Infertility is a serious sequelae of pelvic inflammatory disease. Although evidence suggests that the timing of treatment may influence tubal patency, no studies have quantified the relationship between the delay of care for symptomatic pelvic inflammatory disease and long-term impairment of fertility. Hillis and colleagues examined this relationship in a case-control study.

The study included 443 women, aged 14 to 35 years, who had one episode of clinically recognized pelvic inflammatory disease. The study population included only women who had chlamydia or gonorrhea isolated from samples taken from the lower genital tract. Most of the women had the following signs or symptoms of pelvic inflammatory disease: bilateral lower abdominal pain, cervical motion and adnexal tenderness, and purulent vaginal discharge or painful intermenstrual bleeding.

Of this cohort, 76 women subsequently either had an ectopic pregnancy or were unable to conceive, and 367 control subjects had intrauterine pregnancies. Women who had pelvic inflammatory disease associated with gonorrhea or chlamydia and delayed care for three to nine days after the onset of abdominal pain were 2.6 times as likely to have impaired infertility as those who sought care promptly. Women with chlamydial infections who delayed treatment were more likely to have impaired infertility; 17.8 percent (18 of 101) of those who were treated three or more days after symptoms of pelvic inflammatory disease developed had infertility problems, compared with none of the 13 women who received early treatment.

The authors conclude that delay of treatment for pelvic inflammatory disease is associated with an increased risk of ectopic pregnancy and infertility. Once infection has progressed to the upper genital tract, intraluminal or peritubal scarring appears to develop quickly. The authors recommend that sexually active women be targeted for risk reduction counseling regarding the symptoms of pelvic inflammatory disease. Sexually active women should be instructed to seek prompt medical care for lower abdominal pain. However, primary and secondary prevention of upper genital tract infections should be the major goal in preventing infertility, including safer sexual behaviors and improved sexually transmitted disease control programs. (American Journal of Obstetrics and Gynecology, May 1993, vol. 168, p. 1503.)

COPYRIGHT 1993 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group