ATYPICAL PELVIC INFLAMMATORY DISEASE - CAN WE IDENTIFY CLINICAL PREDICTORS

OBJECTIVE: We used data from a large multicenter case-control study of tubal infertility to analyze further the relationship among demograph ic variables, behavioral measures, history of previous sexually transm itted diseases, and past contraceptive practices, for women with and w ithout a history of pelvic inflammatory disease. STUDY DESIGN: We iden tified 283 white women with tubal infertility who requested rare at se ven participating institutions. Of these women, 238 (84%) did not have a history of pelvic inflammatory disease (''atypical pelvic inflammat ory disease'') whereas 45 reported a history of pelvic inflammatory di sease (''overt pelvic inflammatory disease''). We compared these group s with 1629 white women without a history of either infertility or pel vic inflammatory disease who were delivered of their first live-born c hild at the same institutions as the infertile cases. RESULTS: Women w ith atypical pelvic inflammatory disease were demographically more lik e fertile control subjects and had behavioral characteristics midway b etween those of the overt pelvic inflammatory disease group and the fe rtile group. Both oral contraceptive and diaphragm use protected again st tubal infertility for women with either atypical or overt pelvic in flammatory disease. Atypical pelvic inflammatory disease was related t o a history of Trichomonas infection but not to a reported history of gonorrhea, genital herpes, or other vaginitis. CONCLUSION: Atypical pe lvic inflammatory disease is probably more common than its symptomatic counterpart. Whereas this condition is associated with some character istics of a sexually transmitted infection, clinical predictors remain elusive.