Background: Pelvic inflammatory disease (PID) commonly develops as sequelae of sexually transmitted infections (STIs). There are limited data on PID burden from different pathogens. We assessed the risk of PID from a range of STIs and bacterial vaginosis (BV) among females attending a large urban sexual health clinic in Melbourne.
Methods: Data were extracted from the clinic’s electronic patient database for all females aged 16-49 years attending between Jan 2006-June 2013. PID diagnosis was based on presence of uterine, cervical motion, or adnexal tenderness in women at STI risk and experiencing lower abdominal pain. We calculated the proportion of PID cases due to a single STI and the association between concurrent infections (STIs/BV) and PID. We also calculated PID attributable risk (AR) due to each infection.
Results: During the study period, 1228 PID cases were diagnosed among 90,445 female attendances (1.36%; 95%CI:1.28-1.43). The proportion of attendances with PID ranged from 1.12% in 2008 to 1.55% in 2013 and fluctuated over time (p=0.27). The proportion of PID cases with a single infection was: BV (16.8%,95%CI:14.7-19.0); chlamydia (11.2%,95%CI: 9.5, 13.1); Mycoplasma genitalium (MG) (2.1%,95%CI:1.4-3.1); gonorrhoea (0.6%,95%CI:0.2-1.2); and trichomoniasis (0.5%,95%CI:0.2,1.1). In 63% of PID cases, no causative organism was identified. Compared to no infection, the odds of being diagnosed with PID due to a single infection was OR=6.4 (95%CI:5.6-7.3) increasing 3-fold for ≥two infections (OR=22.5; 95%CI:17.1-29.6). The PID AR percent was highest for gonorrhoea (85.3%,95%CI:70.3-92.7) and chlamydia (80.5%,95%CI:76.8-83.7) and lowest for MG (28.4%,95%CI:-2.9-50.2) and BV (16.3%,95%CI:2.5-28.1).
Conclusions: While BV and chlamydia were most commonly identified in PID cases, no causative organism was identified for over half of PID cases. Concurrent STIs increase the risk of PID considerably. In those with chlamydia, most PID cases were due to chlamydia, whereas for BV and MG, most PID cases were due to other causes.