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Risk factors associated with pelvic inflammatory disease
  1. I Simms1,
  2. J M Stephenson2,
  3. H Mallinson3,
  4. R W Peeling4,
  5. K Thomas5,
  6. R Gokhale6,
  7. P A Rogers7,
  8. P Hay8,
  9. P Oakeshott9,
  10. J Hopwood10,
  11. H Birley11,
  12. M Hernon12
  1. 1Health Protection Agency Centre for Infections, London, UK
  2. 2Department of Primary Care and Population Sciences, Centre for Sexual Health and HIV Research, Royal Free and University College Hospital Medical Schools, London, UK
  3. 3Clinical Microbiology and Health Protection Agency Collaborating Laboratory, University Hospital Aintree, Liverpool, UK
  4. 4Unicef/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
  5. 5Department of Obstetrics and Gynaecology, Southport General Infirmary, Southport, UK
  6. 6Department of Genitourinary Medicine, Arrowe Park Hospital, Upton, UK
  7. 7Cancer Research UK, London, UK
  8. 8The Courtyard Clinic, St George’s Hospital, London, UK
  9. 9St George’s Hospital Medical School, St George’s Hospital, London, UK
  10. 10Wirral NHS Chlamydia Screening Office, Birkenhead and Wallasey Primary Care Trust, Birkenhead, UK
  11. 11Department of Genitourinary Medicine, Cardiff Royal Infirmary, Cardiff, UK
  12. 12Department of Women’s Health, Leighton Hospital, Crewe, UK
  1. Correspondence to:
 Dr Ian Simms
 Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK; ian.simms{at}


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.

  • 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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  • Published Online First 10 August 2006

  • Funding: This study was funded by the Department of Health (England) as part of the Chlamydia Screening Pilot conducted on The Wirral and in Portsmouth.

  • Competing interests: None declared.

  • Ethical approval: Ethical approval for the study was given by the Public Health Laboratory Service (PHLS), Wirral Health Authority (HA), Liverpool HA, South Sefton HA, Wandsworth HA and the Multi-Centre Research Ethics Committee (Northern).

  • IS, JMS, HM, PAR and JH instigated the project, designed and developed the protocol and obtained funding. HM and RWP supervised the laboratory diagnostic methods, including standardising the interpretation of the serological test results. KT, RG, PH, PO, HB and MH advised on all clinical aspects of the study, and oversaw the recruitment of patients into the study. PAR supervised the statistical analysis. IS drafted the manuscript and all authors contributed to revising the manuscript.

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