Hospitalization For Pelvic Inflammatory Disease Research Articles

Sexually Transmitted Infections Part 2: Discharge Syndromes and Pelvic Inflammatory Disease.

Sexually transmitted infections (STIs) disproportionately affect young people, with more than half of the infections occurring in youth aged 15 to 25 years. (1)(2) This review, the second in a 2-part series on STIs, focuses on infections that may cause abnormal vaginal or penile discharge, including trichomonas, chlamydia, gonorrhea, and pelvic inflammatory disease (PID). Most infected persons, however, are asymptomatic. Nucleic acid amplification tests are the most sensitive and specific for the detection of chlamydia, gonorrhea, and trichomoniasis, and they can be performed on provider- or patient-collected swabs. Providers should have a low threshold for diagnosing and treating PID because untreated PID can have serious long-term complications for young women. Indications for hospitalization for PID include the presence of a tubo-ovarian abscess, severe illness with systemic symptoms, pregnancy, human immunodeficiency virus infection, and failure to respond to outpatient oral treatment (within 48-72 hours) or inability to tolerate the oral treatment.

Incidence of pelvic inflammatory disease in a large cohort of women tested for Chlamydia trachomatis: a historical follow-up study

BackgroundChlamydia trachomatis is a highly prevalent sexually transmitted disease. Testing rates among young Norwegian women are high. Young women diagnosed with C. trachomatis are often worried about future complications.MethodsOur cohort consisted of 24,947 women born 1970–1984 who were tested for C. trachomatis infection during 1990–2005. We linked C. trachomatis laboratory data to data on hospitalizations for pelvic inflammatory disease during 1990–2005. Cox regression analysis with time-dependent covariates adjusted for age at first test was used to assess the association between C. trachomatis history and pelvic inflammatory disease.ResultsFollow-up until the end of 2005 included 201,387 woman-years. The incidence rate of hospitalization for pelvic inflammatory disease was higher among women with prior C. trachomatis infection than among women with negative tests only (48 events during 32,057 person-years and 143 events during 169,192 person-years, corresponding to 0.15 and 0.08 per 100 person-years, respectively). The corresponding hazard ratio adjusted for age at first test was 1.69 (95% CI, 1.21–2.36).ConclusionOur data show a link between a diagnosis of C. trachomatis infection and subsequent pelvic inflammatory disease. However, pelvic inflammatory disease was a rare event irrespective of C. trachomatis status. These, together with other recent findings, can be used to reassure women worried about their future reproductive health following a diagnosis of C. trachomatis.

Country of birth and hospitalization for pelvic inflammatory disease, ectopic pregnancy, endometriosis, and infertility: a nationwide study of 2 million women in Sweden

To examine the association between country of birth and hospitalization for pelvic inflammatory disease (PID), ectopic pregnancy (EP), endometriosis, and infertility. Follow-up study. Sweden. A total of 2,170,177 women living in Sweden at some point between 1990 and 2004, categorized into 10 different groups according to country of birth. None. Hospitalization for PID, EP, endometriosis, and infertility. For PID and infertility, all groups of foreign-born women exhibited significantly increased risks compared with Swedish-born women. The highest risks of PID were found among women from southern Europe, Eritrea/Ethiopia/Somalia, and other African countries, whereas the highest risks of infertility were found among women from Middle Eastern countries, other Asian countries, and other African countries. Compared with PID and infertility, country of birth was less associated with endometriosis and EP, although some differences were found. All relative risks were adjusted for age, time period, and the women's socioeconomic status. Even in a country like Sweden, which offers publicly financed treatment for infertility, differences based on country of birth exist. Although data on partners' income were not available to us, it is possible that other factors besides socioeconomic factors are present in the etiology of female health problems related to infertility.

Hospitalization for Pelvic Inflammatory Disease: A Cost-Effectiveness Analysis

Nulliparous women are frequently hospitalized for treatment of pelvic inflammatory disease (PID). The goal of this study was to determine the economic feasibility of hospitalizing adolescents and young women for PID. The authors conducted a Markov decision model, estimating the cost-effectiveness of hospitalization compared with outpatient therapy for mild to moderate PID for adolescents and young women, calculating costs per quality-adjusted life-year (QALY) gained under various assumptions about hospitalization effects on complications. If hospitalization decreases PID complications by 10%, 20%, or 30%, the cost/QALY gained is 145,000 dollars, 67,400 dollars, or 42,400 dollars, respectively, compared with outpatient therapy. Assumptions about hospitalization effects on the development of chronic pelvic pain heavily weight the analysis; costs/QALY gained by hospitalization increase considerably if chronic pain is unaffected. Hospitalization for PID treatment to possibly preserve fertility in nulliparous young women and adolescents is unlikely to be economically reasonable even if substantial improvements in PID complication rates are assumed.

Risk Factors for Ectopic Pregnancy in Women With Symptomatic First-Trimester Pregnancies

Approximately one in 50 pregnancies in the United States is ectopic, and the incidence of ectopic pregnancy (EP) reportedly has increased 6-fold over the past 25 years. Early diagnosis and appropriate outpatient care clearly limit morbidity and mortality from EP as well as helping to preserve future fertility. This study is the first to associate both historical variables and symptoms with the presence of EP in women who present in the first trimester with pain and/or bleeding but in whom the diagnosis is not readily apparent. A total of 2026 such women, seen at a single center in the years 1990 through 1999, were evaluated. EP was diagnosed in 367 patients, ongoing intrauterine pregnancy in 467, and spontaneous abortion (SAB) in 1192. Case patients were slightly older than controls in this largely black study cohort. A large number of possible confounding factors were adjusted for, including age, voluntary interruption of pregnancy in the past, the number of ectopic gestations, a history of pelvic inflammatory disease (PID), parity, moderate to severe bleeding at presentation, pain as the presenting symptom, and the initial level of human chorionic gonadotropin (hCG). A history of EP was positively associated with current EP as were an initial hCG level exceeding 500 mIU/mL, parity of one, past hospitalization for PID, and presentation with either pain or moderate to severe bleeding. Age less than 25 and a history of voluntarily interrupting pregnancy both were negatively associated with EP. Putative risk factors for EP that were not significant factors in the present study included gravidity, previous SAB, previous live births, the past use of an intrauterine device, previous pelvic surgery or cesarean section, and either a history of or current cervical infection with chlamydia and/or gonorrhea. If the risk factors for EP identified in this study do have high predictive value, they may aid the timely diagnosis of this condition, permit medical treatment, lower morbidity and mortality, preserve fertility, and lessen healthcare costs.

Hospitalizations for Pelvic Inflammatory Disease and Tuboovarian Abscess

To describe the demographic characteristics of and procedures for patients hospitalized for pelvic inflammatory disease (PID) and tuboovarian abscess in California from 1991 to 2001. We used the International Classification of Diseases, 9th Revision, Clinical Modification, diagnostic and procedural codes in the California Patient Discharge Database and census data to calculate hospitalization rates for PID and tuboovarian abscess by age and race/ethnicity. We estimated the proportion of PID and tuboovarian abscess hospitalizations associated with procedures and estimated average length of hospital stay, readmission rates, and mortality. From 1991 to 2001, the California hospitalization rate for PID decreased by 61.5% (from 2.6 to 1.0 per 10,000 women). Tuboovarian abscess hospitalization rates declined by 33.3% during the same time period (from 0.6 to 0.4). Pelvic inflammatory disease hospitalization rates were highest among 20-39 year olds compared with other age categories. Black women aged 20-39 had the highest PID hospitalization rates compared with other racial/ethnic groups. The proportion of hospitalizations associated with hysterectomy was lowest for blacks. In California, the hospitalization rate for PID has declined between 1991 and 2001. Black women, 20-39 years of age, had the highest PID hospitalization rates. III.

Current perspectives on oral contraceptive use

Oral contraceptives are one of the most highly effective forms of contraception and provide many short- and long-term noncontraceptive health benefits. They control menstrual cycle irregularities, such as breakthrough bleeding and amenorrhea, and are effective in treating dysfunctional uterine bleeding. In addition, for decades after oral contraceptive use is discontinued they are associated with substantial decreases in the risk of ovarian cancer (up to 80%) and of endometrial cancer (40%-50%), and nearly eliminate benign functional ovarian cysts. Long-term oral contraceptive use confers protection against benign breast disease and colorectal cancer, may help prevent rheumatoid arthritis, decreases ectopic pregnancy and hospitalizations for pelvic inflammatory disease, and helps preserve bone mineral density to reduce risk of fractures. Large bodies of evidence from extensive research have clarified the perceived association of oral contraceptive use with cardiovascular disease and with breast cancer. Findings indicate that there is no increased risk of myocardial infarction or stroke associated with oral contraceptive use in healthy, nonsmoking, normotensive women. Although there is a 3- to 4-fold increased risk of venous thromboembolism with current oral contraceptive use, the absolute risk is very small and is half that associated with pregnancy. Women of all reproductive ages, including perimenopausal women, can realize many health benefits through oral contraceptive use, including improved health status later in life. (Am J Obstet Gynecol 2001;185:S4-12.)

Epidemiology and Clinical Outcome of Patients Hospitalized With Pelvic Inflammatory Disease Complicated by Tubo-Ovarian Abscess

Objective: The purpose of this retrospective study was to compare the clinical outcome and characteristics of pelvic inflammatory disease (PID) complicated by tubo-ovarian abscess (TOA) with PID without TOA. Methods: Chart reviews were performed for all PID admissions to the University of Medicine and Dentistry of New Jersey-University Hospital, Newark, NJ, from January 1, 1992, to December 31, 1993. Results: The incidence in this study of TOA based on sonographic evidence of a complex adnexal mass was 18%. The major differences between the patients with and without TOAs were 1) history of hospitalization for PID: 68% (13/19) vs. 29% (25/85); 2) increased erythrocyte sedimentation rate: 82 vs. 41 mm/h; 3) increased WBC count on admission: 16,200 vs. 14,700/ml; 4) failure to respond to initial antibiotic therapy; and 5) longer hospital stay: 7.8 vs. 4.4 days, respectively. Surgical intervention was required in 3 patients: 2 patients who had TOAs and 1 patient who did not have a TOA by clinical examination or by ultrasound. Conclusions: Despite longer hospital stays and blood tests suggesting more severe disease processes, PID complicated by TOA is usually responsive to intravenous (IV) antibiotic therapy without the need for surgical intervention.

Total Cost of PID in 1990 Is Estimated at $4.2 Billion; Private Insurance Paid Largest Share of Expenditures

The total cost of pelvic inflammatory disease (PID) in the US including costs of hospital and outpatient treatment of treatment of ectopic pregnancy and infertility and including lost productivity is estimated at $4.2 billion for 1990. The methods and data used in the estimation are described: hospital costs were based on California sources. Hospital Discharge Survey data National Disease Therapeutic Index data and National Health Survey of Physician Visits data were accessed to estimate numbers of women treated in hospitals clinics and emergency departments. There were 200000 women hospitalized for PID in 1987-88 and 44000 ectopic pregnancies 1/2 caused by PID. The total cost of treating PID in 1990 is estimated at $2.7 billion 77% for inpatient and outpatient care 14% for ectopic pregnancy and 9% for infertility. Hospital and physician charges amounted to over 80% of this amount. Other indirect cost were estimated at $1.5 billion for lost wages and lost value of household management and 14% for premature death. The average cost of hospitalization for PID was $7200; the cost of outpatient treatment was about $200. Evaluation of infertility cost an estimated $3700. The proportion of women treated on an outpatient basis and the proportion of costs covered by public hospitals as opposed to private insurance have both increased in recent years.

Pelvic inflammatory disease: Trends in hospitalizations and office visits, 1979 through 1988

We attempted to assess trends in pelvic inflammatory disease occurrence and to describe current antibiotic treatment and use of surgical procedures for pelvic inflammatory disease in the United States. Analyses of hospitalizations according to the National Center for Health Statistics, National Hospital Discharge Survey for 1979 to 1988, and of office visits to private physicians from the National Disease and Therapeutic Index for 1979 to 1989 were done. From 1979 to 1988, a mean of 181,700 women aged 15 to 44 years were hospitalized each year for acute pelvic inflammatory disease (3.03/1000 women) and 94,400 for chronic pelvic inflammatory disease (0.90/1000), and nearly 400,000 first visits for pelvic inflammatory disease were made each year to private physicians' offices (7.2/1000 women). Mean visit and hospitalization rates for acute pelvic inflammatory disease were highest for women aged 20 to 24 years and for other-than-white women. By 1987 to 1988, however, pelvic inflammatory disease hospitalization rates were highest for teenagers. Surgery was performed during 42% of hospitalizations for acute pelvic inflammatory disease and 90% of hospitalizations for chronic pelvic inflammatory disease. Over this time period, hospitalization rates for acute pelvic inflammatory disease decreased by 36% while office visit rates remained unchanged. This decrease in hospitalizations for pelvic inflammatory disease may indicate a true decrease in its incidence, changes in physician hospitalization practices, or a shift in the spectrum of severity of pelvic inflammatory disease.

Hospitalizations for pelvic inflammatory disease. Epidemiology and trends in the United States, 1975 to 1981.

To assess trends in hospitalizations for pelvic inflammatory disease (PID) in the United States for 1975 through 1981, we analyzed data from the Hospital Discharge Survey conducted by the National Center for Health Statistics. Overall, both the estimated number and rate of hospitalizations for PID among women aged 15 to 44 years rose slightly. For the seven-year period, an estimated average of 267,200 women were hospitalized annually for PID, with hospitalization rates averaging 5.3 per 1,000 women. Risk of hospitalization for PID was greatest among women in their 20s. Divorced or separated women were considerably more likely to have been hospitalized than single or married women. Although nonwhite women had estimated average rate 2.5 times higher than for white women, the trend of hospitalizations for PID among nonwhite women appeared relatively stable while the trend among young white women showed measurable increases.

Hospitalizations for Pelvic Inflammatory Disease

To assess trends in hospitalizations for pelvic inflammatory disease (PID) in the United States for 1975 through 1981, we analyzed data from the Hospital Discharge Survey conducted by the National Center for Health Statistics. Overall, both the estimated number and rate of hospitalizations for PID among women aged 15 to 44 years rose slightly. For the seven-year period, an estimated average of 267,200 women were hospitalized annually for PID, with hospitalization rates averaging 5.3 per 1,000 women. Risk of hospitalization for PID was greatest among women in their 20s. Divorced or separated women were considerably more likely to have been hospitalized than single or married women. Although nonwhite women had estimated average rate 2.5 times higher than for white women, the trend of hospitalizations for PID among nonwhite women appeared relatively stable while the trend among young white women showed measurable increases.

Risk of PID 5x Greater from Dalkon Shield Than from Other IUDs

2 recent studies provide evidence that use of the Dalkon Shield creates a considerably greater risk of pelvic inflammatory disease (PID) than does use of other types of IUD. Data from the Women's Health Study reveal that women who use the Dalkon are 5 times more likely than those who use other IUDs to be hospitalized for PID, while a Boston-based study, reported in the Journal of the American Medical Association, reports a 4-6 times higher risk. It is advised that women still using the Dalkon Shield have it removed. Table 1 provides risk estimates of hospitalization for PID by type of contraceptive used. The Women's Health study included 622 women aged 18-44 admitted to hospitals with an initial episode of PID. The data for the Boston study was obtained from interviews with 155 women, all of whom were premenopausal, under 45, and not pregnant. When analyzed by type of IUD, the data strongly confirm the findings of the other study.

Barrier-method contraceptives and pelvic inflammatory disease

The protective effect of barrier-method contraception against pelvic inflammatory disease (PID) was examined by analyzing data from the Women's Health Study, a large multicenter case-control study. We compared the contraceptive methods used by 645 women hospitalized for initial episodes of PID with the contraceptive methods used by 2,509 control subjects reporting no history of PID. The risk of hospitalization for PID in women currently using barrier methods relative to women using all other methods and to women using no method of contraception was 0.6 (95% confidence limits, 0.5 to 0.9) for both comparisons. This protective effect was observed for both chemical and mechanical barrier methods, although it was not statistically significant for the former. The prevention of PID and its sequelae is one of the most important noncontraceptive benefits of barrier methods of contraception. (<i>JAMA</i>1982;248:184-187)

Barrier-Method Contraceptives and Pelvic Inflammatory Disease

The protective effect of barrier-method contraception against pelvic inflammatory disease (PID) was examined by analyzing data from the Women's Health Study, a large multicenter case-control study. We compared the contraceptive methods used by 645 women hospitalized for initial episodes of PID with the contraceptive methods used by 2,509 control subjects reporting no history of PID. The risk of hospitalization for PID in women currently using barrier methods relative to women using all other methods and to women using no method of contraception was 0.6 (95% confidence limits, 0.5 to 0.9) for both comparisons. This protective effect was observed for both chemical and mechanical barrier methods, although it was not statistically significant for the former. The prevention of PID and its sequelae is one of the most important noncontraceptive benefits of barrier methods of contraception.

The relationship of genital tract actinomycetes and the development of pelvic inflammatory disease

As a corollary to a case-control study evaluating the risk of pelvic inflammatory disease (PID) among users of an intrauterine countraceptive device (IUD), Papanicolaou smears were studied to detect the presence of actinomycetes. Forty-six PID case patients and 108 control patients were included in the corollary study. The presence of actinomycetes was noted only among current or past wearers of an IUD. Women with actinomycetes present on Papanicolaou smear had a 3.6-fold risk of hospitalization for PID, as compared to women without actinomycetes. This trend persisted when only IUD users were evaluated. Of patients with PID who had actinomycetes noted on the Papanicolaou smear, 87½% had a tuboovarian abscess, compared to 28.9% of patients without actinomycetes. In addition, patients with actinomycetes present had PID treated surgically more frequently.

Pelvic inflammatory disease in the United States. Epidemiology and trends among hospitalized women.

The Hospital Discharge Survey, conducted by the National Center for Health Statistics (Rockville, Md.), provides national estimates for conditions causing hospitalization in short-stay hospitals in the United States. The venereal Disease Control Division of the Centers for Disease Control (Atlanta, Ga.) obtained survey data for 1970-1975 and analyzed the epidemiology of pelvic inflammatory disease (PID) in women hospitalized for this disease. An average of greater than 211,000 female patients older than 10 years of age were hospitalized annually for PID. Acute salpingitis occurred predominantly in women younger than 30 years of age. Women of all races other than white had a PID rate 3.3 times greater than that of white women. Data obtained from the Commission on Professional and Hospital Activities were used for determination of the trend in hospitalizations for PID. In all races other than white, the trend appears stable; however the trend among white women is increasing.