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Recurrent PID, Subsequent STI, and Reproductive Health Outcomes: Findings from the PID Evaluation and Clinical Health (P PowerPoint Presentation
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Recurrent PID, Subsequent STI, and Reproductive Health Outcomes: Findings from the PID Evaluation and Clinical Health (PEACH) Study. Maria Trent, MD, MPH Debra Bass, MS Roberta Ness, MD, MPH Catherine Haggerty, PhD, MPH. Funding: Centers for Disease Control and Prevention: K01DP001128-02;

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Recurrent PID, Subsequent STI, and Reproductive Health Outcomes: Findings from the PID Evaluation and Clinical Health (PEACH) Study

Maria Trent, MD, MPH

Debra Bass, MS

Roberta Ness, MD, MPH

Catherine Haggerty, PhD, MPH

Funding: Centers for Disease Control and Prevention: K01DP001128-02;

Agency for Healthcare Research and Quality Development: HS08358-05

disclosures
Disclosures
  • I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or providers (s) of commercial services discussed in this CME activity.
  • I do not intend to discuss off-label use of products in this presentation
background
Background
  • PID is a common reproductive health disorder
  • Associated with significant reproductive morbidity:
    • Tubal infertility
    • Ectopic pregnancy
    • Chronic pelvic pain (CPP)
  • Risk estimates of morbidity based on Scandinavian cohort of PID inpatients enrolled 1960 -1984
    • Subsequent shifts in the biological organisms causing PID
    • Management shifted to outpatient setting
  • Re-analysis of the impact of recurrent PID and STIs warranted
objective
Objective
  • To examine the risk of longitudinal adverse outcomes associated with recurrent STIs and PID among urban American women with mild-moderate PID
  • To determine the potential impact of adolescence on the observed longitudinal outcomes
methods
Methods
  • Secondary data analysis
  • PID Evaluation and Clinical Health (PEACH)Study
    • Women 14-38 years with mild-moderate PID
    • Urban Settings in United States
    • Randomized to inpatient/outpatient treatment
    • Baseline interview & gynecologic exam (endometrial biopsies, STI testing)
    • Visits at 5 and 30 days
    • Telephone interview quarterly x 84 months
approach to analysis
Approach to Analysis

PEACH

831 Women 14-38 years Mild-Moderate PID

Randomized to Inpatient/ Outpatient Arms

Main PEACH Analysis

No Difference in Outcomes by group

Adolescent Sub-Analysis (≤19 yrs)

N=209

Re-Analysis based on Recurrent PID/STI

methods7
Methods
  • Data evaluated using bivariate & multiple regression analyses
  • Analysis approved by Johns Hopkins IRB
conclusions
Conclusions
  • Women with recurrent PID are more likely to report infertility and CPP at 84 months
  • Substantiates the relationship between recurrent PID and adverse
    • Modern microbiology
    • Outpatient and inpatient care approaches
  • Highlights CPP as a major adverse outcome and recurrent lower genital tract infection (STI) as a key contributor
  • Supports to the concept of tertiary prevention
    • Upper genital tract disease = smaller, well defined public health
    • Adolescents are also an important sub-target
limitations
Limitations
  • Limited Generalizability
    • Demographics
    • Trial Participation
      • Contraception
  • Clinical Criteria for PID
    • Endometrial biopsies
    • Mimics clinical practice
  • Self-Reported Longitudinal Outcomes
    • Supported by medical record review
implications
Implications
  • Young women with a history of PID are a clearly defined target group for public health intervention.
  • Acute PID should prompt linkage of affected patients to tailored STI risk-reduction services to prevent the adverse outcomes associated with PID