Recent trends for gonorrhea and pelvic inflammatory disease in England and Wales are presented using routinely available data. The drawbacks of these data are examined, and a study is described which has attempted to rectify some of these inadequacies. The study attempted to identify patients with and without symptoms of gonorrhea, trichomoniasis, and candidiasis, living in a defined population. In addition, a calculation has been made of the number of cases of PID treated on an ambulatory basis in clinics for sexually transmitted disease in England and Wales.
PIP: The trends for gonorrhea and pelvic inflammatory disease in England and Wales are presented. Reported cases of gonococcal infection during a 12 year period, 1966 through 1977, were examined to determine incidence trends. Incidence rates by sex and age groups were calculated per 100,000 population. The number of patients with pelvic inflammatory disease (PID) admitted to hospitals in England and Wales can be derived from the Hospital In-Patient Enquiry. This is a 10% sample of all hospital deaths and discharges. The Enquiry records cases, not patients, and there are no criteria for the establishment of a diagnosis of PID except that it is the physician's final diagnosis. The rates for gonorrhea for both sexes have shown a steady increase (more marked in women) from 1966 to 1977. These increases appear to have leveled off recently. In 1977, the rates represetned 37,831 and 22,273 cases in men and women, respectively. Despite the leveling off over the last few years, there has been an increase of 31% for men from 1966 to 1977 and 130% for women over the same time period. The major increases have been in women aged 16-19 years and 20-24 years. From 1968 to 1977, both the number of cases of PID and the rate have increased by 50%. The number of cases requiring hospitalization was 10,960 in 1977. The age-specific PID rates are similar to the female age-specific rates for gonorrhea with major increases occurring in the 15-19 and 20-24 year age groups. A total of 2286 women were screened in the special examination of asymptomatic women. Altogether, 228 (10%) were found to have candidiasis, 97 (4%) trichomoniasis, and 5 (0.2%) gonorrhea. The screening concentrated on those who had not sought care for sexually transmitted diseases. England and Wales have excellent STD clinic service with a sophisticated recording system for cases seen in clinics and patients hospitalized with the complications of the diseases. Yet, the data systems can still be improved. These systems indicate only part of the total clinical picture of the STDs. Accurate comprehensive figures are essential for monitoring changes in the STDs and for planning appropriate medical and other facilities needed for clinical care and control.