Kirby Institute, University of New South Wales (UNSW).
Sydney Sexual Health Centre, Sydney Hospital.
Clin Infect Dis. 2018 Jan 18;66(3):437-443. doi: 10.1093/cid/cix769.
There is uncertainty around whether the risks of pelvic inflammatory disease (PID) differ following Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhea) infection. We quantified the risk of PID associated with chlamydia and gonorrhea infection and subsequent repeat infections in a whole-population cohort.
A cohort of 315123 Western Australian women, born during 1974-1995, was probabilistically linked to chlamydia and gonorrhea testing records and to hospitalizations and emergency department presentations for PID from 2002 to 2013. Time-updated survival analysis was used to investigate the association between chlamydia and gonorrhea testing, and positivity, and risk of PID.
Over 3199135 person-years, 120748 women had pathology test records for both chlamydia and gonorrhea, 10745 chlamydia only, and 653 gonorrhea only. Among those tested, 16778 (12.8%) had ≥1 positive chlamydia test, 3195 (2.6%) ≥1 positive gonorrhea test, and 1874 (1.6%) were positive for both. There were 4819 PID presentations (2222 hospitalizations, 2597 emergency presentations). Adjusting for age, Aboriginality, year of follow-up, health area, and socioeconomic status, compared to women negative for chlamydia and gonorrhea, the relative risk (adjusted incidence rate ratio) of PID was 4.29 (95% confidence interval [CI], 3.66-5.03) in women who were both chlamydia and gonorrhea positive; 4.54 (95% CI, 3.87-5.33) in those only gonorrhea positive; and 1.77 (95% CI, 1.61-1.94) in those only chlamydia positive.
Gonorrhea infection conferred a substantially higher risk than chlamydia of hospitalization or emergency department presentation for PID. The emergence of gonorrhea antimicrobial resistance may have a serious impact on rates of PID and its associated reproductive health sequelae.
衣原体（chlamydia）和淋病奈瑟菌（gonorrhea）感染后发生盆腔炎（PID）的风险是否不同，目前尚不确定。我们在全人群队列中定量评估了衣原体和淋病感染相关 PID 以及随后重复感染的风险。
我们对 1974 年至 1995 年期间出生的 315123 名西澳大利亚女性进行了概率性链接，以获取衣原体和淋病检测记录以及 2002 年至 2013 年期间 PID 的住院和急诊就诊记录。时间更新生存分析用于研究衣原体和淋病检测和阳性与 PID 风险之间的关联。
在 3199135 人年中，有 120748 名女性的衣原体和淋病检测结果均为阳性，10745 名女性仅衣原体检测结果阳性，653 名女性仅淋病检测结果阳性。在接受检测的女性中，16778 名（12.8%）至少有 1 次衣原体检测阳性，3195 名（2.6%）至少有 1 次淋病检测阳性，1874 名（1.6%）两种病原体均为阳性。共发生 4819 例 PID 就诊（2222 例住院，2597 例急诊就诊）。调整年龄、原住民身份、随访年限、卫生区和社会经济地位后，与衣原体和淋病均为阴性的女性相比，衣原体和淋病均阳性的女性 PID 的相对风险（调整发病率比）为 4.29（95%置信区间[CI]，3.66-5.03）；仅淋病阳性的女性为 4.54（95%CI，3.87-5.33）；仅衣原体阳性的女性为 1.77（95%CI，1.61-1.94）。
淋病感染导致住院或急诊就诊 PID 的风险明显高于衣原体感染。淋病抗菌药物耐药性的出现可能对 PID 及其相关生殖健康后果的发生率产生严重影响。
