The Role of Delayed Care Seeking and Toll-like Receptors in Pelvic Inflammatory Disease and Its Sequelae

Pelvic Inflammatory Disease (PID), the infection and inflammation of the female upper genital tract, can result in serious sequelae. Markers to predict sequelae following PID are greatly needed. The goal of this research is to explore the role of host genetic factors and delayed care seeking in the development of sequelae following clinically suspected PID. We studied the microbial correlates of delayed care and long-term outcomes among 298 women with histologically confirmed endometritis from the PID Evaluation and Clinical Health (PEACH) study. Mean days of pain prior to care were compared by microbial pathogen, with the longest times among women infected by Chlamydia trachomatis (CT) only (12.3±9.4 days) and Mycoplasma genitalium (MG) only (10.9±8.9 days), and the shortest among women infected by Neisseria gonorrhoeae (NG) only (4.6±5 days) or co-infection (5.6±5.1 days, p<0.001). Infertility, recurrent PID, and chronic pelvic pain were frequent (17%, 20%, and 36%), albeit non-significantly elevated after delayed care. PID patients infected with CT or MG were more likely to delay care, possibly increasing persistent inflammation which may permanently damage the reproductive tract before patients seek care.Toll-like receptors (TLR) eliminate microbes through inflammatory responses. As genetic variations may increase TLR signaling, we determined if 18 tagging single nucleotide polymorphisms assayed in 4 TLR genes (TLR1, TLR2, TLR4, TLR6) and 2 adaptor molecules (TIRAP, MyD88) were associated with CT, endometritis, or infertility among 205 African Americans with PID from the PEACH study. An empirical p-value