Risk of pelvic inflammatory disease (PID) decreases with condom use

A multi-center study from the University of Pittsburgh's Graduate School of Public Health suggests that women wishing to decrease their risk of pelvic inflammatory disease (PID) should ensure that their sexual partners use condoms consistently.

The study is the first 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.

Aside from AIDS, the most common and serious complication of sexually transmitted diseases (STDs) among women is pelvic inflammatory disease (PID), an infection of the upper genital tract. PID can affect the uterus, ovaries, fallopian tubes, or other related structures. Untreated, PID causes scarring and can lead to infertility, tubal pregnancy, chronic pelvic pain, and other serious consequences.

Each year in the United States, more than 1 million women experience an episode of acute PID, with the rate of infection highest among teenagers. More than 100,000 women become infertile each year as a result of PID, and a large proportion of the 70,000 ectopic (tubal) pregnancies occurring every year are due to the consequences of PID. In 1997 alone, an estimated $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.

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