title: Pelvic inflammatory disease in women with endometriosis is more severe than in those without.
abstract: OBJECTIVE
  To determine the incidence and severity of acute pelvic inflammatory disease (PID) or tubo-ovarian abscess (TOA) in hospitalised women with and without a history of endometriosis.
  
  
  METHODS
  Retrospective analysis of hospital records retrieved for all women hospitalised with PID or TOA between January 2008 and December 2011 in a tertiary referral centre. Women were compared with regard to a history of endometriosis for demographic, clinical and fertility data.
  
  
  RESULTS
  26 (15%) of the 174 women hospitalised due to PID or TOA were excluded because of age older than 45 years, leaving 148 for analysis. The mean age was 35.7 ± 9.3 years and mean duration of hospitalisation was 5.9 ± 3.7 days. The women were divided into two groups: Group 1 with endometriosis (n = 21) and Group 2 without endometriosis (n = 127). Women in Group 1 as compared with Group 2 were significantly more likely to have undergone a fertility procedure prior to being admitted to the hospital with PID (9/27 (45%) vs 22/121 (17%), P < 0.001); particularly in vitro fertilisation (IVF) (7/ 27 (33%) vs 12/121 (9%), P < 0.006); Women in Group 1 more frequently experienced a severe and complicated course involving longer duration of hospitalisation (8.8 ± 4.7 vs 4.4 ± 2.3 days, P < 0.0001) and antibiotic treatment failure (10/27 (48%) vs 8/121 (6%), P < 0.0001).
  
  
  CONCLUSIONS
  Pelvic inflammatory disease in women with endometriosis is more severe and refractory to antibiotic treatment, often requiring surgical intervention. It is likely that endometriosis is a risk factor for the development of severe PID, particularly after IVF treatment.
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Shai E
authors.initials: SE
authors.lastname: Elizur
authors.forename: Oshrit
authors.initials: O
authors.lastname: Lebovitz
authors.forename: Adi Y
authors.initials: AY
authors.lastname: Weintraub
authors.forename: Vered H
authors.initials: VH
authors.lastname: Eisenberg
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Seidman
authors.forename: Mordechai
authors.initials: M
authors.lastname: Goldenberg
authors.forename: David
authors.initials: D
authors.lastname: Soriano
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D004715:Endometriosis / Q000150:complications*; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D010298:Parity; D000292:Pelvic Inflammatory Disease / Q000145:classification / Q000188:drug therapy / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents
keywords: endometriosis; in vitro fertilisation; laparoscopy; pelvic inflammatory disease; tubo-ovarian abscess