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Microbiology

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Chlamydia trachomatis and Neisseria gonorrhoea account for the majority of cases. (1)

  • Chlamydia is thought to be the most common cause of PID and is associated with 14% to 35% of cases (1)
  • Neisseria gonorrhoea and chlamydia trachomatis co-infection can occur

Less commonly, PID may result from: (2)

  • Mycoplasma hominis
  • Mycoplasma genitalium
  • anaerobes such as Bacteroides
  • G. vaginalis
  • Haemophilus influenzae
  • Cytomegalovirus
  • U. urealyticum
  • Actinomyces israelii - especially with long term IUCD; may cause unilateral infection
  • Herpes simplex virus type II - very rarely

No microbiological cause can be found in 20%.

Routes of infection include:

  • ascending from the vagina - endogenous infection, for example, Bacteroides; or sexually transmitted infection, especially Chlamydia and Neiserria

  • direct inoculation - for example, during dilatation and curettage, termination of pregnancy, insertion of a intrauterine contraceptive device

  • transperitoneal - for example, following appendicitis or diverticulitis

  • haematogenous - classically tuberculosis, usually at the time of puberty, but theoretically, any bacteraemia may produce pelvic foci of infection

Reference:

1. Goller JL et al. Population attributable fraction of pelvic inflammatory disease associated with chlamydia and gonorrhoea: a cross-sectional analysis of Australian sexual health clinic data. Sex Transm Infect. 2016 Nov;92(7):525-31.

2. Curry A, Williams T, Penny ML. Pelvic Inflammatory Disease. Diagnosis, Management, and Prevention. Am Fam Physician. 2019 Sep 15;100(6):357-364.

 


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