Risk factors for laparoscopically confirmed pelvic inflammatory disease: findings from Mumbai (Bombay), India

Objectives: Sexually transmitted diseases (STDs) are an important cause of pelvic inflammatory disease (PID) but have often not been detected in micro biological studies of Indian women admitted to hospital gynaecology wards o r private clinics. In this cross sectional study, women living in the inner city of Mumbai (Bombay) were investigated for socioeconomic, clinical, and microbiological risk factors for PTD. Methods: Microbiological tests and laparoscopic examination were carried ou t on 2736 women aged less than or equal to 35 years who came to a health fa cility with suspected acute salpingitis or infertility or for laparoscopic sterilisation. 86 women with a clinical diagnosis of PTD were not referred for laparoscopy although their characteristics are described, Associations between various risk factors and PID status were investigated and logistic regression performed on all factors that remained significant. Results: Of women with a laparoscopically confirmed evaluation, 26 women ha d acute and 48 chronic pelvic infection. Independent risk factors for PID w ere later age at menarche (greater than or equal to 14 years), a history of stillbirth and no previous pregnancy, history of tuberculosis, STD, dilata tion and curettage or previous laparoscopy, and presence of Gardnerella vag inalis. Conclusions: It is concluded that STD related risk factors applied to only a small proportion of PID cases and that other determinants of PID are impo rtant, including obstetric complications, invasive surgical procedures such as laparoscopy, and tuberculosis.