Pelvic inflammatory disease (PID), or slapingitis, is a catch all term for a group of bacterial diseases of the uterus, fallopian tubes and ovaries. In addition to these, the bacteria that cause PID can also infect the vagina, throat and rectum. Men and women can both be affected equally

by these bacteria and, left unchecked, infected sexual partners can become part of a vicious cycle of continual re infection. The genitourinary tracts and reproductive organs of both men and women can be damaged by the bacteria which cause PID.

In women, PID is a major cause of fertility and reproductive illness, accounting for the majority of cases of acquired infertility and substantially increasing the risk of subsequent ectopic pregnancy (JAMA, 1988; 259: 1823-7; Am J Epidemiol, 1991; 133: 839-49). Other side effects of PID include abscesses of the ovaries and fallopian tubes and pelvic adhesions, often leading to dyspareunia (painful intercourse) and chronic pelvic pain. If a woman becomes pregnant with untreated PID, her chances of giving birth to a live baby fall dramatically with the severity of her condition from 90 per cent with a woman who has a mild form of the disease to 57 per cent for those with severe disease (Am J Ob Gyn, 1998; 178: 977-98). A woman with recurring PID is eight times less likely to achieve a live birth, compared with a woman with a single mild episode of PID.

PID is usually brought on through sexual contact, but this is not the only route through which bacteria find their way into the normally sterile uterus.

The bacteria contamination may, in fact, happen during gynaecological procedures involving dilating the cervix and/or inserting instruments into the uterus. These can include abortion, D&C, tubal ligation, gynaecological examinations and insertion of an IUD. The risk of contracting an infection is also thought to be greater in the first few weeks after birth, when the cervix is still open. Bacteria can also be transferred from the gastrointestinal tract into the vagina from faeces either through poor hygiene or anal intercourse.

PID appears to be mostly a young woman's disease. Sexually active adolescent girls aged 15 to 19 are more likely to be hospitalised with PID than adult women aged 25 to 29 (Ob Gyn, 1995; 86: 764-9; Morb Mortal Wkly Rep, 1991; 40: 1-25). It is not totally clear why this should be the case, except that younger girls may be more likely to have multiple sexual partners, less likely to take precautions such as using a condom, or less inclined to seek a medical diagnosis when vague symptoms begin to appear.

While PID can be caused by any number of sexually transmitted diseases, including gonorrhoea and myoplasma, two factors seem to contribute more than anything to its development: chlamydial infection and delay in seeking treatment (Sexually Trans Dis, 1998; 25: 378-85). In one study, 48 per cent of women with PID had delayed going to the clinic by one week and one third had delayed by more than one week (Sexually Trans Dis, 1997; 24: 443-8).