July 29, 2004 PITTSBURGH, July 28 – Women wishing to decrease their risk for a common and serious infection of the upper genital tract called pelvic inflammatory disease (PID) should make sure their sexual partners use condoms and use them consistently, according to a multi-center study from the University of Pittsburgh's Graduate School of Public Health (GSPH).
Appearing in the August issue of the American Journal of Public Health, the report is the first prospective study to clearly show an association between regular condom use and a reduced risk not only for recurrent PID, but also for related complications such as chronic pelvic pain and infertility, said Roberta Ness, M.D., M.P.H., professor and chair of the department of epidemiology at GSPH and the study's first author.
Consistent condom users were half as likely to have an episode of recurrent PID as those women whose partners never used condoms, the study found. Significantly, women who reported regular use of condoms were 60 percent less likely to become infertile. The rate of reported condom use appeared to have no effect on future chronic pelvic pain.
"Bacteria that cause cervical infection can travel into the upper genital tract and trigger PID," said Dr. Ness, who also directs the women's health program at GSPH and is professor of medicine and obstetrics and gynecology and reproductive sciences at the University of Pittsburgh School of Medicine. "Many different organisms can cause the disorder, but most cases of PID are associated with sexually transmitted diseases (STDs) such as gonorrhea or chlamydia."
The study population included 684 women aged 14 to 37 who were enrolled at 13 U.S. centers between March 1996 and February 1999. The women, all of whom had symptoms consistent with a diagnosis of PID at enrollment, were interviewed regarding their medical history and contraceptive use, then followed for nearly three years.
While the association between condom use and a decreased risk of acquiring the human immunodeficiency virus (HIV) and other viral STDs is well known, fewer data exists on the relationships among condom use, bacterial STDs and PID, explained Dr. Ness.
"The finding is significant because PID tends to recur," she said, adding that some 8 percent of women will have PID at some time over their reproductive lives, increasing the chances for future chronic pain and infertility.
In the United States, more than a million women will have an episode of acute PID each year, with the rate highest among teenagers, according to the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (NIH). More than 100,000 women become infertile each year as a result of PID, and a large proportion of the 70,000 tubal pregnancies that happen yearly are related to the consequences of PID. In 1997 alone, some $7 billion was spent on PID and its complications.
While the study speaks specifically to a decreased risk of disease recurrence among a population of women who have already had at least one apparent episode of PID, the results may indicate a similar reduced risk for PID acquisition in the general population, Dr. Ness noted, adding that more study is needed.
### Additional authors are Richard Sweet, M.D., University of Pittsburgh and Magee-Womens Hospital of the University of Pittsburgh Medical Center; Debra Bass, M.S., and Kevin Kip, Ph.D., both of the University of Pittsburgh; Hugh Randall, M.D., Emory University, Atlanta; Holley Richter, Ph.D., M.D., University of Alabama School of Medicine, Birmingham; Jeffrey Peipert, M.D., M.P.H., and Andrea Montagno, R.N., both of Women and Infants Hospital, Providence, R.I.; David Soper, M.D., Medical University of South Carolina, Charleston; Deborah Nelson, Ph.D., University of Pennsylvania, Philadelphia; Diane Schubeck, M.D., MetroHealth Medical Center, Cleveland; and Susan Hendrix, D.O., Wayne State University, Detroit.
Funding for the study was received from the Agency for Healthcare Research and Quality and from the National Institute of Allergy and Infectious Diseases at NIH.
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