Pelvic inflammatory disease: a family practice perspective Original paper

What was reviewed?

The paper reviewed key aspects of pelvic inflammatory disease (PID) management from the perspective of family practice physicians. The author assessed diagnostic accuracy, clinical presentations, and effective management strategies, focusing on risk factors, clinical criteria, diagnostic investigations, antimicrobial therapy, and prevention of PID, including asymptomatic forms linked to severe reproductive complications.

Who was reviewed?

This review examined family physicians’ diagnostic and treatment practices for PID, evaluating the challenges encountered in the primary care setting. It synthesized available clinical data, expert guidelines, and recommendations to enhance diagnostic accuracy and improve treatment outcomes among women managed in outpatient family practice environments.

What were the most important findings?

This review highlighted several important insights into PID management. PID, primarily an infection of the upper genital tract involving pathogens such as Chlamydia trachomatis, Neisseria gonorrhoeae, anaerobic bacteria like Bacteroides, and aerobic bacteria such as Escherichia coli, poses diagnostic challenges due to its variable symptoms, ranging from mild discomfort to severe illness. A notable finding was the low diagnostic accuracy by clinical assessment alone, underscoring the necessity of adjunct diagnostic methods. Inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) significantly improved diagnostic certainty when positive. However, even with these markers, clinical diagnosis alone remains insufficient; thus, laparoscopy or endometrial biopsy is recommended for uncertain cases to enhance diagnostic precision.

The review underscored that many family physicians inadequately adhere to antibiotic treatment guidelines, often prescribing single antibiotics despite recommendations advocating combination therapy. Recommended antibiotic regimens consistently include doxycycline or tetracycline combined with other antibiotics like cefoxitin, ampicillin, or ceftriaxone to adequately cover common pathogens. Compliance with antibiotic regimens remains critical, especially among adolescents who may require hospitalization to ensure effective treatment completion. The review stressed that asymptomatic PID, often caused by Chlamydia trachomatis, is an important precursor to infertility and ectopic pregnancy. Therefore, the review strongly advocated screening and early treatment of sexually transmitted infections (STIs), particularly chlamydial infections, as an essential preventative measure.

What are the greatest implications of this review?

The greatest implications involve the need for heightened clinical suspicion, better adherence to recommended multi-antibiotic treatments, improved diagnostic practices using biomarkers and laparoscopic confirmation when uncertainty exists, and proactive screening for asymptomatic infections. Emphasis on compliance and partner treatment to prevent recurrent infections also holds significant practical implications. Adopting these approaches in family practice will significantly reduce complications such as infertility, ectopic pregnancy, and chronic pelvic pain, thereby improving women’s overall reproductive health outcomes.