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Recurrent PID, Subsequent STI, and Reproductive Health Outcomes: Findings from the PID Evaluation and Clinical Health (PEACH) Study Maria Trent, MD, MPH.

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Presentation on theme: "Recurrent PID, Subsequent STI, and Reproductive Health Outcomes: Findings from the PID Evaluation and Clinical Health (PEACH) Study Maria Trent, MD, MPH."— Presentation transcript:

1 Recurrent PID, Subsequent STI, and Reproductive Health Outcomes: Findings from the PID Evaluation and Clinical Health (PEACH) Study Maria Trent, MD, MPH Debra Bass, MS Roberta Ness, MD, MPH Catherine Haggerty, PhD, MPH Funding: Centers for Disease Control and Prevention: K01DP001128-02; Agency for Healthcare Research and Quality Development: HS08358-05

2 Disclosures I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or providers (s) of commercial services discussed in this CME activity. I do not intend to discuss off-label use of products in this presentation

3 Background PID is a common reproductive health disorder Associated with significant reproductive morbidity: – Tubal infertility – Ectopic pregnancy – Chronic pelvic pain (CPP) Risk estimates of morbidity based on Scandinavian cohort of PID inpatients enrolled 1960 -1984 – Subsequent shifts in the biological organisms causing PID – Management shifted to outpatient setting Re-analysis of the impact of recurrent PID and STIs warranted

4 Objective To examine the risk of longitudinal adverse outcomes associated with recurrent STIs and PID among urban American women with mild- moderate PID To determine the potential impact of adolescence on the observed longitudinal outcomes

5 Methods Secondary data analysis PID Evaluation and Clinical Health (PEACH)Study – Women 14-38 years with mild-moderate PID – Urban Settings in United States – Randomized to inpatient/outpatient treatment – Baseline interview & gynecologic exam (endometrial biopsies, STI testing) – Visits at 5 and 30 days – Telephone interview quarterly x 84 months

6 PEACH 831 Women 14-38 years Mild-Moderate PID Randomized to Inpatient/ Outpatient Arms Main PEACH Analysis No Difference in Outcomes by group Re-Analysis based on Recurrent PID/STI Adolescent Sub-Analysis (≤19 yrs) N=209 Approach to Analysis

7 Methods Data evaluated using bivariate & multiple regression analyses Analysis approved by Johns Hopkins IRB

8 Selected Demographics Baseline Measure% (N) Race/Ethnicity Black White Hispanic Native American/Alaskan Native 74.5% (621) 16.0% (133) 6.1% (51) 3.1% (26) Insurance Status Uninsured Private Public 43.8% (364) 13.8% (115) 33.5% ( 278) Regular Access to Care65% (539) Ever Pregnant75.2% (625) Prior history of PID37.4% (311) New Sexual Partner 9.3% (78) Any Contraceptive use past 4 weeks61.0% (508)

9 84-Month Reproductive Health Outcomes

10 Subsequent STI & Reproductive Health Outcomes: All Women Subsequent STI (N = 195) No Subsequent STI (N = 596) OR (95% CI) Adjusted OR (95% CI)* Pregnancy**124 (63.6)330 (55.4)1.4 (1.0 – 2.0)1.0 (0.7 – 1.5) Live Birth*91 (46.7)239 (40.1)1.3 (.09 – 1.8)1.0 (0.7 – 1.4) Infertility41 (21.0)104 (17.4)1.3 (0.8 – 1.9)1.4 (0.9 – 2.2) Chronic pelvic pain 105 (53.8)218 (37.7)1.9 (1.4 – 2.7)2.3 (1.6 – 3.2)

11 Outcomes by Recurrent PID Status: ALL Women Recurrent PID (N = 168) No Recurrent PID (N = 621) OR (95% CI) Adjusted OR (95% CI)* Pregnancy**95 (56.5)356 (57.3)1.0 (0.7 – 1.4)1.0 (0.6 – 1.4) Live Birth*61 (36.3)270 (43.5)0.7 (0.5 – 1.1)0.7 (0.5 – 1.0) Infertility44 (26.2)104 (16.7)1.8 (1.2 – 2.6)1.8 (1.2 – 2.8) Chronic pelvic pain 115 (68.5)213 (35.3)4.0 (2.8 – 5.7)4.2 (2.8 – 6.2)

12 Subsequent STI & Reproductive Health Outcomes: Adolescent Subsequent STI (N = 195) No Subsequent STI (N = 596) OR (95% CI) Adjusted OR (95% CI)* Pregnancy**124 (63.6)330 (55.4)1.4 (1.0 – 2.0)1.0 (0.7 – 1.5) Live Birth*91 (46.7)239 (40.1)1.3 (.09 – 1.8)1.0 (0.7 – 1.4) Infertility41 (21.0)104 (17.4)1.3 (0.8 – 1.9)1.4 (0.9 – 2.2) Chronic pelvic pain 105 (53.8)218 (37.7)1.9 (1.4 – 2.7)2.3 (1.6 – 3.2)

13 Outcomes by Recurrent PID Status: Adolescents Recurrent PID (N = 50) No Recurrent PID (N =149) OR (95% CI) Adjusted OR (95% CI)* Pregnancy**34 (68.0)108 (72.5)0.8 (0.4 – 1.6)1.1 (0.5 – 2.2) Live Birth22 (44.0)80 (53.7)0.7 (0.4 – 1.3)0.9 (0.4 – 1.7) Infertility13 (26.0)23 (15.4)1.9 (0.9 – 4.2)1.9 (0.8 – 4.4) Chronic pelvic pain 34 (68.0)44 (30.1)4.9 (2.5 – 9.8)5.0 (2.3 – 10.6)

14 Conclusions Women with recurrent PID are more likely to report infertility and CPP at 84 months Substantiates the relationship between recurrent PID and adverse – Modern microbiology – Outpatient and inpatient care approaches Highlights CPP as a major adverse outcome and recurrent lower genital tract infection (STI) as a key contributor Supports to the concept of tertiary prevention – Upper genital tract disease = smaller, well defined public health – Adolescents are also an important sub-target

15 Limitations Limited Generalizability – Demographics – Trial Participation Contraception Clinical Criteria for PID – Endometrial biopsies – Mimics clinical practice Self-Reported Longitudinal Outcomes – Supported by medical record review

16 Implications Young women with a history of PID are a clearly defined target group for public health intervention. Acute PID should prompt linkage of affected patients to tailored STI risk-reduction services to prevent the adverse outcomes associated with PID


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