Acute pelvic inflammatory disease (PID) : Aspects of diagnosis, aetiology and sequelae epidemiology and prevention

Abstract: This long-period (1970-1997) longitudinal clinical and epidemiologic study elucidated risk factors, diagnosis and causative agents of acute pelvic inflammatory disease (PID), more importantly Neisseria gonorrhoeae (Ng) and Chlamydia trachomatis (Ct), and analysed the occurrence of late sequelae, particularly ectopic pregnancy (EP), and prevention.Totally 2574 patients (age 14-55 years) were hospitalised and treated for PID. The mean incidence rate increased from 2.68/1000 in the first 5-year period 1970-1974, to 3.23/1000 in 1974-1979 with the highest rate of 8.5/1000 in women 20-24 years of age, then steadily decreased to 0.5/1000, for all age groups in 1995-1997.Intrauterine contraceptive device use was a significant risk factor for young nulliparous women. Gonococcal PID was common at the beginning of the study with a relative ratio of 44.6%, then, steadily decreased to zero since 1988. Relative ratio of chlamydial PID peaked in 1985, then declined to 8% in 1995, and zero the last two years. The decline of gonococcal and chlamydial PID reflected the decline of these infections in the community both locally and nationally.About 60% of male sexual partners to PID women were found to have Ng and/or Ct infection or nonspecific urethritis. All male partners of women with PID are therefore examined, treated, and counselled since 1984.PID is the strongest predictor for EP, and the mean incidence rate of this late sequelae increased from 7.8 per 1000 pregnancies the first 5-year period 1970-1974 to the peak of 16.5 in 1985-1989. EP incidences for women <-24 years paralleled PID incidences with a peak of 10.0 in 1975-1979, and then decreased to 4.0 per 1000 pregnancies in 1995-1997, an almost 60% reduction. Women >-25, particularly those >30 had highest incidence rates. EP reduction for these age groups started a decade later which was interpreted as a cohort effect. Treatment of male partners to women with PID was a plausible preventive measure of EP.This study has shown that primary, secondary and tertiary prevention strategies are all important to reduce pelvic inflammatory disease and its sequelae, particularly the most serious one, ectopic pregnancy.