Book Review

Pelvic Inflammatory Disease

N Engl J Med 1997; 336:1765-1766June 12, 1997

Article

Pelvic Inflammatory Disease
Edited by Daniel V. Landers and Richard L. Sweet. 210 pp., illustrated. New York, Springer-Verlag, 1997. $39. ISBN: 0-387-94462-1

Pelvic inflammatory disease is an enormous health problem for women. The preface to this excellent book states that pelvic infections affect a million American women annually, at a cost to our health care system of $4 billion. The difficulty of controlling the spectrum of organisms that cause pelvic infections and the sequelae to which the infections lead are well described throughout the book.

The chapters on microbial causes, diagnosis, and treatments for pelvic infection show that many of the responsible pathogens have been identified and appropriate antibiotics are available, but the clinical presentation may vary greatly and timely diagnosis may be difficult. Overdiagnosis leads to inappropriate care, underdiagnosis allows the development of permanent sequelae, and misdiagnosis delays the appropriate treatment of other disease. These are problems with which clinicians continue to struggle.

A chapter on pelvic inflammatory disease among adolescents focuses on their vulnerability to cervical infection due to physiologic changes (ectopy of the cervix) and on the risks associated with early, often unprotected intercourse and multiple sexual partners. Annually, 3 million cases of sexually transmitted disease occur that involve young women, 16 percent of whom are hospitalized with pelvic inflammatory disease. The book makes important points about the early recognition of the disease and the aggressive treatment of affected women and their partners. Chapters on epidemiology, risk factors, and the prevention of pelvic infection underscore the importance of educating patients. Increased use of barrier methods of contraception and early recognition of the symptoms of pelvic inflammatory disease by affected women will be the keys to preventing the long-term sequelae of infertility, ectopic pregnancy, and chronic pelvic pain.

For clinicians who frequently see women with pelvic infection, this book, by authors well versed in the field, will be an excellent review. For clinicians who see such patients less frequently, the newer concepts of treatment may serve to update information learned in training. For example, vaginal drainage of tubo-ovarian abscesses has largely been abandoned in favor of drainage by laparoscopic techniques or laparotomy. One proposal, especially interesting in this era of managed care, is that all adolescents with pelvic infection be hospitalized for aggressive treatment. Lack of compliance with outpatient oral therapy greatly increases the risk of recurrent infection and long-term sequelae.

One problem with this book that always confronts editors is that a number of the chapters repeat the same information and sources. This repetition allows each chapter to stand alone when the book is used for reference, but it is frustrating for the clinicians who read much of the book. Nevertheless, the book will be an excellent reference work for clinicians interested in this important medical problem.

William H. Parker, M.D.
UCLA School of Medicine, Los Angeles, CA 90024

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   Jose I. Figueroa. (2000) Head lice: is there a solution?. Current Opinion in Infectious Diseases 13:2, 135-139
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