Rate Of Pelvic Inflammatory Disease Research Articles

Copper IUDs, PID, and fertility in nulliparous women

Some authors have suggested that use of IUDs (intrauterine contraceptive devices) in nulliparous women should be contraindicated because of the risk for PID (pelvic inflammatory disease); others have found nulliparous women to be suitable candidates for IUD use. Clinical studies of copper IUDs in which parous and nulliparous women have been compared with regard to risk of PID often point to young age as a risk factor, regardless of parity. Vital statistics of PID rates also show this trend. An overall PID rate of 1.49/100 woman-years (WY) was calculated from data contained in 28 of the clinical studies reviewed in this paper. These studies included 25,674 women, of whom 42.5% were nulliparous. Studies of fertility following use of copper IUDs indicate that fertility is not impaired by their use.

Protective Effect of Intrauterine Release of Levonorgestrel on Pelvic Infection: Three Yearsʼ Comparative Experience of Levonorgestrel- and Copper-Releasing Intrauterine Devices

A randomized, multicenter comparison of two intrauterine contraceptive devices (IUDs) was carried out. Nine hundred thirty-seven women were fitted with a copper-releasing IUD, the Nova-T, and 1821 women with an IUD that releases 20 micrograms of levonorgestrel daily. After 36 months, the cumulative gross rates of amenorrhea and hormonal side effects were significantly higher in the levonorgestrel-IUD users. The cumulative 36-month gross pregnancy rate was 3.7 for the Nova-T and 0.3 for the levonorgestrel IUD (P less than .001), demonstrating the levonorgestrel IUD's high contraceptive efficacy. For the first time, a protective effect of the levonorgestrel IUD against pelvic inflammatory disease as compared with the Nova-T was seen statistically. The cumulative 36-month gross rate of pelvic inflammatory disease was 2.0 in Nova-T- and 0.5 in levonorgestrel-IUD users (P less than .013). This significantly lowered incidence of pelvic inflammatory disease may help to solve one of the major concerns associated with intrauterine contraception.

Rates of Pelvic Inflammatory Disease in England Increase by 28 Percent in the 1975-1985 Period

Rates of Pelvic Inflammatory Disease in England Increase by 28 Percent in the 1975-1985 Period

First coitus before menarche and risk of sexually transmitted disease

The prevalence of sexually transmitted disease (STD), pelvic inflammatory disease (PID), and cervical cancer, and the relation between these conditions were studied in 2111 Ethiopian women. Early sexual activity was associated with an increase in prevalence rates of STD and PID; possible aetiological factors include physical and immunological immaturity of the female genital tract and the number of sexual partners.

A Comparative Evaluation of the Multiload 250 and Multiload 375 Intrauterine Devices

The experience of 1254 women who had Multiload 250s (MLCu250) and 754 women who had Multiload 375s (MLCu375) inserted by the author was evaluated. The performance of the two Multiload models was similar over 4 years of use, except for a significantly lower (p less than 0.05) pregnancy rate for the MLCu375 (4-year cumulative life table rates: 3.0 vs 5.4 per 100 women). Use of the MLCu250 and MLCu375 provided women with a very safe method of contraception. Many of the removals for medical reasons other than bleeding, pain or pelvic inflammatory disease (PID) appeared to be unrelated to IUD use. Thirty-nine women had their IUDs removed for suspected PID, but the diagnosis of PID was confirmed in only 44% of these cases. The overall rate of confirmed cases of PID was 0.3 per 100 woman-years. Except for a higher rate of PID during the first few months of Multiload use, the results of the study did not indicate that IUD use is associated with an increased risk of PID. Multiload use did not impair future pregnancy or affect the outcomes of these pregnancies.

The benefits of combined oral contraceptives.

The benefits of combined oral contraceptives are put into perspective, considering their effectiveness as a contraceptive, actual risks for breast, ovarian, endometrial and cervical cancer, and effects of reproductive and other body systems. Combined oral contraceptives are the best contraceptives available except for injectable progestogens, therefore they an reduce the risk of maternal mortality by at least 5 in nonsmoking western women, or over 100 in developing countries. No data are available on mortality risk of the presumed safer low-dose pills. Pills reduce ectopic pregnancy to virtually nil. They decrease the risk of endometrial cancer, and of ovarian cancer for up to 15 years after use. Although they protect against benign breast disease, both fibrocystic disease and fibroadenoma, which are risk factors for breast cancer, it is unsettled whether pills affect breast cancer incidence. Cervical cancer risk may be slightly higher. Functional ovarian cysts requiring surgery are cut about 10-fold; corpus luteum and follicular cysts are also reduced. Fibroids are decreased in proportion to duration of use. Pelvic inflammatory disease rates fall 50% during use. Chlamydial infections have not fallen in pill users, but it is not known whether sexual activity is a factor. Combined pills cut abnormal uterine bleeding by about half, reduce the incidence of iron deficiency anemia and of premenstrual tension. Seizures related to menses also are controlled. Some studies find a reduction in rheumatoid arthritis. Most of the cardiovascular complications of pills are thought to be dose related. Since today's pills contain approximately the same dose as a whole cycle of the original pills, it is expected that these risks will be greatly reduced, especially with better screening of candidates that is now the rule.

Preventive lymecycline therapy in women with a history of pelvic inflammatory disease undergoing first-trimester abortion: a clinical, controlled trial

In a clinical, controlled trial 55 women with a history of pelvic inflammatory disease (PID) undergoing first-trimester abortion were randomized to either lymecycline therapy or placebo. Twenty-four women received lymecycline capsules 300 mg b.i.d. for 14 days starting on the morning of the abortion and 31 received similar placebo medication. In the lymecycline group 2 women (8.3%) and in the placebo group 7 (22.6%) contracted postabortal PID, a non-significant difference (p > 0.2). The variables age, gestational age, number of spontaneous abortions, births and episodes of PID, and Hegar size were not associated with the rate of postabortal PID. Women without previous induced abortions had a significantly increased rate of postabortal infection (p = 0.02), but the treatment did not influence this rate. Three women had a positive culture for Chlamydia trachomatis at the time of abortion and two of these had postabortal PID. None of 7 women with postabortal PID had significant increases in IgA, IgG or IgM chlamydia antibody titers, but two women with uncomplicated abortions had serological evidence of infection. The number of hospital days and amounts of antibiotics prescribed to women with postabortal PID were not significantly different between the two treatment groups (p > 0.05). Women with a history of PID had an elevated risk of postabortal PID warranting the use of some sort of prophylaxis, and screening for C. trachomatis in an abortion population is recommended.

Pelvic inflammatory disease and its sequelae in adolescents

Pelvic Inflammatory Disease (PID) is the most common serious complication of sexually transmitted diseases (STDs). Each year over one million women in the United States experience an episode of PID, with approximately 16-20% of cases occurring in teenagers. Acute PID increases a woman's risk for recurrent PID, chronic pelvic pain, infertility, and ectopic pregnancy. Recent reports indicating that PID rates are rising and are highest among adolescent females aged 15-19 underscore the need to remain current on the clinical as well as the epidemiologic aspects of PID. We present such an update in this article. Trends in incidence and key risk factors are discussed; besides adolescence itself and STD, other important categories of risk factors include sexual activity, contraceptive method, and previous episode(s) of PID. The polymicrobial nature of PID is discussed along with an analysis of the role of specific organisms, such as Chlamydia trachomatis, Neisseria gonorrhoeae, anaerobic and aerobic bacteria, and mycoplasmas in PID. Early diagnosis and the institution of appropriate treatment regimens are essential to the prevention of PID's devastating sequelae. Clinicians must maintain a high index of suspicion for the wide range of clinical presentations associated with PID and be prepared to provide effective management, including proper evaluation and prompt treatment of sexual partners.

Long-term use of intrauterine contraceptive devices in a private practice

Clinical experience with 1504 insertions of intrauterine contraceptive devices (Lippes Loop, Dalkon Shield, Cu-7) in a private practice is evaluated. Expulsion rates and removal rates for bleeding and/or pain and personal reasons differed for the three types of devices. Pregnancy rates associated with use of the three types of devices were similar. Pelvic inflammatory disease rates were similar for Dalkon Shield and Cu-7 users but were higher than the rate for Lippes Loop users. Use of intrauterine contraceptive devices did not appear to compromise future fertility based on the experience of women who had the devices removed. The study shows that long-term IUD use (up to 5 years) provides a safe and effective method of contraception.

Acute Pelvic Inflammatory Disease

Acute pelvic inflammatory disease is one of the most important consequences of sexually transmitted infection. Of sexually active women in the United States, one million (or 1 per cent) develop the infection. The sequelae include infertility (10 per cent), ectopic pregnancy (5 per cent), chronic pain (15 per cent), and recurrent infection (25 per cent). Organisms that cause the infection include Neisseria gonorrhoeae, Chlamydia trachomatis, genital mycoplasma, and a wide variety of facultative and anaerobic bacteria. Prompt recognition and therapy are necessary to reduce the sequelae.

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.

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.

RELATIONSHIP OF PELVIC INFECTION TO VARIOUS TYPES OF CONTRACEPTION

A reported increased incidence of upper genital tract infection not yet verified among women using oral contraceptives exposed to the gonococcus compared to women using other types of contraception suggests the importance of detecting gonorrhea involving the lower genital tract in this possibly high-risk female population to prevent salpingo-oophoritis and its possible sequelae. It also suggests possible elucidation of protective mechanisms against the genococcus by intensive study of changed genital tract secretions of women in whom the pill has apparently diminished local protective mechanisms. Results of microbiological study have indicated that bacteria from the endocervix are introduced into the endometrial cavity at IUD insertion but are eliminated by local defense mechanisms of the uterus. An outpouring of white cells into the cavity and elevated IgG and IgM levels are associated with an IUD in situ. Lack of available data on late sequelae of mild pelvic infection in IUD users and on the general incidence of pelvic inflammatory disease wide variations in numbers of cases in different studies perhaps related to socioeconomic status of study groups and difficulty in quatitating severity of infection discourage conclusions although the general consensus is that IUD use is not associated with an unduly high rate of pelvic inflammatory disease. However 1 study of a poor urban population found increased incidence of upper genital tract inflammation among women wearing an IUD compared to the overall female population. Patient selection patterns might be responsible. Good medical practice dictates screening for Neisseria gonnorrhea before or at the time of insertion of an IUD and subsequent prompt treatment. More chronic forms of salpingo-oophoritis e.g. tuboovarian abscess formation seem related to other organisms although there is a lack of firm data about pelvic infections in general. Women with an IUD in place may have severe pelvic infections due to the group A beta-hemolytic streptococcus. Unilateral sequelae of pelvic infection observed in women using an IUD may be only an apparent association that has been diagnosed because of increased use of laparoscopy. Improved pregnancy protection and lower expulsion rates of new devices such as the Majzlin spring and the Dalkon shield are associated with increased problems related to soft tissue trauma. The presence of copper in the endometrial cavity has resulted in a measured outpouring of uterine white cells and copper has inhibited in vitro gonococcus growth. Use of the condom and diaphragm offer incomplete protection to women against organisms associated with salpingo-oophoritis.