Pelvic inflammatory disease (PID) is an ascending infection (sexually transmitted disease) from the cervix to the endometrium, fallopian tubes, and pelvic cavity. The infecting organisms are most frequently nongonococcal organisms, including Chlamydia, Mycoplasma hominis and endogenous flora. Broad-spectrum antibiotics are therapeutic.
The distribution of disease includes the endometrium (endometritis), fallopian tubes (salpingitis), and pelvic cavity (peritonitis and pelvic abscesses). Fitz-Hugh– Curtis syndrome (perihepatitis) can occur, characterized by “violin-string” adhe-sions between the fallopian tube and liver capsule. Symptoms include the following:
• Vaginal discharge (cervicitis)
• Vaginal bleeding and midline abdominal pain (endometritis)
• Bilateral lower abdominal and pelvic pain (salpingitis)
• Abdominal tenderness and peritoneal signs (peritonitis)
• Pleuritic right upper quadrant pain (perihepatitis)
Complications of PID include tubo-ovarian abscess; tubal scarring (increasing risk of infertility and ectopic tubal pregnancies), and intestinal obstruction secondary to fibrous adhesions.
Cervical carcinoma is most commonly squamous cell carcinoma but can also be adenocarcinoma or small cell neuroendocrine carcinoma. It is the third most com-mon malignant tumor of the lower female genital tract in the United States, with peak incidence at ages 35–44. Risk factors include the following:
• Early age of first intercourse
• Multiple sexual partners
• Multiple pregnancies
• Oral contraceptive use
• STDs (including human papilloma virus)
Human papilloma virus infection is the most important risk factor, with high-risk types being 16, 18, 31, and 33, and having viral oncoproteins E6 (binds to p53) and E7 (binds to Rb).
The precursor lesion is cervical intraepithelial neoplasia (CIN), which is increasing in incidence and occurs commonly at the squamocolumnar junction (transformation zone). Cervical intraepithelial lesions show a progression of changes on histologic examination:
• Low grade SIL (squamous intraepithelial lesion)
• High grade SIL
• Carcinoma in situ
• Superficially invasive squamous cell carcinoma
• Invasive squamous cell carcinoma
Squamous cell carcinoma of the cervix may be asymptomatic or may present with postcoital vaginal bleeding, dyspareunia, and/or malodorous discharge. To establish the diagnosis, the Papanicolaou (Pap) test is useful for early detection, and colpos-copy with biopsy for microscopic evaluation.
Acute cervicitis and chronic cervicitis are common and usually nonspecific inflam-matory conditions.
• Acute cervicitis is often caused by C. trachomatis, N. gonorrhoeae, T. vaginalis, Candida, and herpes simplex type 2.
• A specific, severe form of chronic cervicitis (follicular cervicitis) can be caused by C. trachomatis; it can result in neonatal conjunctivitis and pneu-monia in infants delivered vaginally through an infected cervix.
Cervical polyp is a common non-neoplastic polyp that can be covered with columnar or stratified squamous epithelium.
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