SEXUALLY-TRANSMITTED DISEASES AS MAJOR CAUSES OF ECTOPIC PREGNANCY - RESULTS FROM A LARGE CASE-CONTROL STUDY IN FRANCE

Objective: To evaluate the current impact of sexually transmitted dise ases (STDs) and their consequences on the occurrence of ectopic pregna ncy (EP). Design: Case-control study. Setting: Fifteen maternity hospi tals in the Rhone-Alpes region, France. Subjects: Six hundred twenty-f our women with EP diagnosed from October 1988 to December 1991 and 1,2 47 controls who delivered liveborn children during the same period. Ma in Outcome Measures: Information on risk factors included behavioral, clinical, and serological indicators of STDs and other known risk fact ors of EP. Results: Logistic regression identified several indicators of STDs as strong and independent risk factors for EP: previously trea ted STD without history of salpingitis; history of probable pelvic inf lammatory disease (PID) and, especially, history of confirmed PID; pre vious STDs of the sexual partner; and Chlamydia trachomatis seropositi vity. The adjusted attributable fractions of EP for previous symptomat ic STDs, symptomatic STDs of the sexual partner, and C. trachomatis se ropositivity were 20%, 3.5%, and 25.2%, respectively, giving a total o f 43% of EP cases attributable to infectious factors. Conclusions: Our findings and previous epidemiological and biological evidence suggest that STD is a major cause of EP. The evidence is particularly strong in the case of C. trachomatis infection. An effective way of dramatica lly reducing the EP rate would be to prevent STD through education pro grams sensitizing young women to the complications of STD and public h ealth measures promoting the use of protective methods such as condoms .