CHICAGO – Women with recurrent pelvic inflammatory disease are significantly more likely to report infertility and chronic pelvic pain long-term than are those without recurrent PID, according to a secondary analysis of the PEACH study.
Rates of pregnancy (odds ratio, 1.0) and live births (OR, 0.7) were similar at 84 months after adjustment for age, race, parity, prior history of PID, and gonorrhea and chlamydia infection among 831 women with mild to moderate PID enrolled in the PID Evaluation and Clinical Health (PEACH) study.
Dr. Maria Trent
Women with recurrent PID, however, were 1.8 times more likely to report infertility and 4.2 times more likely to report chronic pelvic pain than were those without recurrent episodes of PID, lead author Dr. Maria Trent said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
Women with a subsequent sexually transmitted infection (STI) of the lower genital tract were 2.3 times more likely to have chronic pelvic pain than were those without an STI, but not more likely to have infertility.
"Our data and analysis substantiate the relationship between recurrent PID and adverse outcomes in the context of modern microbiology and outpatient and inpatient care approaches," said Dr. Trent, director of interdisciplinary education at the Johns Hopkins Children’s Center in Baltimore.
She explained that much of the current knowledge of the longitudinal outcomes of women with PID has been driven by research on a Scandinavian cohort of PID inpatients enrolled between 1960 and 1984. Since that time, however, there has been a shift in biological organisms causing PID and in clinical management to the outpatient setting. Previously, 60% of patients with PID had noncoccal or chlamydial disease, whereas newer data demonstrate that as few as 30% of PID patients have noncoccal or chlamydial disease and that newer organisms such as Mycoplasma genitalium are emerging, Dr. Trent said.
In the main PEACH study analysis, there was no difference in outcomes among the 831 women, aged 14-38 years, randomized to inpatient treatment initially using intravenous cefoxitin and doxycycline, or outpatient treatment with a single intramuscular injection of cefoxitin and oral doxycycline (Obstet. Gynecol. 2005;106:573-80). Participants were primarily African American (74.5%) and low income, and had regular access to care (65%).
When the women were interviewed at 84 months, 61% of them reported they were using some form of contraception. A prior history of PID was present in only 37% of women and 25% of adolescents (19 years or younger). Nine percent of all women and 12% of adolescents reported a new sexual partner.
At 84 months, 21% of women reported recurrent PID, 19% were categorized as infertile, 43% reported chronic pelvic pain, 57% became pregnant, and 42% had a live birth, Dr. Trent said.
Among the 209 adolescents, 71% had a pregnancy, 51% had a live birth, 18% were characterized as infertile, and 39% had chronic pelvic pain.
In an adjusted subanalysis of the adolescents, there were no significant differences in rates of pregnancy, live birth, and infertility based on PID status, but those with recurrent episodes of PID were five times more likely to report chronic pelvic pain than were adolescents without recurrent PID (OR, 5.0), Dr. Trent said.
"For PID, we often talk to adolescent girls about the difficulty of getting pregnant in the future, but we don’t necessarily talk to them about the possibility of chronic pelvic pain, which this study highlights is a significant issue," she said.
Based on the findings, the authors also advocate targeting public health interventions to young women and adolescents with PID.
"Acute PID should prompt linkage of affected patients to tailored STI risk-reduction services to prevent the adverse outcomes associated with PID," Dr. Trent said.
Dr. Maria Trent and her associates said they had no relevant financial disclosures.