A study of the long-term consequences of pelvic inflammatory disease (PID) led by researchers at the Johns Hopkins Children's Center shows repeated bouts of the disease can double a woman's risk of infertility and quadruple her risk of chronic pelvic pain. Teenage girls with recurrent PID also face dire consequences, the researchers found, including a fivefold risk of chronic pelvic pain and alarming rates of infertility.
A report on the findings is published in the journal Sexually Transmitted Diseases.
A complication of sexually transmitted infections (STI), PID is marked by an inflammation of the reproductive organs. It affects more than 800,000 women in the United States each year, one in 10 of whom develops infertility, according to the Centers for Disease Control and Prevention (CDC). PID can also cause chronic pelvic pain and ectopic pregnancy.
The definitive knowledge of PID's long-term consequences comes from a series of Swedish studies from the1990s that followed nearly 2,000 women with PID over 25 years and demonstrated that even a single episode of PID seriously jeopardized a woman's ability to conceive or have a healthy pregnancy.
But over the last 20 years, shifts in PID-causing pathogens and new treatment approaches have led many researchers to wonder whether some of the disease's long-term effects might have changed as well. They have not, the current study shows.
PID, the researchers found, can still take a serious toll on a woman's reproductive health, a finding that underscores the importance of STI prevention, early diagnosis and aggressive treatment, the investigators say.
"When it comes to PID, we must remain as vigilant as ever. Even though PID has changed over time, it is still very much a disease that can have detrimental consequences to a woman's childbearing ability and can lead to chronic pelvic pain down the road," says lead investigator Maria Trent, M.D., M.P.H., a pediatrician and expert on teen reproductive health at Hopkins Children's.
In the past, gonorrhea and chlamydia were the main causes of PID, but recent findings show these two infections account for only a third of all PID cases today, and other pathogens such as Mycoplasma genitalium are now fueling many of the cases. PID is currently treated on an outpatient basis — except for severe cases — in stark contrast with past approaches that required uniform hospitalization of all women diagnosed with PID, regardless of severity. While fiscally prudent, outpatient therapy allows for less control and uniformity of treatment. Some patients fail to return for follow-ups, and some may deviate from the complex drug regimen increasing their risk for incomplete cure or relapse.
The multi-center trial involved 831 women, ages 14 through 38, with mild to moderate PID and followed them for seven years after the initial diagnosis. Roughly, one in five women (21 percent) had one or more PID episodes after the initial diagnosis, nearly one-fifth were deemed infertile, and 43 percent reported chronic pelvic pain. Fifty-seven percent got pregnant. Women with recurrent PID were nearly twice as likely to report infertility as women who never had another PID episode after the initial treatment. Women with recurrent PID were four times more likely to report chronic pelvic pain.
Teens with recurrent PID had a fivefold risk of chronic pelvic pain compared with PID-free counterparts. In the teen group, nearly 40 percent reported chronic pelvic pain. While recurrent PID did not increase a teen's statistical risk of infertility, a concerning number of teenage girls—18 percent of 209 — showed signs of infertility, the researchers found.
"The fact that close to one-fifth of these girls were already showing signs of infertility is quite alarming and might mean that the numbers will increase as these girls get older and actively try to get pregnant," Trent says.
While repeated STIs did not affect fertility, they did double a woman's risk of developing chronic pelvic pain.
Examining how pain could play a direct protective role in the gut