Skip to main content

Upper Genital Tract Infections in Women

  • Chapter
Sexually Transmitted Diseases

Part of the book series: Current Clinical Practice ((CCP))

Abstract

Female upper genital tract infections can occur in the endometrium (endometritis), uterine wall (myometritis), the uterine serosa and broad ligaments (parametritis), the fallopian tubes (salpingitis), the ovary (oophoritis), and the pelvic peritoneum (peritonitis). Because itmay not be possible to identify the site of infection precisely, the term pelvic inflammatory disease (PID) is often used when one or more of these organs are involved. The terms upper genital tract infections and PID are used interchangeably in this chapter. Salpingitis is the most common form of PID. These infections can result from ascent of cervical sexually transmitted infections (STIs) or other pathogens or from complications of surgery. Direct medical costs of upper genital tract infections and their sequelae are estimated to be nearly $2 billion annually in the United States (1).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Rein DB, Kassler WJ, Irwin KL, Rabiee L. Direct medical cost of pelvic inflammatory disease and its sequelae: decreasing, but still substantial. Obstet Gynecol 2000; 95:397–402.

    Article  CAS  PubMed  Google Scholar 

  2. Washington AE, Cates W Jr, Zaidi AA. Hospitalizations for pelvic inflammatory disease. Epidemiology and trends in the United States, 1975 to 1981. JAMA 1984; 251:2529–2533.

    Article  CAS  PubMed  Google Scholar 

  3. Velebil P, Wingo PA, Xia Z, Wilcox LS, Peterson HB. Rate of hospitalization for gynecologic disorders among reproductive-age women in the United States. Obstet Gynecol 1995; 86:764–769.

    Article  CAS  PubMed  Google Scholar 

  4. Curtis KM, Hillis SD, Kieke BA Jr, Brett KM, Marchbanks PA, Peterson HB. Visits to emergency departments for gynecologic disorders in the United States, 1992–1994. Obstet Gynecol 1998; 91:1007–1012.

    Article  CAS  PubMed  Google Scholar 

  5. Stenchever MA, Droegemueller W, Herbst AL, Mishell DR. Infections of the upper genital tract: endometritis, acute and chronic salpingitis. In: Comprehensive Gynecology, 4th Ed. St. Louis, MO: Mosby, 2001, pp.707–739.

    Google Scholar 

  6. Beigi RH, Wiesenfeld HC. Pelvic inflammatory disease: new diagnostic criteria and treatment. Obstet Gynecol Clin North Am 2003; 30:777–793.

    Article  PubMed  Google Scholar 

  7. Dallabetta G, Kamenga MC, Field ML. Infections of the female pelvis including septic abortion. In: Cohen J, Powderly WG, Berkley SF, et al., eds. Infectious Diseases, 2nd Ed. Edinburgh, Scotland: Mosby, 2004, pp. 693–700.

    Google Scholar 

  8. Bell TA, Holmes KK. Age-specific risks of syphilis, gonorrhea, and hospitalized pelvic inflammatory disease in sexually experienced U. S. women. Sex Transm Dis 1984; 11:291–295.

    Article  CAS  PubMed  Google Scholar 

  9. Westrom L. Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. Am J Obstet Gynecol 1980; 138:880–892.

    CAS  PubMed  Google Scholar 

  10. Suss AL, Homel P, Hammerschlag M, Bromberg K. Risk factors for pelvic inflammatory disease in inner-city adolescents. Sex Transm Dis 2000; 27:289–291.

    Article  CAS  PubMed  Google Scholar 

  11. Thejls H, Gnarpe J, Lundkvist O, Heimer G, Larsson G, Victor A. Diagnosis and prevalence of persistent chlamydia infection in infertile women: tissue culture, direct antigen detection, and serology. Fertil Steril 1991; 55:304–310.

    CAS  PubMed  Google Scholar 

  12. Sweet RL, Gibbs RS. Infectious Diseases of the Female GenitalTract, 4th Ed. Philadelphia, PA: Lippincott Williams &Wilkins, 2002.

    Google Scholar 

  13. Soper DE, Brockwell NJ, Dalton HP, Johnson D. Observations concerning the microbial etiology of acute salpingitis. Am J Obstet Gynecol 1994; 170:1008–1017.

    Article  CAS  PubMed  Google Scholar 

  14. Bukusi EA, Cohen CR, Stevens CE, et al. Effects of human immunodeficiency virus 1 infection on microbial origins of pelvic inflammatory disease and on efficacy of ambulatory oral therapy. Am J Obstet Gynecol 1999; 181:1374–1381.

    Article  CAS  PubMed  Google Scholar 

  15. Hillier SL, Kiviat NB, Hawes SE, et al. Role of bacterial vaginosis-associated microorganisms in endometritis. Am J Obstet Gynecol 1996; 175:435–441.

    Article  CAS  PubMed  Google Scholar 

  16. Sweet RL, Gibbs RS. Pelvic Inflammatory disease. In: Infectious Diseases of the Female GenitalTract, 4th Ed. Philadelphia, PA: Lippincott Williams &Wilkins, 2002, pp. 368–412.

    Google Scholar 

  17. Peipert JF, Boardman L, Hogan JW, Sung J, Mayer KH. Laboratory evaluation of acute upper genital tract infection. Obstet Gynecol 1996; 87:730–736.

    Article  CAS  PubMed  Google Scholar 

  18. Yudin MH, Hillier SL, Wiesenfeld HC, Krohn MA, Amortegui AA, Sweet RL. Vaginal polymorphonuclear leukocytes and bacterial vaginosis as markers for histologic endometritis among women without symptoms of pelvic inflammatory disease. Am J Obstet Gynecol 2003; 188: 318–323.

    Article  PubMed  Google Scholar 

  19. Kahn JG, Walker CK, Washington AE, Landers DV, Sweet RL. Diagnosing pelvic inflammatory disease. A comprehensive analysis and considerations for developing a new model. JAMA 1991; 266:2594–2604.

    Article  CAS  PubMed  Google Scholar 

  20. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep 2006; 55(RR-11):56–61. Available from: http://www.cdc.gov/std/treatment/. Accesssed Nov. 24, 2006.

    Google Scholar 

  21. Boardman LA, Peipert JF, Brody JM, Cooper AS, Sung J. Endovaginal sonography for the diagnosis of upper genital tract infection. Obstet Gynecol 1997; 90:54–57.

    Article  CAS  PubMed  Google Scholar 

  22. Gaitan H, Angel E, Diaz R, Parada A, Sanchez L, Vargas C. Accuracy of five different diagnostic techniques in mild-to-moderate pelvic inflammatory disease. Infect Dis Obstet Gynecol 2002; 10:171–180.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Tukeva TA, Aronen HJ, Karjalainen PT, Molander P, Paavonen T, Paavonen J. MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology 1999; 210: 209–216.

    Article  CAS  PubMed  Google Scholar 

  24. Kiviat NB, Wolner-Hanssen P, Eschenbach DA, et al. Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis. Am J Surg Pathol 1990; 14:167–175.

    Article  CAS  PubMed  Google Scholar 

  25. Risser WL, Cromwell PF, Bortot AT, Risser JM. Impact of new diagnostic criteria on the prevalence and incidence of pelvic inflammatory disease. J Pediatr Adolesc Gynecol 2004; 17: 39–44.

    Article  CAS  PubMed  Google Scholar 

  26. Cibula D, Kuzel D, Fucikova Z, Svabik K, Zivny J. Acute exacerbation of recurrent pelvic inflammatory disease. Laparoscopic findings in 141 women with a clinical diagnosis. J Reprod Med 2001; 46:49–53.

    CAS  PubMed  Google Scholar 

  27. Ness RB, Soper DE, Holley RL, et al. 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. Am J Obstet Gynecol 2002; 186:929–937.

    Article  PubMed  Google Scholar 

  28. Brookoff D. Compliance with doxycycline therapy for outpatient treatment of pelvic inflammatory disease. South Med J 1994; 87:1088–1091.

    Article  CAS  PubMed  Google Scholar 

  29. Kamwendo F, Johansson E, Moi H, Forslin L, Danielsson D. Gonorrhea, genital chlamydial infection, and nonspecific urethritis in male partners of women hospitalized and treated for acute pelvic inflammatory disease. Sex Transm Dis 1993; 20:143–146.

    Article  CAS  PubMed  Google Scholar 

  30. Ness RB, Randall H, Richter HE, et al. Condom use and the risk of recurrent pelvic inflammatory disease, chronic pelvic pain, or infertility following an episode of pelvic inflammatory disease. Am J Public Health 2004; 94:1327–1329.

    Article  PubMed  Google Scholar 

  31. Yeh JM, Hook EW 3rd, Goldie SJ. A refined estimate of the average lifetime cost of pelvic inflammatory disease. Sex Transm Dis 2003; 30:369–378.

    Article  PubMed  Google Scholar 

  32. Landers DV, Sweet RL. Current trends in the diagnosis and treatment of tuboovarian abscess. Am J Obstet Gynecol 1985; 151:1098–1110.

    Article  CAS  PubMed  Google Scholar 

  33. Chen MJ, Yang JH, Yang YS, Ho HN. Increased occurrence of tubo-ovarian abscesses in women with stage III and IV endometriosis. Fertil Steril 2004; 82:498–499.

    Article  PubMed  Google Scholar 

  34. Hager WD. Follow-up of patients with tubo-ovarian abscess(es) in association with salpingitis. Obstet Gynecol 1983; 61:680–684.

    CAS  PubMed  Google Scholar 

  35. Perez-Medina T, Huertas MA, Bajo JM. Early ultrasound-guided transvaginal drainage of tubo-ovarian abscesses: a randomized study. Ultrasound Obstet Gynecol 1996; 7:435–438.

    Article  CAS  PubMed  Google Scholar 

  36. Corsi PJ, Johnson SC, Gonik B, Hendrix SL, McNeeley SG Jr, Diamond MP. Transvaginal ultrasound-guided aspiration of pelvic abscesses. Infect Dis Obstet Gynecol 1999; 7:216–221.

    CAS  PubMed Central  PubMed  Google Scholar 

  37. Nelson AL, Sinow RM, Renslo R, Renslo J, Atamdede F. Related Articles, Endovaginal ultrasonographically guided transvaginal drainage for treatment of pelvic abscesses. Am J Obstet Gynecol 1995; 172:1926–1932.

    Article  CAS  PubMed  Google Scholar 

  38. Nelson AL, Sinow RM, Oliak D. Transrectal ultrasonographically guided drainage of gynecologic pelvic abscesses. Am J Obstet Gynecol 2000; 182:1382–1388.

    Article  CAS  PubMed  Google Scholar 

  39. Halperin R, Levinson O, Yaron M, Bukovsky I, Schneider D. Tubo-ovarian abscess in older women: is the woman’s age a risk factor for failed response to conservative treatment? Gynecol Obstet Invest 2003; 55:211–215.

    Article  PubMed  Google Scholar 

  40. Wang SP, Eschenbach DA, Holmes KK, Wager G, Grayston JT. Chlamydia trachomatis infection in Fitz-Hugh-Curtis syndrome. Am J Obstet Gynecol 1980; 138:1034–1038.

    CAS  PubMed  Google Scholar 

  41. Litt IF, Cohen MI. Perihepatitis associated with salpingitis in adolescents. JAMA 1978; 240: 1253–1254.

    Article  CAS  PubMed  Google Scholar 

  42. Peter NG, Clark LR, Jaeger JR. Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain. Cleve Clin J Med 2004; 71:233–239.

    Article  PubMed  Google Scholar 

  43. Westrom L, Joesoef R, Reynolds G, Hagdu A, Thompson SE. Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis 1992; 19:185–192.

    Article  CAS  PubMed  Google Scholar 

  44. Pavletic AJ, Wolner-Hanssen P, Paavonen J, Hawes SE, Eschenbach DA. Infertility following pelvic inflammatory disease. Infect Dis Obstet Gynecol 1999; 7:145–152.

    CAS  PubMed Central  PubMed  Google Scholar 

  45. Lepine LA, Hillis SD, Marchbanks PA, Joesoef MR, Peterson HB, Westrom L. Severity of pelvic inflammatory disease as apredictor of the probability of live birth. Am J Obstet Gynecol 1998; 178:977–981.

    Article  CAS  PubMed  Google Scholar 

  46. Hubacher D, Grimes D, Lara-Ricalde R, de la Jara J, Garcia-Luna A. The limited clinical usefulness of taking a history in the evaluation of women with tubal factor infertility. Fertil Steril 2004; 81:6–10.

    Article  PubMed  Google Scholar 

  47. Miettinen A, Heinonen PK, Teisala K, Hakkarainen K, Punnonen R. Serologic evidence for the role of Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma hominis in the etiology of tubal factor infertility and ectopic pregnancy. Sex Transm Dis 1990; 17: 10–14.

    CAS  PubMed  Google Scholar 

  48. Rosenfeld DL, Seidman SM, Bronson RA, Scholl GM. Unsuspected chronic pelvic inflammatory disease in the infertile female. Fertil Steril 1983; 39:44–48.

    CAS  PubMed  Google Scholar 

  49. Sellors JW, Mahony JB, Chernesky MA, Rath DJ. Tubal factor infertility: an association with prior chlamydial infection and asymptomatic salpingitis. Fertil Steril 1988; 49:451–457.

    CAS  PubMed  Google Scholar 

  50. Wolner-Hanssen P. Silent pelvic inflammatory disease: is it overstated? Obstet Gynecol 1995; 86:321–325.

    Article  CAS  PubMed  Google Scholar 

  51. Songer TJ, Lave JR, Kamlet MS, Frederick S, Ness RB; Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Study. Preferences for fertility in women with pelvic inflammatory disease. Fertil Steril 2004; 81:1344–1350.

    Article  PubMed  Google Scholar 

  52. Westrom L, Bengtsson LP, Mardh PA. Incidence, trends, and risks of ectopic pregnancy in a population of women. Br Med J (Clin Res Ed) 1981; 282:15–18.

    Article  CAS  Google Scholar 

  53. Kamwendo F, Forslin L, Bodin L, Danielsson D. Epidemiology of ectopic pregnancy during a 28 year period and the role of pelvic inflammatory disease. Sex Transm Infect 2000; 76:28–32.

    Article  CAS  PubMed  Google Scholar 

  54. Westrom L. Effect of acute pelvic inflammatory disease on fertility. Am J Obstet Gynecol 1975; 121:707–713.

    CAS  PubMed  Google Scholar 

  55. American College of Obstetricians and Gynecologists (ACOG). ACOG practice bulletin no. 51: chronic pelvic pain. Washington, DC: ACOG, 2004.

    Google Scholar 

  56. Buchan H, Vessey M, Goldacre M, Fairweather J. Morbidity following pelvic inflammatory disease. Br J Obstet Gynaecol 1993; 100:558–562.

    Article  CAS  PubMed  Google Scholar 

  57. Haggerty CL, Schulz R, Ness RB; PID Evaluation and Clinical Health Study Investigators. Lower quality of life among women with chronic pelvic pain after pelvic inflammatory disease. Obstet Gynecol 2003; 102:934–939.

    Article  PubMed  Google Scholar 

  58. Haggerty CL, Ness RB, Amortegui A, et al. Endometritis does not predict reproductive morbidity after pelvic inflammatory disease. Am J Obstet Gynecol 2003; 188:141–148.

    Article  PubMed  Google Scholar 

  59. Ness RB, Soper DE, Holley RL, et al. Hormonal and barrier contraception and risk of upper genital tract disease in the PID Evaluation and Clinical Health (PEACH) study. Am J Obstet Gynecol 2001; 185:121–127.

    Article  CAS  PubMed  Google Scholar 

  60. Hatcher RA, Zieman M, Cwiak C, Darney PD, Creinen MD, Stosur HR. Managing Contraception: 2004–2005. Tiger, GA: Bridging the Gap Foundation, 2004.

    Google Scholar 

  61. Hubacher D, Grimes DA. Noncontraceptive health benefits of intrauterine devices: a systematic review. Obstet Gynecol Surv 2002; 57:120–128.

    Article  PubMed  Google Scholar 

  62. Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med 1996; 334:1362–1366.

    Article  CAS  PubMed  Google Scholar 

  63. Washington AE, Cates W Jr, Wasserheit JN. Preventing pelvic inflammatory disease. JAMA 1991; 266:2574–2580.

    Article  CAS  PubMed  Google Scholar 

  64. Whiteside JL, Katz T, Anthes T, Boardman L, Peipert JF. Risks and adverse outcomes of sexually transmitted diseases. Patients’ attitudes and beliefs. J Reprod Med 2001; 46:34–38.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Humana Press Inc.,Totowa NJ

About this chapter

Cite this chapter

Likis, F.E. (2006). Upper Genital Tract Infections in Women. In: Nelson, A.L., Woodward, J., Wysocki, S. (eds) Sexually Transmitted Diseases. Current Clinical Practice. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59745-040-9_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-59745-040-9_8

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-58829-570-5

  • Online ISBN: 978-1-59745-040-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics