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State of Alaska Epidemiology Bulletin

Bulletin No. 6
March 27, 1981
Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) is the most serious complication of gonorrhea in women, resulting in long-term risks of chronic pelvic pain and involuntary sterilization. Approximately 100,000 women per year in the United States are rendered sterile because of gonococcal PID (GPID); most will be initially seen in hospital emergency rooms. The annual direct cost of complications of GPID in the U.S. is estimated at $644 million, while the indirect cost is estimated to be greater than $2 billion.

In an effort to determine the extent of GPID in Alaska, the VD Unit, Section of Communicable Disease Control, conducted medical chart reviews at three hospitals during 1980. Of OPD/ER females with a positive gonorrhea culture, 86 of 355 (24%) had GPID. For use in our medical chart review, GPID was defined as:

(1) A clinician's diagnosis of PID; or
(2) Pelvic symptoms or signs (i.e., abdominal pain, adnexal tenderness, etc.) other than an abnormal vaginal discharge when other conditions are judged unlikely.

Plus one or more of the following in order of preference:

(1) Positive endocervical or anal culture for N. gonorrhea.
(2) Typical gram-negative intracellular diplococci (as determined by an experienced microscopist) on an endocervical smear.
(3) Gonococcal urethritis diagnosed in a current established male sex consort (sexual contact within the last 30 days).

In order to improve diagnosis, treatment, management, and reporting of GPID, we recommend the following:

(1) That all women presenting to Out-patient/ER with symptoms suggestive of PID receive a bimanual examination and an endocervical culture.
(2) That antibiotic therapy is begun immediately when PID is clinically suspected and that the treatment regimens employed are consistent with the Centers for Disease Control recommended treatment schedules. (Communicable Disease Bulletin, Week Ending February 2, 1979, Number 2).
(3) That all GPID patients receive medical follow-up including:
a) An evaluative bimanual examination to be performed within 3-5 days after therapy was initiated to check improvement.
b) A test-of-culture and repeat bimanual examination 13-17 days after therapy was initiated. The test-of-culture should include specimens from both the cervix and anal canal.
c) A final follow-up bimanual examination and culture 4-6 weeks after therapy was initiated to check for reinfection.
(4) That adequate locating information is obtained on all patients to facilitate notification should the patient fail to keep scheduled appointments.
(5) That GPID patients are counseled about the importance of returning for their test results and medical follow-up. They should also be counseled about the need to notify all their sexual contacts during the previous 60 days and to avoid further sexual contact with them until they have also been examined and treated. GPID patients should avoid all sexual contact for at least 2-3 weeks after treatment begins.
(6) That all GPID patients with I.U.D.'s have them removed and be provided with an alternate method of contraception for at least 3 months because of the suspected correlation between I.U.D. usage and the increased risk of additional episodes of PID.
(7) That all cases of gonorrhea are immediately reported to the VD Unit of the Section of Communicable Disease Control and that GPID is differentiated from uncomplicated gonorrhea. Reporting can be made on our Rapid Telephonic Reporting System by dialing 279-5535 in the Anchorage area or by calling the long distance operator and asking for Zenith 1700.

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