Do short-term markers of treatment efficacy predict long-term sequelae of pelvic inflammatory disease?

• Published in: American journal of obstetrics and gynecology Vol. 198; no. 1; pp. 30.e1 - 30.e7
• Main Authors: Trautmann, Gail M., MA, Kip, Kevin E., MPH, PhD, Richter, Holly E., PhD, MD, Soper, David E., MD, Peipert, Jeffrey F., MD, MPH, Nelson, Deborah B., PhD, Trout, Wayne, MD, Schubeck, Dianne, MD, Bass, Debra C., MS, Ness, Roberta B., MD, MPH
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 2008; Elsevier
• Subjects: Administration, Oral; adnexitis; Adolescent; Adult; Bacterial diseases; Bacterial diseases of the genital system; Biological and medical sciences; Cefoxitin - administration & dosage; chlamydia; chronic pain; Dose-Response Relationship, Drug; Doxycycline - administration & dosage; Drug Administration Schedule; Drug Therapy, Combination; endometritis; Female; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Human bacterial diseases; Humans; Infectious diseases; infertility; Infertility, Female; Inflammation Mediators - analysis; Infusions, Intravenous; Medical sciences; Obstetrics and Gynecology; Pain Measurement; Pelvic Inflammatory Disease - diagnosis; Pelvic Inflammatory Disease - drug therapy; prediction; Predictive Value of Tests; Probability; Probenecid - administration & dosage; Proportional Hazards Models; Recurrence; recurrent pelvic inflammatory disease; Severity of Illness Index; Time Factors; treatment; Treatment Outcome; treatment; chronic pain; adnexitis; chlamydia; prediction; endometritis; infertility; recurrent pelvic inflammatory disease; Short term; Treatment; Treatment efficiency; Gynecology; Prediction; Biological marker; Salpingitis; Predictive factor; Long term; Obstetrics; Female genital diseases; Fallopian tube pathology
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2007.05.021

Objective This study was undertaken to assess whether short-term markers, often used to measure clinical cure after treatment for pelvic inflammatory disease, predict sequelae of lack of pregnancy, recurrent pelvic inflammatory disease, and chronic pelvic pain. Study Design Women with mild-to-moderate pelvic inflammatory disease were assessed after treatment initiation at 5 days for tenderness (n = 713) and at 30 days for tenderness, cervical infections and endometritis (n = 298). Pregnancy, recurrent pelvic inflammatory disease, and chronic pelvic pain were evaluated after 84 months, on average. Results Pelvic tenderness at 5 and at 30 days significantly elevated the risk for developing chronic pelvic pain; tenderness at 30 days was also significantly associated with recurrent pelvic inflammatory disease. However, pelvic tenderness at 5 and at 30 days was only modestly clinically predictive of chronic pelvic pain or recurrent pelvic inflammatory disease (positive predictive values 22.1-66.9%). No short-term marker significantly influenced the likelihood of achieving a pregnancy. Conclusion Tenderness at 5 or 30 days did not accurately predict the occurrence of pelvic inflammatory disease-related reproductive morbidities.