Simms, Ian David; (2003) The epidemiology of pelvic inflammatory disease in England. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background Pelvic inflammatory disease (PID) is considered to be a leading cause of morbidity in women but little is known of its epidemiology in England. Aim To investigate the epidemiology of PID and explore factors associated with PID. Objectives Four studies were undertaken: (1) to evaluate surveillance data available from health care settings; (2) to investigate the diagnosis, treatment and management of PID in general practice; (3) to use an available dataset to assess diagnostic accuracy based on clinical presentation; and (4) to investigate demographic and behavioural factors, serological parameters and causative agents associated with PID through an original case-control study. Results The highest burden of disease was seen in general practice where 1.7% of reproductive age women were diagnosed with PID, although management fell below acceptable standards. The most effective diagnostic criteria were the presence of lower abdominal pain and the exclusion of competing diagnoses. The case-control study showed that PID had the characteristics typical of a sexually transmitted disease. When compared against a tubal ligation control group increased risk of PID was associated with: age group 25 years; age at first sexual intercourse 20 years; non-White ethnic identity; having had children; a self reported history of an STD; and exposure to C. trachomatis. When compared against the general practice control group increased risk was associated with: age group 25 years; age at first sexual intercourse 15 years; lower socio-economic status; marital status other than being married; adverse pregnancy outcome; a self reported history of an STD; and exposure to C. trachomatis. Of the cases, 64% were not associated with any of the infectious agents measured in this study (idiopathic). Some idiopathic cases were associated with Mycoplasma genitalium. Conclusions Diagnostic methods and knowledge of disease aetiology need to be improved if further epidemiological investigations and surveillance initiatives are undertaken.

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