Coste J, Laumon B, Brémond A, Collet P, Job-Spira N
Institut National de la Sante et de la Recherche Medicale (INSERM) U.292, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Fertil Steril. 1994 Aug;62(2):289-95. doi: 10.1016/s0015-0282(16)56881-2.
To evaluate the current impact of sexually transmitted diseases (STDs) and their consequences on the occurrence of ectopic pregnancy (EP).
Case-control study.
Fifteen maternity hospitals in the Rhône-Alpes region, France.
Six hundred twenty-four women with EP diagnosed from October 1988 to December 1991 and 1,247 controls who delivered liveborn children during the same period.
Information on risk factors included behavioral, clinical, and serological indicators of STDs and other known risk factors of EP.
Logistic regression identified several indicators of STDs as strong and independent risk factors for EP: previously treated STD without history of salpingitis; history of probably pelvic inflammatory disease (PID) and, especially, history of confirmed PID; previous STDs of the sexual partner; and Chlamydia trachomatis seropositivity. The adjusted attributable fractions of EP for previous symptomatic STDs, symptomatic STDs of the sexual partner, and C. trachomatis seropositivity were 20%, 3.5%, and 25.2%, respectively, giving a total of 43% of EP cases attributable to infectious factors.
Our findings and previous epidemiological and biological evidence suggest that STD is a major cause of EP. The evidence is particularly strong in the case of C. trachomatis infection. An effective way of dramatically reducing the EP rate would be to prevent STD through education programs sensitizing young women to the complications of STD and public health measures promoting the use of protective methods such as condoms.
评估性传播疾病（STD）的当前影响及其对异位妊娠（EP）发生的后果。
病例对照研究。
法国罗纳-阿尔卑斯地区的15家妇产医院。
1988年10月至1991年12月期间诊断为EP的624名女性以及同期分娩活产婴儿的1247名对照。
关于危险因素的信息包括性传播疾病的行为、临床和血清学指标以及异位妊娠的其他已知危险因素。
逻辑回归确定了几种性传播疾病指标为异位妊娠的强独立危险因素：既往有性传播疾病治疗史但无输卵管炎病史；可能的盆腔炎（PID）病史，尤其是确诊的PID病史；性伴侣既往有性传播疾病；以及沙眼衣原体血清阳性。既往有症状性传播疾病、性伴侣有症状性传播疾病和沙眼衣原体血清阳性导致的异位妊娠调整归因分数分别为20%、3.5%和25.2%，总计43%的异位妊娠病例可归因于感染因素。
我们的研究结果以及先前的流行病学和生物学证据表明，性传播疾病是异位妊娠的主要原因。在沙眼衣原体感染的情况下，证据尤为确凿。大幅降低异位妊娠率的有效方法是通过教育项目提高年轻女性对性传播疾病并发症的认识，并通过公共卫生措施推广使用避孕套等保护方法来预防性传播疾病。
