Washington A E, Gove S, Schachter J, Sweet R L
JAMA. 1985 Apr 19;253(15):2246-50.
Management of pelvic inflammatory disease (PID) and decisions about contraception are being influenced by reports that oral contraceptives decrease the risk of PID. To evaluate the validity of this association, we have examined published epidemiologic evidence and reviewed relevant information from other disciplines. Current information does not permit the generalization that oral contraceptives protect against all forms of PID. Most studies conducted (1) have been limited to hospitalized women, who represent less than 25% of all PID cases and are likely to have relatively severe forms of the disease, and (2) have failed to distinguish between gonococcal and nongonococcal PID. While oral contraceptives may provide some protection against gonococcal PID, no basis exists for assuming similar protection is provided against chlamydial PID. In fact, epidemiologic and biologic evidence suggests that infection with Chlamydia trachomatis, the leading cause of nongonococcal PID, is enhanced by oral contraceptives. We judge the conclusion that oral contraceptives protect against all PID to be premature, and urge caution in its application in health policy and clinical decisions.
盆腔炎（PID）的管理以及避孕决策正受到口服避孕药可降低PID风险这一报告的影响。为评估这种关联的有效性，我们审视了已发表的流行病学证据，并查阅了其他学科的相关信息。现有信息并不支持口服避孕药能预防所有形式PID这一普遍结论。多数已开展的研究存在两个问题：一是局限于住院女性，而她们在所有PID病例中所占比例不到25%，且可能患有相对严重的疾病形式；二是未能区分淋菌性PID和非淋菌性PID。虽然口服避孕药可能对淋菌性PID有一定预防作用，但并无依据假定其对衣原体性PID也有类似预防作用。事实上，流行病学和生物学证据表明，口服避孕药会增加沙眼衣原体（非淋菌性PID的主要病因）感染几率。我们认为口服避孕药能预防所有PID的结论尚不成熟，并敦促在健康政策和临床决策应用中保持谨慎。
