DECREASING INCIDENCES OF GONORRHEA-ASSOCIATED AND CHLAMYDIA-ASSOCIATED ACUTE PELVIC INFLAMMATORY DISEASE - A 25-YEAR STUDY FROM AN URBAN AREA OF CENTRAL SWEDEN

Background and Objectives: Acute pelvic inflammatory disease (PID) aff ects women in their reproductive years and is often a complication of a sexually transmitted disease (STD), particularly Neisseria gonorrhoe ae and Chlamydia trachomatis. Infertility, ectopic pregnancy, and chro nic lower abdominal pain are common long-term sequelae to acute PID. T hrough different preventive measures, endemic N. gonorrhoeae is almost eliminated, and C. trachomatis has been reduced almost fourfold in Sw eden. 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 Des ign: Hospital records of 2499 patients admitted and treated for acute PID from January 1, 1970 to December 31, 1994 were analyzed for infect ion with N. gonorrhoeae. Routine laboratory diagnosis for C. trachomat is infection started June 1, 1980. Detailed statistical analysis for c hlamydial-associated PLD in this study, therefore, covers the period J anuary 1, 1981 to December 31, 1994 and includes 1030 patients. Result s: Gonorrhea occurred in 42% of patients with acute PID in 1970 and de creased continuously to zero in 1988 and beyond. Concomitant urogenita l chlamydial infection reduced almost fourfold from 28.4% in 1985 to 7 .7% in 1994. Yearly admissions for acute PID fluctuated slightly (less than or equal to 16%) in the early 1970s and early 1980s but increase d greatly (>60%) in the middle and late 1970s; the highest was 180 per year in 1976. This coincided with high incidence rates of gonorrhea i n the general population, and probably of genital C. trachomatis infec tion as well, coupled with an increased use of intrauterine contracept ive device in nulliparous women. The largest increase in admissions fo r acute PID was in the 15- to 29-year-old group. A steady decrease sta rted 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 r elative age distribution of 28.9% in the period 1970 to 1974 to 12.9% in 1990 to 1994. Yearly admissions for the greater than or equal to 35 -year-old group remained almost constant during the study period, but the relative age distribution shifted from second lowest (excluding th ose 14 years or younger, totaling 15 admissions for the entire study p eriod), 9.1% at the beginning of the study period, to the second large st, 24.9% at the end of it. The study also showed that the total and r elative 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 the se STDs, acute PID, and, in turn, its long-term sequelae.