Departments of Obstetrics, Gynecology and Reproductive Sciences and Pathology, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Obstet Gynecol. 2012 Jul;120(1):37-43. doi: 10.1097/AOG.0b013e31825a6bc9.
The reported incidence of acute pelvic inflammatory disease (PID) has decreased but rates of tubal infertility have not, suggesting that a large proportion of PID leading to infertility may be undetected. Subclinical PID is common in women with uncomplicated chlamydial or gonococcal cervicitis or with bacterial vaginosis. We assessed whether women with subclinical PID are at an increased risk for infertility.
A prospective observational cohort of 418 women with or at risk for gonorrhea or chlamydia or with bacterial vaginosis was recruited. Women with acute PID were excluded. An endometrial biopsy was performed to identify endometritis (subclinical PID). After provision of therapy for gonorrhea, chlamydia and bacterial vaginosis participants were followed-up for fertility outcomes.
There were 146 incident pregnancies during follow-up, 50 pregnancies in 120 (42%) women with subclinical PID and 96 in 187 (51%) women without subclinical PID. Women with subclinical PID diagnosed at enrollment had a 40% reduced incidence of pregnancy compared with women without subclinical PID (hazard ratio 0.6, 95% confidence interval 0.4-0.8). Women with Neisseria gonorrhoeae or Chlamydia trachomatis, in the absence of subclinical PID, were not at increased risk for infertility.
Subclinical PID decreases subsequent fertility despite provision of treatment for sexually transmitted diseases. These findings suggest that a proportion of female infertility is attributable to subclinical PID and indicate that current therapies for sexually transmitted diseases are inadequate for prevention of infertility.
急性盆腔炎（PID）的报告发病率有所下降，但输卵管不孕率并未下降，这表明导致不孕的很大一部分 PID 可能未被发现。亚临床 PID 在患有单纯衣原体或淋病奈瑟菌宫颈炎或细菌性阴道病的女性中很常见。我们评估了患有亚临床 PID 的女性是否有更高的不孕风险。
招募了 418 名患有或有淋病或衣原体感染风险或患有细菌性阴道病的女性进行前瞻性观察性队列研究。排除急性 PID 患者。进行子宫内膜活检以确定子宫内膜炎（亚临床 PID）。在提供淋病、衣原体和细菌性阴道病治疗后，对参与者进行了生育结局随访。
随访期间发生了 146 例妊娠事件，50 例妊娠发生在 120 名（42%）患有亚临床 PID 的女性中，96 例妊娠发生在 187 名（51%）无亚临床 PID 的女性中。与无亚临床 PID 的女性相比，在入组时诊断出患有亚临床 PID 的女性妊娠发生率降低了 40%（风险比 0.6，95%置信区间 0.4-0.8）。患有淋病奈瑟菌或沙眼衣原体且无亚临床 PID 的女性不孕风险并未增加。
尽管对性传播疾病进行了治疗，但亚临床 PID 仍会降低随后的生育能力。这些发现表明，一部分女性不孕是由亚临床 PID 引起的，并表明目前用于治疗性传播疾病的疗法不足以预防不孕。
