Chlamydia and Gonorrhea Infection among Female Family Planning Clients Diagnosed with Pelvic Inflammatory Disease in California, 2003-2005

Background:
Out-patient visits associated with pelvic inflammatory disease (PID) decreased in the US since 1996. It is unknown if the prevalence of current chlamydia (CT) and gonorrhea (GC) remains common among out-patient PID cases.

Objective:
To estimate current CT/GC prevalence among family planning (FP) clinic PID cases.

Method:
We linked Quest Diagnostics CT/GC test results (1/1/03-12/31/05) for female FP clients in the California Family PACT program to paid claims with ICD-9 codes and pharmacy claims associated with PID. We calculated age-specific “current” CT/GC prevalence using test results on dates ±7 days of the PID diagnosis date.

Result:
There were 39 providers that used Quest Diagnostics for CT/GC testing and linked to 391 PID cases of whom 84% had current CT/GC test results. Females age ≤ 25 years comprised 50.1% of PID cases. Among 328 PID cases with “current” CT tests, the prevalence of CT was 9.7% and significantly higher among cases age ≤25 years (16.6%) compared with older clients (3.0%). Among 315 PID cases with “current” GC tests, 1.6% were GC-positive with prevalence highest among cases age ≤20 years (5.7%) compared with older cases (1.9% among cases age 21-25; 0.0% among cases age >25 years). Three clients were co-infected with CT and GC.

Conclusion:
Higher prevalence among young PID cases supports screening of young women to identify upper and lower genital tract CT/GC. The high proportion of PID cases and the lower CT/GC prevalence among older women suggests that PID etiology may not be similar across age groups.

Implications:
Higher prevalence among young PID cases supports screening of young women to identify upper and lower genital tract CT/GC. The high proportion of PID cases and the lower CT/GC prevalence among older women suggests that the etiology of PID may not be similar to that in younger women.