Factors associated with pelvic inflammatory disease: A case series analysis of family planning clinic data

BACKGROUND: We aimed to better understand factors associated with pelvic inflammatory disease in an outpatient setting. METHODS: We analysed the characteristics of pelvic inflammatory disease cases diagnosed in an outpatient setting during 2018. There were 72 cases included in the final analysis. RESULTS: Of the pelvic inflammatory disease cases analysed, 55% were idiopathic, 22.2% were related to a sexually transmitted infection, and 22.2% had onset of symptoms within 6 weeks of a gynaecological procedure. Of the sexually transmitted infection–positive pelvic inflammatory disease cases, Chlamydia trachomatis was present in 56%, Mycoplasma genitalium was present in 38%, and Neisseria gonorrhoeae was present in 12.5% of cases. Many pelvic inflammatory disease cases had evidence of vaginal dysbiosis or features associated with vaginal flora disruption (recent antibiotic usage and/or vulvovaginal candidiasis). CONCLUSION: This case series highlights the burden of Mycoplasma genitalium pelvic inflammatory disease, and clinicians should be aware to include testing for this when diagnosing pelvic inflammatory disease. Our findings also support the hypothesis that host dysbiotic microbiota may contribute to pelvic inflammatory disease pathogenesis, with further research required to explore this proposition.