Prevention of PID: a challenge for the health service.

The control of sexually transmitted diseases (STD) will reduce the prevalence of pelvic inflammatory disease (PID). In most developing countries, treatment services are limited, coverage of the infected female population is inadequate and women seeking treatment are likely to be mismanaged. Family planning clinics do not usually provide routine screening for non-pregnant women. Screening only at family planning clinics would result in failure to treat some high-risk individuals, especially unmarried adolescents. The use of simplified protocols in the community has been recommended, but these may underestimate the problems of contact tracing, provide no systematic screening and induce passivity in the patient. For pregnant women, STD control has targetted syphilis, which does not cause PID. An integrated service for the management of reproductive health is required, and the development of women's clinics is suggested, using well-trained nurses and affordable technologies.