Pelvic inflammatory disease: clinical aspects and influence on women’s reproductive health

Abstract

Pelvic inflammatory disease (PID) remains a leading cause of impaired reproductive health in women. This study aimed to identify clinical and anamnestic characteristics associated with PID and to evaluate subsequent reproductive outcomes following inpatient management. We retrospectively analyzed clinical and anamnestic data from 66 women diagnosed with PID and assessed fertility-related outcomes in those who completed inpatient treatment. Early menarche and sexual debut before age 16 were significantly associated with an increased risk of complicated PID (p=0,033), likely attributable to alterations in vaginal microbiota secondary to high-risk sexual behavior. The clinical presentation of PID was notably non-specific: 90.9 % of the patients reported abdominal pain, and 90.9 % exhibited elevated C-reactive protein levels. Notably, 77.3 % of the cases were initially misdiagnosed as acute appendicitis, underscoring the persistent diagnostic challenges in differentiating PID from other acute abdominal conditions. Etiologically, all identified pathogens in this cohort belonged exclusively to opportunistic microflora; no sexually transmitted infection (STI) agents, including Chlamydia trachomatis or Neisseria gonorrhoeae, were detected. Polymicrobial (mixed) infections were present in 29.5 % of the cases and were significantly associated with tubo-ovarian abscess formation and more severe pelvic adhesions (p=0.024). Uncomplicated PID predominated (86.4 % of the cases), whereas the presence of a tubo-ovarian abscess correlated strongly with extensive adnexal adhesions. Among the patients with uncomplicated disease who received timely, fertility-sparing laparoscopic intervention, pregnancy occurred in 16.7 % and live birth was achieved in 12.1 %. The annual fertility rate in this subgroup was 88.9 live births per 1,000 women, which is comparable to the agematched national population rate reported by Rosstat (Russian Federal State Statistics Service). These findings demonstrate that appropriate broad-spectrum antimicrobial therapy combined with minimally invasive, organpreserving surgical management can effectively preserve fertility even after an episode of PID.