PELVIC INFLAMMATORY DISEASE

Risk factors associated with pelvic inflammatory disease

I Simms¹, J M Stephenson², H Mallinson³, R W Peeling⁴, K Thomas⁵, R Gokhale⁶, P A Rogers⁷, P Hay⁸, P Oakeshott⁹, J Hopwood¹⁰, H Birley¹¹ and M Hernon¹²

¹ Health Protection Agency Centre for Infections, London, UK
² Department of Primary Care and Population Sciences, Centre for Sexual Health and HIV Research, Royal Free and University College Hospital Medical Schools, London, UK
³ Clinical Microbiology and Health Protection Agency Collaborating Laboratory, University Hospital Aintree, Liverpool, UK
⁴ Unicef/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
⁵ Department of Obstetrics and Gynaecology, Southport General Infirmary, Southport, UK
⁶ Department of Genitourinary Medicine, Arrowe Park Hospital, Upton, UK
⁷ Cancer Research UK, London, UK
⁸ The Courtyard Clinic, St George’s Hospital, London, UK
⁹ St George’s Hospital Medical School, St George’s Hospital, London, UK
¹⁰ Wirral NHS Chlamydia Screening Office, Birkenhead and Wallasey Primary Care Trust, Birkenhead, UK
¹¹ Department of Genitourinary Medicine, Cardiff Royal Infirmary, Cardiff, UK
¹² Department of Women’s Health, Leighton Hospital, Crewe, UK

Correspondence to:
Correspondence to:
Dr Ian Simms
Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK; ian.simms{at}hpa.org.uk

Objective: To investigate factors associated with pelvic inflammatory disease (PID).

Methods: A case–control study was used to investigate demographic and behavioural factors, and causative agents associated with PID.

Results: A total of 381 participants were recruited: 140 patients, and 105 and 136 controls in tubal ligation and general practice groups, respectively. When compared with a PID-free tubal ligation control group, increased risk of PID was associated with: age <25 years; age at first sexual intercourse <20 years; non-white ethnicity; not having had children; a self-reported history of a sexually transmitted disease; and exposure to Chlamydia trachomatis. When compared with a general practice control group, increased risk was associated with: age <25 years; age at first sexual intercourse <15 years; lower socioeconomic status; being single; adverse pregnancy outcome; a self-reported history of a sexually transmitted disease; and exposure to C trachomatis. Of the cases, 64% were not associated with any of the infectious agents measured in this study (idiopathic).

Conclusions: A high proportion of cases were idiopathic. PID control strategies, which currently focus on chlamydial screening, have to be reviewed so that they can prevent all cases of PID. Behavioural change is a key factor in the primary prevention of PID, and potential modifiable risk factors were associated with PID.

Abbreviations: CHSP60, heat shock protein 60; GUM, gastrourinary medicine; LCR, ligase chain reaction; MIF, microimmunofluorescence; O&G, obstetrics and gynaecology; PID, pelvic inflammatory disease; TOP, termination of pregnancy

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