SupplementProgrammes to reduce pelvic inflammatory disease—the Swedish experience
Section snippets
The Swedish experience
Under Swedish law, gonorrhoea and syphilis have been reportable as contagious diseases since 1919. Genital infection with Chlamydia trachomatis has been reported by diagnostic laboratories since 1982, and was made a notifiable disease in April, 1988.18 This change in the law was preceded by intense discussions over the pros and cons, but because of the emerging HIV epidemic, the argument prevailed that treatable gonococcal and chlamydial infections could be used as realistic opportunities to
Role of the intrauterine contraceptive device (IUCD)
In our study, the number of patients admitted to hospital with PID varied less than 16% from year to year in the early 1970s and 1980s, by contrast with an almost 75% increase in the mid-1970s (figure 1). This increase mainly resulted from an indiscriminate use of IUCDs in young, sexually active, nulliparous women;25 findings that agree with those of others.26, 27 The majority of infections related to use of IUCDs were not associated with STDs but were caused by ascending indigenous vaginal
Epidemiology of gonococcal and chlamydial PID
The incidence of gonorrhoea peaked in Sweden in 1970 with an annual incidence of almost 500 per 100 000 population. Since then, incidence has steadily declined in both women and men, and endemic gonorrhoea has now been eradicated in Sweden.28 Cases diagnosed today are usually imported.
In the late 1960s, and in 1970 when the gonorrhoea epidemic peaked, 40–45% of patients had gonococcal PID (figure 1),21, 24 and 15–17% of women with untreated gonorrhoea developed acute PID. These figures changed
Antibiotic treatment
Effective antibiotic treatment of patients with PID is essential. Treatment must be started early, preferably within 2 days of the onset of abdominal pain, to avoid the serious sequelae of tubal infertility and ectopic pregnancy.3, 4 However, most patients with PID delay in seeking medical care because of vague symptoms, which is especially true for women with chlamydial disease. Although most PID patients younger than 25 years of age may have a gonococcal and/or chlamydial infection, these
The male sexual partner
In countries with legislation to control gonorrhoea, contact tracing and notification of the male sex partner(s) of a woman with gonococcal PID is usually mandatory. In our hospital, 40–45% of all patients treated for PID in the late 1960s and early 1970s had gonococcal disease.21 However, male partners were not usually contacted by the STD outpatient clinic until after the patient was discharged from hospital. Thus, the opportunity was often missed to counsel and inform both patient and
Prevention strategies
Measures being used or recommended for the prevention of PID will differ between countries because medical and cultural/social practices, ethical, legal, and economic factors must be considered. Although reduction and prevention of gonococcal and chlamydial infections are probably the most productive steps in prevention of PID, these pathogens cannot be found in about one-third of PID cases, in which the indigenous flora of the genital tract (mycoplasmas, anaerobes, enterobacteria, &c) may be
Conclusions
Primary, secondary, and tertiary prevention strategies are all important to reduce PID and its sequelae. Counselling, education, and information campaigns, directed at both society as a whole and the individual to increase awareness of the consequences of sexual risk behaviour, can be combined with targeted screening programmes. Early and effective antibiotic treatment of PID will reduce adverse effects on tubal patency, and inclusion of male sexual partners in management will reduce recurrence
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