TOPLINE

Among women hospitalised with pelvic inflammatory disease, endometriosis was independently associated with threefold higher odds of treatment failure and recurrence, as well as longer hospital stay.

METHODOLOGY

• Researchers conducted a retrospective cohort study to compare the severity of pelvic inflammatory disease in women with vs without endometriosis and to examine the impact of deep endometriosis on clinical outcomes.
• They included a total of 159 women hospitalised for pelvic inflammatory disease at a tertiary endometriosis centre in Spain between 2018 and 2023, of whom 48 had endometriosis (mean age, 37.5 years) and 111 did not (mean age, 32.5 years).
• Endometriosis was identified on transvaginal ultrasound by expert sonographers and confirmed on follow-up imaging after resolution of the acute pelvic inflammatory disease episode.
• Primary outcomes were the need for surgery during hospitalisation, length of hospital stay, treatment failure, and recurrence of pelvic inflammatory disease.
• Treatment failure was defined as the lack of improvement or clinical deterioration within 48-72 hours post-admission; recurrence was defined as a new episode of pelvic inflammatory disease requiring hospitalisation at least 30 days after discharge.

TAKEAWAY

• After multivariate adjustment, endometriosis was associated with threefold higher odds of both treatment failure (adjusted odds ratio [aOR], 3.0; P = .02) and recurrent pelvic inflammatory disease (aOR, 3.0; P = .03), as well as 1.7 additional days of hospital stay on average (P = .01). No significant association was observed between endometriosis and the need for surgery.
• Ovarian endometrioma was identified as the most common endometriosis subtype in 72.9% of women, and deep endometriosis was confirmed in 64.5% of patients on follow-up imaging.
• Overall, 2.1% of patients with endometriosis vs 42.3% of those without endometriosis tested positive for sexually transmitted disease (P = .01).
• In a subgroup analysis, women with deep endometriosis had higher rates of treatment failure and recurrence than those without deep disease, but the differences were not statistically significant.

IN PRACTICE

"[The study] findings suggest the need to adapt current management protocols. Empirical antibiotic regimens may require modification to cover non-STD [sexually transmitted disease] pathogens more effectively, and admission criteria should consider the likelihood of longer hospital stays," the authors wrote.

"Overall, personalized diagnostic and therapeutic approaches, along with clear and reassuring patient communication, are essential to improve outcomes in this high-risk population," they added.

SOURCE

This study was led by Marta Camacho, Institut Clínic de Ginecologia, Obstetrícia I Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain. It was published online on July 19, 2026, in Acta Obstetricia et Gynecologica Scandinavica.

LIMITATIONS

The single-centre design may have limited the generalisability of the findings. The diagnosis of endometriosis was confirmed on the basis of transvaginal ultrasound rather than histologic confirmation, which may have introduced diagnostic misclassification. Because the study included only hospitalised patients, the findings may not be generalisable to those with mild pelvic inflammatory disease managed in outpatient settings.

DISCLOSURES

The authors did not report any specific funding and declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.