Introduction

The current emphasis upon evidence-based medicine has poorly served our approach to pelvic inflammatory disease (PID). On paper, the goal of determining the best therapeutic strategy by prospective randomized double-blind studies is laudable, but it makes the assumption that patients with similar risk factors can be grouped into large study groups for such endeavors. It is increasingly apparent that this has not been the case.

PID is a classification that attempts to encompass too wide a range of clinical syndromes. It includes seriously ill women with a tubo-ovarian abscess, who require hospitalization, intravenous antibiotics, and sometimes operative intervention for a cure. In contrast, most women with PID either are asymptomatic or have such mild symptoms that they do not seek medical care. To address these concerns, the International Infectious Disease Society for Obstetrics-Gynecology (I-IDSOG-USA) suggested the term “upper genital tract disease” (UGTI) be used with the designation of the etiologic agent. In addition, the UGTI can be placed in stages, depending upon the clinical severity of the infection.

Epidemiology studies have added to the confusion about risk factors for PID. For the past two decades, study after study has shown bacterial vaginosis (BV) and douching as risk factors for the development of PID, but in separate prospective studies, on BV and douching, no increased risk was seen.

In addition, epidemiologic studies that suffer from inaccurate reporting of condom use and imperfect diagnosis of sexually transmitted disease (STD) infection have been used to bolster the faith-based emphasis upon abstinence over condoms to prevent infection.