Epidemiology and diagnosis of acute pelvic inflammatory disease.

Epidemiologic factors important in acute pelvic inflammatory disease (PID) are the pathogenic organisms Neisseria gonorrhoeae and Chlamydia trachomatis, less pathogenic mycoplasma, and endogenous aerobic and anaerobic bacteria. Other risk factors for PID include the number of sexual partners, previous PID, previous gonorrhea, and male gonorrhea. The patient's age, IUD use, and social factors may be dependent variables for the development of PID. The diagnosis is often difficult to establish; practical diagnostic methods include a careful history and physical examination, laboratory tests (particularly a cervical Gram stain), culdocentesis, and examination of the male. Laparoscopy should be used when the diagnosis is unclear.