The Effectiveness for Treatment of Pelvic Inflammatory Disease on Long-Term Sequelae

Among women with pelvic inflammatory disease (PID), prevention of adverse reproductive sequelae is similarly achieved by outpatient and inpatient treatment. It is unknown if outpatient treatment is as effective as inpatient treatment among women in various subgroups based on relevant categories of age, race and clinical presentation, and if there are short-term outcomes of PID treatment that predict pregnancy, recurrent PID and chronic pelvic pain.Women with clinical symptoms of mild-to-moderate pelvic inflammatory disease (n=831) were randomized into the PID Evaluation and Clinical Health trial, a multicenter trial of outpatient versus inpatient treatment. Comparisons between treatment groups during a mean of 84 months of follow-up were made for: pregnancies, live births, time-to-pregnancy, infertility, PID recurrence, chronic pelvic pain, and ectopic pregnancy. Outpatient treatment assignment did not adversely impact the proportion of women having any of the outcomes among women of various races; with or without previous PID; with or without baseline Neisseria gonorrhoeae and/or Chlamydia trachomatis infection; and with or without severe PID. In analyses of the full study cohort irrespective of random assignment, four short-term markers (pelvic tenderness at 5 and 30 days, cervical infection at 30 days, endometritis at 30 days) were evaluated in relation to long-term sequelae. Pelvic tenderness at five days (adjusted HR 1.32, 95% CI: 1.05-1.67) and at thirty days (adjusted HR 2.45; 95% CI: 1.56-3.85) significantly elevated the relative risk for developing chronic pelvic pain; tenderness at 30 days was also significantly associated with recurrent PID (adjusted HR: 2.11; 95% CI: 1.18-3.79). However, pelvic tenderness at five days and at thirty days were poorly predictive of chronic pelvic pain or recurrent PID (positive predictive values 20.5-64.1%). In contrast to pelvic tenderness, cervical infection and endometritis at thirty days were not associated with chronic pelvic pain or recurrent PID. Moreover, none of the short-term markers significantly increased the likelihood of achieving a pregnancy. The public health significance of these findings are that women with pelvic inflammatory disease will not be adversely impacted by outpatient treatment and that no short-term marker of pelvic tenderness or infection can be predict the occurrence of PID-related reproductive morbidities