PELVIC INFLAMMATORY DISEASE
Clinical manifestations of pelvic inflammatory disease (PID) vary but generally include lower abdominal pain elicited by movement of the cervix or palpation of the adnexal or endometrial areas. About 50% of cases are caused by N. gonorrhoeae. Nongonococcal PID has a complex and sometimes polymicrobial etiology, including C. trachomatis, Bac-teroides, anaerobic streptococci, and Mycoplasma hominis alone or in various combina-tions. In general, nongonococcal PID is milder than that associated with N. gonorrhoeae infection. The incidence of PID is five to ten times higher in women with intrauterine de-vices than in those not using this form of contraception. The diagnosis is established most reliably by culture of peritoneal aspirates from the vaginal cul-de-sac. Treatment of PID is complex because of the multiple etiologies and relative inaccessibility of the definitive diagnostic specimen.