Recurrent pelvic inflammatory disease (PID) leads to increased risk of infertility and chronic pelvic pain syndrome, a study published in the September 2011 issue of Sexually Transmitted Diseases

Compared to women who did not have recurrent PID, patients who relapsed PID have an 80% higher probability of developing infertility and a 4-fold increase in the probability of chronic pelvic pain syndrome.

Each year, approximately 800,000 women in the United States are diagnosed with PID. Potential complications of this disease are tubal infertility, ectopic pregnancy and the development of chronic pelvic pain syndrome. Studies from the 1960 to 1984 period indicate that women with recurrent PID are in the group at increased risk for complications of the reproductive system compared to patients who have not had relapses.

After conducting such studies, special emphasis was placed on identifying the microorganisms that cause PID. In a series of previous studies, it has been found that Neisseria gonorrhoeae and Chlamydia trachomatis are the main pathogens associated with PID, but a later study has shown that these pathogens are only responsible for 1/3 all cases of PID.

In addition, over time, the strategy for managing patients with PID has changed. Previously, PID patients were treated in a hospital setting, but currently, most PIDs are treated on an outpatient basis.

To determine whether PIDs and STIs cause reproductive system complications, data from the PID Clinical Health and Evaluation (PEACH) study were analyzed. A multicenter randomized clinical trial of PEACH in women aged 14 to 38 with mild to moderate forms of PID was carried out in 1996-1999.

During the study, 1515 patients were screened, 831 women were then included in the study. The study participants were randomly assigned to receive treatment in a hospital setting (cefoxitin at a dose of 2 g every 6 hours for 48 hours iv + doxycycline 100 mg 2 times a day for 14 days) or ambulatory (cefoxitin 2 g iv m once + probenicide 1 g indoors, then doxycycline 100 mg 2 times a day indoors for 14 days).

The researchers asked the patients to abstain from sex throughout the treatment period. Patients underwent gynecological examination and determination of N. gonorrhoeae by culture and C. trachomatis using PCR diagnostics. Gram stain was used to diagnose bacterial vaginosis and endometrial biopsy was used to diagnose endometritis. The patients were assessed on days 5 and 30, after which the researchers contacted participants every 3 months for the next 84 months to detect STIs, PIDs, chronic pelvic pain syndrome and infertility.

Of all study participants, 75% were representatives of the Negroid race, 75.2% had already had one or more pregnancies, and 37.4% had already been diagnosed with PID. After 84 months, 21.3% of patients experienced a VZOMT relapse and 19% were found to be sterile due to the absence of pregnancy within 12 months of intercourse without the use of contraceptives.

Data were correlated by age, race, number of previous PID episodes, presence of infection caused by N. gonorrhoeae and C. trachomatis.

Compared to women with no history of recurrent PID, in patients with recurrent PID, the correlated odds ratio for the development of infertility was 1.8 (95% confidence interval 1.2-2.8) and chronic pelvic pain syndrome 4.2 - (95% CI 2.8-6.2).

In women with history of STIs, the correlated chance of developing chronic pelvic pain syndrome was 2.3 compared to women without such history (95% CI 1.2-3.2), but the risk of infertility did not increase statistically significantly.

There was no statistically significant increase in the risk of infertility in the adolescent group (girls aged 19 and under) (a correlated odds ratio of 1.9, 95% CI 0.8-4 , 4), but these patients had an increased risk of developing chronic pelvic pain syndrome (The adjusted odds ratio is 5.0, 95% CI 2.3-10.6).

Researchers recognize some limitations of this study, in particular, its results cannot be transferred to other patient populations. For example, in this study, more than 70% of women used contraceptives, while according to other studies in patients with PID, the frequency of contraceptive use did not exceed 25%. In addition, the main results were evaluated on the basis of information provided by the patients alone.

In light of the results, the researchers recommend that doctors pay special attention to young women with PID, in order to optimize their management tactics to prevent the long-term consequences associated with this disease.