Microbial Correlates of Delayed Care for Pelvic Inflammatory Disease

Abstract

We studied the microbial correlates of time to care and long-term outcomes among pelvic inflammatory disease (PID) patients, as delayed care may increase the risk for reproductive sequelae. Mean days of pain before care were compared by microbial pathogen (Chlamydia trachomatis only, Neisseria gonorrhoeae only, Mycoplasma genitalium only, coinfection with 2 or more pathogens, or no pathogens) among 298 women with histologically confirmed endometritis from the PID Evaluation and Clinical Health study. Times to pregnancy and recurrent PID were assessed over a mean of 84 months and compared between women who delayed care (≥14 days) and women who sought early care, in the entire cohort and in subsets defined by microbial infection. Analyses were adjusted for age and race, additionally time to pregnancy was adjusted for self-reported baseline infertility. Patients waited a mean of 7 days before seeking care for symptoms. Time to care was longest among women infected by C. trachomatis only (12.3 ± 9.4 days) and M. genitalium only (10.9 ± 8.9 days) and the shortest among women infected by N. gonorrhoeae only (4.6 ± 5 days) or coinfection (5.6 ± 5.1 days, P < 0.001). Rates of infertility, recurrent PID, and chronic pelvic pain were frequent overall (17%, 20%, and 36%) and tended to be higher, albeit nonsignificantly, after delayed care. Among women with clinically suspected PID, time to care was generally high. C. trachomatis and M. genitalium positive women had the longest times to care. Although reproductive morbidity was high in this cohort, associations with delayed care were nonsignificant.