We turn our attention now to what is really a complication
of a sexually transmitted infection,
and that is pelvic inflammatory disease.
We would define it as a sexually transmitted infection
which leads to a clinical syndrome of
inflammation from the cervix to the endometrium,
and involving the fallopian tubes
and the contiguous pelvic structures.
It can be quite a serious process.
The numbers are pretty serious as well.
A million women in the United States each year
present with pelvic inflammatory disease.
We call it PID.
You can expect it in about 40% of women
who develop endocervicitis,
and get no treatment,
whether it's due to Neisseria gonorrhoeae
or Chlamydia trachamatis.
The women who are likely to get PID are often teenagers --
three times more than women of the age 25 to 29
women who have multiple sexual partners
someone with a new sexual partner within the previous 30 days,
or frequent sexual intercourse with a single partner.
These are also risky types of behavior
for pelvic inflammatory disease.
There are some other associations some of which, we don't clearly understand,
and one of these is bacterial vaginosis.
Women with this process are more prone to developing PID.
For reasons that are probably a little more obvious,
a woman who has an intrauterine device
is more likely to have organisms track up the genital tract.
Women who douche a lot
also may be subject to pelvic inflammatory disease,
and the process seems to occur during menses.
It's fascinating that women who smoke cigarettes
have an increased incidence of pelvic inflammatory disease
in virtually all studies.
The mechanism is not very clear.
Some speculate that the cigarette smoke
makes the cilia of the fallopian tubes, dysfunctional.
perhaps allowing organisms to move up the fallopian tubes.
And there is an association that's not well explained
with substance abuse and PID.
So the causes of pelvic inflammatory disease
are these notorious pathogens again --
and a wide variety of other bugs as well.
These include anaerobic bacteria,
and it should be pointed out,
that in human beings
life on man and woman is anaerobic.
Anaerobes actually outnumber aerobes,
for example, in the colon, by a thousand to one.
Aerobic Gram-negative rods
other colonic type organisms
and Mycoplasma can be involved.
So very often when you have infection
that's pelvic inflammatory disease,
you actually have mixed organisms on a Gram-stain smear.
So a little about the pathogenesis.
We have direct, canalicular spread of organisms
from the endocervix to the endometrial mucosa
and to the fallopian tubes.
And this is not proven,
but it is speculated that sexually transmitted organisms
like Neisseria gonorrhoeae
cause this inflammation of the tubal mucosa
and they facilitate other organisms,
say, from the GI tract moving up into the female genital tract.
But as I mentioned, the mechanisms are rather poorly understood
but unfortunately, pelvic inflammatory disease
comes with some long-term sequelae, like scarring.
And when the fallopian tubes are scarred
things like ectopic pregnancy can develop.