The Challenge of Pelvic Inflammatory Disease

elvic inflammatory disease (PID) is a polymicrobial infection that originates from upward spread of infecting organisms through the cervix and into the uterus, fallopian tubes, or peritoneal cavity. It affects up to 1.5 mil-lion women in the United States and costs an estimated $1.06 billion each year.1 The etiologic agent often is never identified, but common causal agents are Chlamydia tra-chomatis, Neisseria gonorrhoeae, and aero-bic and anaerobic vaginal f lora (including organisms involved in bacterial vaginosis). Symptoms of PID include lower abdomi-nal pain, dyspareunia, fever, back pain, an