Decreasing Incidences of Gonorrhea- and Chlamydia-Associated Acute Pelvic Inflammatory Disease: A 25-Year Study From an Urban Area of Central Sweden

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Background and Objectives:Acute pelvic inflammatory disease (PID) affects women in their reproductive years and is often a complication of a sexually transmitted disease (STD), particularlyNeisseria gonorrhoeaeandChlamydia trachomatis.Infertility, ectopic pregnancy, and chronic lower abdominal pain are common long-term sequelae to acute PID. Through different preventive measures, endemicN. gonorrhoeaeis almost eliminated, andC. trachomatishas been reduced almost fourfold in Sweden.Goals:To investigate variations in STD-associated acute PID and the extent to which this influenced the yearly incidences of patients hospitalized for this complication during a 25-year-period.Study Design:Hospital records of 2499 patients admitted and treated for acute PID from January 1, 1970 to December 31, 1994 were analyzed for infection withN. gonorrhoeae.Routine laboratory diagnosis forC. trachomatisinfection started June 1, 1980. Detailed statistical analysis for chlamydial-associated PID in this study, therefore, covers the period January 1, 1981 to December 31, 1994 and includes 1030 patients.Results:Gonorrhea occurred in 42% of patients with acute PID in 1970 and decreased continuously to zero in 1988 and beyond. Concomitant urogenital chlamydial infection reduced almost fourfold from 28.4% in 1985 to 7.7% in 1994. Yearly admissions for acute PID fluctuated slightly (≤16%) in the early 1970s and early 1980s but increased greatly (>60%) in the middle and late 1970s; the highest was 180 per year in 1976. This coincided with high incidence rates of gonorrhea in the general population, and probably of genitalC. trachomatisinfection as well, coupled with an increased use of intrauterine contraceptive device in nulliparous women. The largest increase in admissions for acute PID was in the 15- to 29-year-old group. A steady decrease started in 1987 and reached the low figure of 26 admissions in 1994. The greatest decrease occurred in the 15- to 19-year-old group, from the relative age distribution of 28.9% in the period 1970 to 1974 to 12.9% in 1990 to 1994. Yearly admissions for the ≥35-year-old group remained almost constant during the study period, but the relative age distribution shifted from second lowest (excluding those 14 years or younger, totaling 15 admissions for the entire study period), 9.1% at the beginning of the study period, to the second largest, 24.9% at the end of it. The study also showed that the total and relative rates of recurrence decreased.Conclusions:Measures aimed at reducing incidences of gonorrhea and genital chlamydial infection will reduce the incidences of one of the most serious complications of these STDs, acute PID, and, in turn, its long-term sequelae.

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