Pelvic inflammatory disease and the general surgeon.

New causal agents of pelvic inflammatory disease that have recently been determined are Chlamydia trachomatis, anaerobic bacteria and penicillinase-producing gonococci. It is also recognized that the pelvic infection is normally polybacterial. The symptoms produced by these organisms are so indefinite that diagnosis based on clinical findings alone is often difficult. The diagnosis of pelvic inflammatory disease should therefore be established by laparoscopy in these cases. Antibiotics capable of eradicating most pelvic infections are now available. As a result of their use, the primary therapy has become medical. The indication for surgery is, in essence, failed medical therapy. Ablative surgery should generally be delayed until adequate antibiotic therapy has been tried and found inadequate. Furthermore, the surgery should be conservative because the disease is often unilateral. Total abdominal hysterectomy and bilateral salpingo-oophorectomy as a treatment for pelvic inflammatory disease should be the exception rather than the rule.