Lower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease

doi:10.1016/S0029-7844(02)02118-X

Obstetrics & Gynecology

Volume 100, Issue 3, September 2002, Pages 456-463

https://doi.org/10.1016/S0029-7844(02)02118-X Get rights and content

Abstract

OBJECTIVE:

To investigate the association between lower genital tract infections and subclinical PID. Fallopian tube damage is a common complication of acute symptomatic pelvic inflammatory disease (PID), yet most women with tubal factor infertility do not have a history of acute PID. Subclinical PID is believed to be an important cause of tubal factor infertility.

METHODS:

We conducted a cross-sectional study among women attending a sexually transmitted diseases or ambulatory gynecology clinic. A convenience sample of 556 women with bacterial vaginosis, gonorrhea, or chlamydia, or women at risk for gonorrhea or chlamydia were enrolled. Women diagnosed with acute PID were not eligible to participate. The main outcome was subclinical PID, as defined by the presence of histologic endometritis.

RESULTS:

Subclinical PID was more common in women with lower genital tract infection than in uninfected women. Subclinical PID was present in 27% of women with Chlamydia trachomatis (odds ratio 3.4; 95% confidence interval [CI] 1.8, 6.3) and in 26% of women infected with Neisseria gonorrhoeae (odds ratio 2.4; 95% CI 1.1, 5.1). Among women with bacterial vaginosis, 15% had endometritis (odds ratio 2.7; 95% CI 1.02, 7.2).

CONCLUSION:

Subclinical PID is common among women with lower genital tract infections. Additional prospective studies are necessary to determine the reproductive impact of these asymptomatic upper genital tract infections.

Section snippets

Materials and methods

In this cross-sectional study, women between the ages of 15 and 30 with lower genital tract infections or who were determined to be at risk for these infections were approached for enrollment between 1998 and 2000. This study was approved by Magee-Womens Hospital’s Institutional Review Board. Women were recruited from the following ambulatory care sites: Allegheny County Health Department’s Sexually Transmitted Diseases Clinic, Magee-Womens Hospital Ambulatory Care Clinics, and clinics of the

Results

Among the 556 women enrolled in this study, 57 women (10%) were diagnosed with cervical N gonorrhoeae infections, 103 women (18.5%) had cervical C trachomatis infections, and 377 (68%) were diagnosed with bacterial vaginosis by Gram stain. The median age of our cohort was 22 years. As women enrolled in our study were known to have bacterial vaginosis, chlamydia, or gonorrhea, or suspected of the latter two infections, most participants reported lower genital tract symptoms. Abnormal vaginal

Discussion

Findings from this study indicate that in the absence of signs or symptoms of acute PID, one in four women with gonorrhea or chlamydia, and one in seven women with bacterial vaginosis have subclinical PID. Subclinical PID is believed to cause similar long-term reproductive sequelae as acute PID. Tubal factor infertility, ectopic pregnancy, and chronic pelvic pain are common sequelae of PID, yet most women with these conditions have no history of acute PID.17 Evidence supporting the important

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^☆: This study was supported by National Institutes of Health grant R01 AI41624. The authors are indebted to Ingrid Macio, PA-C, Anne Rideout, CRNP, Christine Donahue, CRNP, April Lehman, and Tracy Zamborsky for their assistance in the implementation of this study.

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Original researchLower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease☆

Abstract

Section snippets

Materials and methods

Results

Discussion

Obstet Gynecol

Fertil Steril

Fertil Steril

Fertil Steril

Am J Obstet Gynecol

Obstet Gynecol

Am J Med

Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Hum Pathol

Pelvic inflammatory disease and fertility. A cohort study of 1844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results

Sex Transm Dis

Prevalence of antibodies to Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma hominis in infertile women

Genitourin Med

Tubal infertilitySerologic relationship to post chlamydial and gonococcal infection

Sex Transm Dis

Original research
Lower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease☆