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Recurrent chlamydial infections increase the risks of hospitalization for ectopic pregnancy and pelvic inflammatory disease

      Abstract

      OBJECTIVE: We examined whether the risks of hospitalization for ectopic pregnancy and pelvic inflammatory disease increase with increasing numbers of chlamydial infections. STUDY DESIGN: A retrospective cohort design was used to evaluate the risks of hospitalization for ectopic pregnancy or pelvic inflammatory among 11,000 Wisconsin women who had one or more chlamydial infections between 1985 and 1992. Logistic regression was used to evaluate the strength of association between recurrent infection and sequelae. RESULTS: After adjustment in multivariate analyses, we observed elevated risks of ectopic pregnancy among women who had had two (odds ratio 2.1, 95% confidence interval 1.3 to 3.4) and three or more chlamydial infections (odds ratio 4.5, 95% confidence interval 1.8 to 5.3). These groups were also at increased risk for pelvic inflammatory (two infections: odds ratio 4.0, 95% confidence interval 1.6 to 9.9; three or more infections: odds ratio 6.4, 95% confidence interval 2.2 to 18.4). CONCLUSIONS: A unique prevention opportunity occurs at the diagnosis of any chlamydial infection because women with subsequent recurrences are at increased risk for reproductive sequelae.

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      References

        • Centers for Disease Control and Prevention
        Ectopic pregnancy—United States, 1990-1992.
        MMWR Morb Mortal Wkly Rep. 1995; 44: 46-48
        • National Center for Health Statistics
        Advanced report of final mortality statistics, 1992.
        in: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, Hyattsville (MD)1994 (Monthly Vital Statistics Report, Vol. 43(Suppl), No.: 6)
        • Goldner TE
        • Lawson HW
        • Xia Z
        • Atrash HK
        Surveillance for ectopic pregnancy—United States, 1970-1989.
        MMWR CDC Surveill Summ. 1993; 42: 73-85
        • Barnes A
        • Weinburg C
        • Barnes B.
        Ectopic pregnancy incidence and review of determinant factors.
        Obstet Gynecol Surv. 1983; 38: 345-356
        • Chow WH
        • Daling JR
        • Cates W
        • Greenberg RS.
        Epidemiology of ectopic pregnancy.
        Epidemiol Rev. 1987; 9: 70-94
        • Martin DH.
        Chlamydial infections.
        Med Clin North Am. 1990; 74: 1367-1387
        • Brunham RC
        • Binns B
        • McDowell J
        • Paraskevas M
        Chlamydia trachomatis infection in women with ectopic pregnancy.
        Obstet Gynecol. 1986; 67: 722-726
        • Westrom L.
        Influence of sexually transmitted diseases on sterility and ectopic pregnancy.
        Acta Eur Fertil. 1985; 16: 21-24
        • Westrom L.
        Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries.
        Am J Obstet Gynecol. 1980; 138: 880-891
        • Addiss DG
        • Vaughn ML
        • Hillis SD
        • Amsterdam L
        • Davis JP
        History and essential features of the Wisconsin Chlamydia trachomatis Control Program.
        Fam Plann Perspect. 1994; 2: 83-87
        • Hillis SD
        • Nakashima A
        • Marchbanks PA
        • Addiss DG
        • Davis JP
        Risk factors for recurrent Chlamydia trachomatis infections in women.
        Am J Obstet Gynecol. 1994; 170: 801-806
        • U.S. Department of Health and Human Services
        International classification of diseases, ninth revision, clinical modification.
        U.S. Department of Health and Human Services, Ann Arbor (MI)1980 (DHHS publication No.: PHS 80-1260)
        • Centers for Disease Control and Prevention
        Recommendations for the prevention and management of Chlamydia trachomatis infections.
        MMWR 1993. 1993; 42: RR-112
        • Hennekens CH
        • Buring JE.
        Epidemiology in medicine.
        Little, Brown, Boston1987
        • Morrison RP
        Immune responses to Chlamydia are protective and pathogenetic.
        in: Chlamydial infections: proceedings of the seventh international symposium on human chlamydial infections. Cambridge University Press, Cambridge1990: 580-583
        • Patton DL
        • Kuo CC
        Histopathology of Chlamydia trachomatis salpingitis after primary and repeated reinfections in the monkey subcutaneous pocket model.
        J Reprod Fertil. 1989; 85: 647-656
        • Taylor HR
        • John SL
        • Prendergast RA
        • Schachter J
        • Dawson CR
        • Silverstein AM.
        An animal model of trachoma, II: the importance of repeated reinfection.
        Invest Ophthalmol Vis Sci. 1982; 23: 507-515
        • Monnickendam MA
        • Darougar S
        • Treharne JD
        • Tilbury AM.
        Development of chronic conjunctivitis with scarring and pannus, resembling trachoma, in guinea-pigs.
        Br J Ophthalmol. 1980; 64: 284-290
        • Rolfs RT
        • Galaid EL
        • Zaidi AA.
        Pelvic inflammatory disease: trends in hospitalizations and office visits, 1979 through 1988.
        Am J Obstet Gynecol. 1992; 166: 983-990
        • Katz BP
        • Zwickl BW
        • Caine VA
        • Jones RB
        Compliance with antibiotic therapy for Chlamydia trachomatis and Neisseria gonorrhoeae.
        Sex Transm Dis. 1992; 19: 351-354
        • Stamm WE.
        Azithromycin in the treatment of uncomplicated genital chlamydial infections.
        Am J Med. 1991; 91: 19S-22S