Hospitalisations for pelvic inflammatory disease temporally related to a diagnosis of Chlamydia or gonorrhoea: a retrospective cohort study.

Joanne Reekie,Louisa Jorm,David Preen,Donna B Mak,Sallie Pearson,John M Kaldor,Basil Donovan,Christine L Roberts,Handan Wand,James Ward,Rebecca Guy,Jane S Hocking,Louise Stewart,Bette Liu,Adam J Ratner

doi:10.1371/journal.pone.0094361

Abstract

ObjectivesThe presence and severity of pelvic inflammatory disease (PID) symptoms are thought to vary by microbiological etiology but there is limited empirical evidence. We sought to estimate and compare the rates of hospitalisation for PID temporally related to diagnoses of gonorrhoea and chlamydia.MethodsAll women, aged 15–45 years in the Australian state of New South Wales (NSW), with a diagnosis of chlamydia or gonorrhoea between 01/07/2000 and 31/12/2008 were followed by record linkage for up to one year after their chlamydia or gonorrhoea diagnosis for hospitalisations for PID. Standardised incidence ratios compared the incidence of PID hospitalisations to the age-equivalent NSW population.ResultsA total of 38,193 women had a chlamydia diagnosis, of which 483 were hospitalised for PID; incidence rate (IR) 13.9 per 1000 person-years of follow-up (PYFU) (95%CI 12.6–15.1). In contrast, 1015 had a gonorrhoea diagnosis, of which 45 were hospitalised for PID (IR 50.8 per 1000 PYFU, 95%CI 36.0–65.6). The annual incidence of PID hospitalisation temporally related to a chlamydia or gonorrhoea diagnosis was 27.0 (95%CI 24.4–29.8) and 96.6 (95%CI 64.7–138.8) times greater, respectively, than the age-equivalent NSW female population. Younger age, socio-economic disadvantage, having a diagnosis prior to 2005 and having a prior birth were also associated with being hospitalised for PID.ConclusionsChlamydia and gonorrhoea are both associated with large increases in the risk of PID hospitalisation. Our data suggest the risk of PID hospitalisation is much higher for gonorrhoea than chlamydia; however, further research is needed to confirm this finding.

Highlights

Pelvic inflammatory disease (PID) is a common condition in women of reproductive age and can lead to infertility, ectopic pregnancy, recurrent PID, and chronic pelvic pain[1,2,3]
PID can be caused by multiple microorganisms, in young women PID commonly results from the ascent of sexually transmitted Chlamydia trachomatis or Neisseria gonorrhoea infections from the cervix to the upper genital tract[4,5,6]
As the presence and severity of PID symptoms are thought to vary depending on the causative organism, but there is little published empirical evidence[11], this study aimed to estimate and compare the incidence of PID hospitalisation temporally related to diagnoses of chlamydia and gonorrhoea in a population-based sample of women of reproductive age in the state of New South Wales (NSW), Australia

Summary

Introduction

Pelvic inflammatory disease (PID) is a common condition in women of reproductive age and can lead to infertility, ectopic pregnancy, recurrent PID, and chronic pelvic pain[1,2,3]. Chlamydia is the most frequently reported notifiable sexually transmitted infection (STI), in Australia and a number of other countries, with rates of diagnoses increasing consistently over the past decade[7,8,9]. Over this same period the rates of gonorrhoea diagnoses have been more variable[7,8,9]. As the presence and severity of PID symptoms are thought to vary depending on the causative organism, but there is little published empirical evidence[11], this study aimed to estimate and compare the incidence of PID hospitalisation temporally related to diagnoses of chlamydia and gonorrhoea in a population-based sample of women of reproductive age in the state of New South Wales (NSW), Australia

Objectives

Methods

Results

Conclusion