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Characteristics of pelvic inflammatory disease where no sexually transmitted infection is identified: a cross-sectional analysis of routinely collected sexual health clinic data
  1. Jane L Goller1,
  2. Alysha M De Livera1,
  3. Christopher K Fairley2,
  4. Rebecca J Guy3,
  5. Catriona S Bradshaw2,
  6. Marcus Y Chen2,
  7. Jane S Hocking1
  1. 1Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
  2. 2Central Clinical School, Monash University and Melbourne Sexual Health Centre, Carlton, Victoria, Australia
  3. 3Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
  1. Correspondence to Jane Louise Goller, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, Parkville VIC 3010, Australia; jane.goller{at}


Objectives Pelvic inflammatory disease (PID) occurs when pathogens, often sexually transmitted, ascend to the upper genital tract, yet a causative pathogen is not detected in a substantial proportion of diagnosed PID. We assessed the characteristics associated with PID in women in whom chlamydia, gonorrhoea, Mycoplasma genitalium (MG) and bacterial vaginosis (BV) were not detected (‘pathogen-negative-PID’).

Methods Cross-sectional analysis of routinely collected clinical data from new female patients attending a sexual health clinic between 2006 and 2013. Women were eligible if they had been diagnosed with PID and tested for genital chlamydia, gonorrhoea, MG and BV. Logistic regression was conducted to identify characteristics associated with pathogen-negative-PID.

Results Among 330 women with clinically diagnosed PID, 204 (61.8%, 95% CI 56.3% to 67.1%) had pathogen-negative-PID. Compared with pathogen-positive-PID, pathogen-negative-PID cases were more likely to be aged ≥30 years (adjusted odds ratio (AOR) 1.7, 95% CI 1.0 to 3.0), had less evidence of vaginal inflammation (AOR 0.5, 95% CI 0.3 to 0.9) and reported less unprotected sex (AOR 0.6, 95% CI 0.4 to 1.0).

Conclusions These findings highlight uncertainties around PID diagnosis and aetiology. Pathogen-negative-PID could represent (i) a false positive diagnosis where the woman does not have a sexually transmitted infection (STI) or PID, (ii) PID of another microbiological aetiology or associated with a past STI or (iii) PID where the cervical infection has cleared. However, until diagnostic biomarkers are available, PID treatment should be based on clinical features and sexual risk.


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  • Handling editor Jackie A Cassell

  • Contributors JLG collected the data, conducted the analysis and wrote the manuscript. AMDL supervised the analysis and contributed to the manuscript. JH, RG, CKF, CB and MYC contributed to the design and/or interpretation, provided feedback and contributed to the manuscript. All authors approved the final submitted version of the manuscript.

  • Funding JLG is supported by an Australian Postgraduate Award from the University of Melbourne.

  • Competing interests None declared.

  • Ethics approval Alfred Health Human Research Ethics Committee (EC00315).

  • Provenance and peer review Not commissioned; externally peer reviewed.