Incidence Of Pelvic Inflammatory Disease Research Articles

Fertility after contraception or abortion

There is a very small correlation, if any, between the prior use of OCs and congenital malformations, including Down's syndrome. There are few, if any, recent reports on masculinization of a female fetus born to a mother who took an OC containing 1 mg of a progestogen during early pregnancy. However, patients suspected of being pregnant and who are desirous of continuing that pregnancy should not continue to take OCs, nor should progestogen withdrawal pregnancy tests be used. Concern still exists regarding the occurrence of congenital abnormalities in babies born to such women. The incidence of postoperative infection after first trimester therapeutic abortion in this country is low. However, increasing numbers of women are undergoing repeated pregnancy terminations, and their risk for subsequent pelvic infections may be multiplied with each succeeding abortion. The incidence of prematurity due to cervical incompetence or surgical infertility after first trimester pregnancy terminations is not increased significantly. Asherman's syndrome may occur after septic therapeutic abortion. The pregnancy rate after treatment of this syndrome is low. The return of menses and the achievement of a pregnancy may be slightly delayed after OCs are discontinued, but the fertility rate is within the normal range by 1 year. The incidence of postpill amenorrhea of greater than 6 months' duration is probably less than 1%. The occurrence of the syndrome does not seem to be related to length of use or type of pill. Patients with prior normal menses as well as those with menstrual abnormalities before use of OCs may develop this syndrome. Patients with normal estrogen and gonadotropin levels usually respond with return of menses and ovulation when treated with clomiphene. The rate for achievement of pregnancy is much lower than that for patients with spontaneous return of menses. The criteria for defining PID or for categorizing its severity are diverse. The incidence of PID is higher among IUD users than among patients taking OCs or using a barrier method. The excess risk of PID among IUD users, with the exception of the first few months after insertion, is related to sexually transmitted diseases and not the IUD. Women with no risk factors for sexually transmitted diseases have little increased risk of PID or infertility associated with IUD use. There appears to be no increased risk of congenital anomalies, altered sex ratio, or early pregnancy loss among spermicide users. All present methods of contraception entail some risk to the patient. The risk of imparied future fertility with the use of any method appears to be low.(ABSTRACT TRUNCATED AT 400 WORDS)

The IUCD-associated incidence of Actinomyces israelii in the female genital tract.

Cervical swabs and in many cases also intrauterine contraceptive devices were examined from 973 women for the presence of Actinomyces israelii. It was detected in 11.6% of these women, the majority of whom were asymptomatic. The detection, however, of A. israelii in the female genital tract was associated with an almost 4-fold increase in the incidence of pelvic inflammatory disease (PID), indicating that colonization may progress to an infection in a small number of women. The incidence of A. israelii in the female genital tract of IUCD wearers was more than doubled when the IUCD was worn for longer than 4 years. The type of IUCD worn did not appear to be an important risk factor. Immunofluorescent staining of cervical smears identified 64% of cases. Specific culturing for A. israelii or cytological screening of Papanicolaou smears in addition were required to increase the isolation rate to nearly 90%.

Histopathologic findings in ectopic tubal pregnancy.

In 141 consecutive cases of tubal ectopic pregnancy at Hermann Hospital in Houston, Texas, the histologic appearance of 129 surgically removed fallopian tubes containing ectopic pregnancies was reviewed and compared with an age- and race-matched control population. There was a higher incidence of chronic salpingitis (88 versus 2%) and salpingitis isthmica nodosa (SIN) (43 versus 5%). The ectopic pregnancy patients had a higher incidence of pelvic inflammatory disease, gonorrhea, previous abortions, bitubal ligation, intrauterine device use, and previous abdominal surgery. In our population, chronic salpingitis was the most commonly associated finding. The increase in SIN was associated with postinflammatory changes (89%). We also found that ectopic tubal pregnancies may grow either intratubally or extratubally by villous invasion into the wall and blood vessels; therefore, surgical salvage of the fallopian tube by extracting the products of conception will not always be curative.

Oral contraceptives: a reassessment.

Cardiovascular risks attributable to oral contraceptive use may now be subdivided into those that appear to be secondary to the estrogen component, i.e., venous thrombosis, pulmonary embolism, and those linked to the progestin component, i.e., small vessel disease including myocardial infarction and cerebrovascular accident. It appears that venous risk is attributable to subtle changes in clotting factors, while arterial risk may be secondary to changes in glucose and lipid metabolism. In order to determine which women are at greatest risk from oral contraceptive use, Spellacy et al. has developed a risk scoring form that aids in the screening process. After excluding women with an absolute contraindication to pill use, women at greatest risk for cardiovascular disease related to oral contraceptive use are those with a family history of hyperlipidemia, gestational or overt diabetics, hypertensives, and smokers over the age of 35. The gradual reduction by manufacturers of the steroid content of oral contraceptives appears to have lessened the incidence of adverse effects. Our current knowledge of risk factors permits the clinician to reduce exposure to oral contraceptive-related mortality by as much as 86 per cent. As we continue to search for ways to reduce risk among oral contraceptive users, it is important to note that more than 25 per cent of women are still taking formulations containing 50 micrograms of estrogen. It becomes the responsibility of the practicing physician to "step-down" these patients to lower-dose preparations such as the multiphasics. Such preparations also represent optimal therapy for first-time pill users.

Comparison of copper T-200 with Lippes loop as a contraceptive device

A comparison has been made between Lippes loop and T Cu 200 intra-uterine contraceptive device with respect to their acceptability and effectiveness in a developing country. A total of 1054 patients were studied; 697 with Lippes loop and 357 with T Cu 200. The ages of the patients ranged between 14 and 44 years, with a peak age of 21–25 years for T Cu 200 and 26–30 for Lippes loop. The event rates were similar but T Cu 200 displayed lower expulsion rate, lower intermenstrual bleeding rate and a lower incidence of pelvic inflammatory disease. The Lippes loop had lower event rate for the other parameters considered, pregnancy and pelvic pain. The continuation rate was similar for both devices. Both devices are useful for women who wish to space out their children but for those who wish to achieve effective contraception for more than 5 years, Lippes loop should be the IUD of choice.

Pelvic inflammatory disease and the intrauterine contraceptive device

The relationship between the use of intrauterine contraceptive device (IUD) and pelvic inflammatory disease (PID) was examined in 1054 patients who were seen at the Family Planning Clinic of Jos University Teaching Hospital and were followed up. The overall risk of PID developing in women wearing the IUD was minimal: 62 out of 1054 (5.9%). The rates, however, varied for the 6-month periods studied. The incidence of PID decreased as the period of usage increased. The greater number of patients developed PID less than 3 months from the date of IUD insertion. When PID occurred it was usually of mild or moderate intensity and the response to antibiotic therapy was very encouraging. There was no relationship between the parity of the patients and the development of PID. Even though there is a definite link between the use of IUD and the development of PID it does not obliterate the benefits which the use of IUD provide for the majority of its patrons; and so the use of IUD should continue.

Mobiluncus and clue cells as predictors of PID after first-trimester abortion.

Women attending our Department for a first-trimester abortion were examined for the presence of Mobiluncus species. C. trachomatis or clue cells in vaginal discharge in an attempt to identify risk groups for development of pelvic inflammatory disease (PID) after first-trimester abortion. A correlation was found between the presence of Mobiluncus and clue cells in vaginal discharge and the incidence of PID after first-trimester abortions. These women were also older than those in whom C. trachomatis was identified. Our study indicates that screening for C. trachomatis and clue cells in vaginal discharge will identify two different risk groups for developing PID after first-trimester abortion.

The effects of contraceptive hormone of Chlamydia trachomatis in human endometrial cells

Several recent reports have documented a lower incidence of pelvic inflammatory disease (PID) among oral contraceptive users. The interpretation of this observation is difficult because the action of the contraceptive hormones may be directly by action on a specific host cellparasite relationship, or indirectly via their action on other systems. In the present study we investigated the susceptibility of cultured human epithelial cells of the endometrium to infection by chlamydia and the influence of contraceptive steroids (ethinyl estradiol, mestranol and medroxyprogesterone acetate) upon replication of chlamydia in these cells. Forty-eight hours post-infection, elementary and reticulate bodies were observed in vacuoles of the infected endometrial cells by electron microscopy. Treatment of chlamydial-infected cells with contraceptive steroids in three different concentrations (10 −5M, 10 −6M and 10 −7M) resulted in no effect on chlamydial replication, as examined by one-step growth curve. These results indicate that contraceptive hormones do not prevent chlamydial infection by direct effect on the replication of the agent.

Epidemiology of ectopic pregnancy.

The epidemiology of ectopic pregnancy, both the numbers and rates of which have tripled in the U.S. from 1970 to 1983, is analyzed here. Ectopic pregnancy includes all implantations other than in the anatomically normal uterine cavity. Improved ascertainment and earlier diagnosis, due to ultrasound and beta-hCG assays, have probably raised reported numbers of cases. On the other hand, there has been a parallel climb in incidence of pelvic inflammatory disease, thought to be associated with ectopic pregnancy. Rates were higher among women over 35, black, or previously married, although similar in various regions of the country. Mortality from ectopic pregnancy has become the most common cause of maternal death, replacing mortality resulting from illegal abortion. Despite this, death from ectopic pregnancy fell 7-fold, to 0.5 per 1000 ectopic pregnancies, or 40-50 per year nationally in 1983. Ectopic pregnancy was 3 times as risky for blacks as whites, 10 times as dangerous as childbirth, and 50 times as deadly as legal abortion. Some factors acting in the fatalities included delay of treatment (53%) and misdiagnosis (almost half).

The Economic Cost of Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is one of the most widespread and debilitating diseases affecting women today. To calculate the economic costs of PID and PID-associated ectopic pregnancy and infertility in the United States, we analyzed data from local hospitals and from several state and national sources. Direct and indirect costs were computed. We found that the total cost of PID and PID-associated ectopic pregnancy and infertility exceeded +2.6 billion in 1984. By 1990, the estimated cost of PID and its sequelae will total +3.50 billion per year, if the annual medical care inflation is 5% and the incidence of PID remains constant during this six-year period. These estimated costs of PID and its associated sequelae emphasize the urgent need for effective programs to prevent PID.

Pelvic Inflammatory Disease

A dramatic increase in the incidence of pelvic inflammatory disease in recent years has led to a parallel increase in consequent infertility. The economic and psychologic costs of infection and infertility are severe and preventable. The author reviews and outlines current diagnostic and therapeutic recommendations that are now being used to prevent infectious morbidity. A brief review of the indications, techniques, and prospects for surgical correction of tubal disease and pelvic adhesions is also presented.

Current views on the concept of pelvic inflammatory disease.

This article reviews the current literature on the etiology clinical manifestations sequelae and management of pelvic inflammatory disease (PID). PID is now regarded as a complex clinical syndrome with a polymicrobial etiology. Both exogenous (largely sexually transmissible) and endogenous microorganisms have been identified in PID. 60-80% of PID cases in women under 25 years of age involve neisseria gonorrhoeae chlamydia trachomatis or Mycoplasma hominis. PID cases caused by endogenous agents such as aerobic and anaerobic streptococci are clinically more severe than cases associated with sexually transmitted diseases. The microbial etiology of the tubal infection cannot be determined in 20% of cases suggesting 1 or more as yet unidentified microorganism. 75% of PID cases involve women under 24 years of age 75% of whom are nulliparous. The annual incidence of PID among women 15-24 years of age in the US and Europe is 20/1000 women. The classical signs of PID (e.g. elevated erythrocyte sedimentation rate febrile illness palpable adnexal swelling) are present in less than 20% of cases. Use of laparoscopy verifies the diagnosis of PID and enables specimen collection for microbiological examinations. The most common diagnostic problem is differentiation between acute salpingitis and lower genital tract infection. Prospective studies after PID have indicated that 20% of women have repeat infections. The infertility ate increases significantly with the number of tubal infections. Overall it is estimated that 25% of women with PID will experience chronic abdominal pain ectopic pregnancy and/or infertility. Conservative treatment with rest and antibiotics is recommended in acute PID episodes. Surgery is indicated in life-threatening disease abscesses and cases that fail to respond to conservative treatment. Since 75% of PID cases are associated with sexually transmitted diseases control of these infections is central to PID prevention.

Intrauterine contraceptive devices

Uterine perforation is the most serious complication of IUD insertion; the risk is less than 1/1000 insertions for currently available IUDs. Most perforations occur at the time of insertion and the risk is increased in the 4-8 weeks postpartum. It is important to choose an IUD appropriate to the size of the endometrial cavity and to clean the area with an antiseptic solution. When the string is found to be missing, pregnancy must be excluded, and the endometrial cavity explored. Ultrasonography can often determine if the IUD is in the uterus; most IUDs that perforate the uterus are often found in the pelvis. Alterations in vital signs that occur at the time of insertion have been documented in 35-60% of patients; these generally require no therapy. If there are severe vasovagal reactions, treatment with intravenous atropine sulfate 0.4 mg, may be required. Bleeding is the most common reason for IUD removal, but its cause is not extremely clear. Blood loss is greatest with the large inert devices, less with small copper-containing devices, and least with a progesterone-containing IUD. The addition of supplementary iron to the diet and periodic hemoglobin determinations are recommended for IUD users. The risk of pelvic inflammatory disease (PID) is increased in IUD users, ranging from 1.6-10.5 compared with other forms of contraception. Risk is greatest during the 1st few months after insertion but continues to be higher than normal as long as the IUD is used. Studies have shown that women using hormonal or barrier contraceptives have a decreased incidence of PID. For mild infection, tetracycline 500 mg orally 4 times daily suffices; in more severe cases a regimen consisting of an animoglycoside plus penicillin is adequate. The pregnancy rate in IUD users varies between 1.6-5.3/100 women/year. Pregnancy in an IUD-wearer must be considered ectopic until proven otherwise, although the rate of ectopic pregnancy in this group is extremely low. The IUD's protective effect seems to extend to the fallopian tube and is greatest in the 1st and 2nd years of use. Once pregnancy is determined the IUD should be removed; studies have shown that the spontaneous abortion rate with the IUD left in situ is about 50% versus 20-30% with removal or subsequent spontaneous expulsion. Some contraindications to IUD use include acute PID, allergy to heavy metals, bleeding diathesis, cervical stenosis, and uterine myoma.

Incidence of pelvic inflammatory disease in clinical trials with cu-7 (intrauterine copper contraceptive): A statistical analysis

Pelvic inflammatory disease (PID) was recorded for 365 of 10,760 women using the Cu-7 for up to 48 months during clinical investigations in the United States. This involved a total exposure of 242,169 woman-months, or some 20,000 woman-years. The overall incidence of PID was 18 cases/1000 woman-years. Incidence was inversely related to age and to duration of use. It was statistically significantly greater in parous subjects than in nulliparous, after stratifying for age. The estimated rates in this study do not differ markedly from those in most other prospective investigations.

3 ESTIMATED RISKS OF SEXUALLY TRANSMITTED DISEASES AMONG ADOLESCENT FEMALES

Sexual activity of adolescent females increased greatly from 1971 through 1979, and reported gonorrhea rates rose more in 15-19 yr. old females than in any other age-sex group. Using data on reported incidence of syphilis, estimated incidence of hospitalized pelvic inflammatory disease (PID) in 1976 (National Hospital Discharge Survey), age and sex composition of the U.S. population and the estimated proportion of U.S. adolescent females sexually experienced (SE) (Zelnick et al), we estimated the annual incidence of syphilis and PID per 100,000 among all and among sexually experienced females: For SE females in 1976, the risk of hospitalized PID decreased by 22% per year between ages 15 and 19 yr. (r=.80). In King County, WA, 40% of 455 reported cases of gonococcal PID in 1979-80 were in adolescents. In pregnant women in Seattle, Chlamydia trachomatis infection was found in 14% of 182 ≤19 yr. old and 4% of 697 ≥20 yr. old. Thus, adolescents seem to be at much greater risk of certain sexually transmitted diseases than are older women.

Pelvic inflammatory disease and the intrauterine device: findings in a large cohort study.

The incidence of pelvic inflammatory disease was investigated among parous women taking part in the Oxford-Family Planning Association contraceptive study. Hospital admission rates for "acute definite" disease were 1.51 per 1000 woman-years among those currently using an intrauterine device (IUD) and 0.14 per 1000 woman-years among those using other methods of birth control (age-standardised relative risk 10.5 to 1 with 95% confidence limits of 5.4 to 1 and 32 to 1). There was little evidence of an increased risk of such disease in ex-users of an IUD. Hospital admission for "chronic definite" disease, on the other hand, was commoner in ex-users of an IUD than in current users. Acute definite disease occurred somewhat more frequently during the early months of use of an IUD than during the later months. While the rate of such disease was increased in users of each type of device, the highest rate (8.1 per 1000 woman-years) was observed in users of the Dalkon shield. This rate, however, was based on only three affected women.

An overview of infectious agents of salpingitis, their biology, and recent advances in methods of detection

It was only in the decade of the 1970s that more extensive research into the etiology of acute salpingitis (pelvic inflammatory disease) was performed. Recently the development of new laboratory diagnostic methods and the detection and taxonomic differentiation of new organisms such as strictly anerobic bacteria chlamydiae and microplasms have contributed to an understanding of the etiology of acute salpingitis (AS). In this discussion AS and pelvic inflammatory disease (PID) are used synonymously. In reviewing infectious agents of salpingitis their biology and recent advances in methods of detection attention is directed to the following: 1) nontuberculous salpingitis (Neisseria gonorrhea anerobic infections mycoplasma hominis and Ureaplasma urealyticum Chlamydia trachomatis Chlamydial perihepatitis in acute salpingitis and miscellaneous and uncommon etiologic agents); 2) tuberculous salpingitis; 3) obtaining specimens in AS (lower genital tract uterine cavity and cul-de-sac and fallopian tubes); and 4) recent advances in laboratory diagnostic methods (tests for tubal isoamylases Neisseria gonorrhea anerobic bacteria mycoplasma hominis and Ureaplasma urealyticum Chlamydia trachomatis and mycobacteria. A common condition AS is on the increase in many countries as exemplified by studies from Lund Sweden. This increase in the incidence of PID appears to be associated with the pandemic situation of gonorrhea and other sexually transmitted diseases that has prevailed over the last 20 years. Most cases of AS are the result of an infection ascending from the cervix and in a large percentage of all women who develop AS the cervix is colonized by organisms known to be spread by sexual intercourse.

IUD Users May Have Higher Risk of Contracting PID, Studies Find; Pill May Have Protective Effect

The incidence of pelvic inflammatory disease (PID), which can lead to serious reproductive impairment, infertility, or ectopic pregnancy, is increasing worldwide. About 500,000 women in their childbearing years contract PID for the first time each year in the U.S., and the incidence among young women appears to be increasing. Sexually transmitted diseases are responsible for many PID cases worldwide, while in developing countries postpartum and postabortion sepsis and endemic diseases such as filariasis and schistosomiasis may also be implicated. Some increase of PID is associated with legal abortion and IUD insertion, while pill use appears to protect women from PID. A worldwide review of medical literature indicates that the risk of PID is 3.5 times greater for IUD users than for nonusers, although several variables other than IUD use affect PID risk, such as age, race, socioeconomic status, and sexual activity. The risk for never pregnant IUD users in a Swedish study was 11.8 per 100 woman years, compared to 3.4 for ever-pregnant IUD users. There was no difference in relative risk for users of the pill or barrier methods, or for non-contraceptors. Another study reported a higher relative risk of PID related to duration of IUD use.

Pelvic inflammatory disease and the intrauterine device: a causal relationship?

IUD use in the U.S. has been declining in the past 5 years partly because of the adverse publicity given to the increased risk of pelvic inflammatory disease (PID) of IUD users. In 1977, the U.S. Food and Drug Administration recommended, on the basis of results from epidemiologic studies, that IUD labeling include the statement that "IUD use is associated with a 3-5 fold increase in infection rate." A review of the major results and some of the features of epidemiologic studies in which the contraceptive practices of PID cases were compared with controls (those without PID) showed that there is indeed an increased risk of PID among IUD users. The studies, except that of Vessey et al. however, do not provide any estimate of the magnitude of increased risk of PID to the IUD users nor ascertain whether there is a cause-and-effect relationship between IUD use and PID. Vessey found that the increased incidence of PID among IUD users was only 1.65/1000 woman-years and when compared with nonusers, the IUD user was at a 3.5-fold increased risk of PID. There is yet no evidence that any one type of IUD is associated with a higher rate of PID. Overall, although available evidence suggests that there is an increased risk of PID among IUD users compared to nonusers, the magnitude of the risk is small. It is possible that a woman's lifestyle has a greater influence on the risk of PID than the IUD per se.

Effect of age on pelvic inflammatory disease in nulliparous women using a copper 7 intrauterine contraceptive device.

Factors affecting the incidence of pelvic inflammatory disease (PID) in a sample of nulliparous women are tabulated and reported briefly. Life-table analyses were used to calculate net rates for the first segment of IUD use. 871 women were inserted with Copper 7 devices in a 30-month period. The disease was diagnosed in 54 women during the 30 months after insertion, and the disease incidence was highest during the first 6 months (3.4 per 100 women); the rate then fell progressively in each successive 6-month period (2, 1.3, .7, and .4 per 100 women). This trend is statistically significant (P .01). Also, the risk of developing the disease was strongly related to age. Cumulative rates were always higher in the younger women at every time interval and decreased as age increased (P .01). Other predisposing factors discovered, besides age, included a history of previous PID (6%), a history of abortion (6%), and a difficult IUD insertion (11%). But the respective rates in women without the disease were not significantly different from those with PID (3, 20, and 9%, respectively). This study cautions young, nulliparous women when choosing IUD contraception because of the infertility likely to result from contracting PID.