |issue=5 |pages=293–9 |year=2005 |pmid=15849530 |doi= |url=}}</ref>

===Infertility===
*PID may cause permanent damages to the [[fallopian tubes]], this damages include loss of ciliary action, [[fibrosis]], and occlusion that may result in [[infertility]].<ref name="pmid8362945">{{cite journal |vauthors=Cates W, Joesoef MR, Goldman MB |title=Atypical pelvic inflammatory disease: can we identify clinical predictors? |journal=Am. J. Obstet. Gynecol. |volume=169 |issue=2 Pt 1 |pages=341–6 |year=1993 |pmid=8362945 |doi= |url=}}</ref>
*Risk factors for infertility include:
*#[[Chlamydial]] infection<ref name="pmid17548070">{{cite journal |vauthors=Svenstrup HF, Fedder J, Kristoffersen SE, Trolle B, Birkelund S, Christiansen G |title=Mycoplasma genitalium, Chlamydia trachomatis, and tubal factor infertility--a prospective study |journal=Fertil. Steril. |volume=90 |issue=3 |pages=513–20 |year=2008 |pmid=17548070 |doi=10.1016/j.fertnstert.2006.12.056 |url=}}</ref>
*#Delayed PID treatment<ref name="pmid8498436">{{cite journal |vauthors=Hillis SD, Joesoef R, Marchbanks PA, Wasserheit JN, Cates W, Westrom L |title=Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility |journal=Am. J. Obstet. Gynecol. |volume=168 |issue=5 |pages=1503–9 |year=1993 |pmid=8498436 |doi= |url=}}</ref>
*#Frequent PIDs<ref name="pmid7008604">{{cite journal |vauthors=Weström L |title=Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries |journal=Am. J. Obstet. Gynecol. |volume=138 |issue=7 Pt 2 |pages=880–92 |year=1980 |pmid=7008604 |doi= |url=}}</ref>
*#Severity of infection<ref name="pmid9609570">{{cite journal |vauthors=Lepine LA, Hillis SD, Marchbanks PA, Joesoef MR, Peterson HB, Westrom L |title=Severity of pelvic inflammatory disease as a predictor of the probability of live birth |journal=Am. J. Obstet. Gynecol. |volume=178 |issue=5 |pages=977–81 |year=1998 |pmid=9609570 |doi= |url=}}</ref>

===Ectopic pregnancy===
*[[Fallopian tubes|Tubal]] damage due to PID may result in anatomical distortion, which can predispose the patient to [[ectopic pregnancy]].<ref name="pmid1411832">{{cite journal |vauthors=Weström L, Joesoef R, Reynolds G, Hagdu A, Thompson SE |title=Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results |journal=Sex Transm Dis |volume=19 |issue=4 |pages=185–92 |year=1992 |pmid=1411832 |doi= |url=}}</ref>

===Hydrosalpinx===
*Tubal damage may lead to tubal blockade, sterile fluid accumulation, and/or [[fallopian tube]] enlargement, which may cause pain or [[infertility]].<ref name="pmid23812461">{{cite journal |vauthors=Kawwass JF, Crawford S, Kissin DM, Session DR, Boulet S, Jamieson DJ |title=Tubal factor infertility and perinatal risk after assisted reproductive technology |journal=Obstet Gynecol |volume=121 |issue=6 |pages=1263–71 |year=2013 |pmid=23812461 |pmc=4292839 |doi=10.1097/AOG.0b013e31829006d9 |url=}}</ref>

===Fitz Hugh Curtis syndrome===
*[[Inflammation]] and adhesion formation in the liver capsule ([[perihepatitis]]) may cause [[Right upper quadrant abdominal pain resident survival guide|right upper quadrant abdominal pain]] and [[tenderness]].<ref name="pmid25992748">{{cite journal |vauthors=Brunham RC, Gottlieb SL, Paavonen J |title=Pelvic inflammatory disease |journal=N. Engl. J. Med. |volume=372 |issue=21 |pages=2039–48 |year=2015 |pmid=25992748 |doi=10.1056/NEJMra1411426 |url=}}</ref>

==References==
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