INTRODUCTION

The current emphasis on evidence-based medicine has poorly served our approach to pelvic inflammatory disease. 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.

Pelvic inflammatory disease (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 infection (UGTI) be used with the designation of the etiologic agent. In addition, the UGTI can be placed in stages, depending on the clinical severity of the infection.

Epidemiologic studies have added to the confusion about risk factors for PID. Since the early 1980s, 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.