Microbial correlates of delayed care for pelvic inflammatory disease
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Published on: December 4, 2020
Brandie D Taylor1, Roberta B Ness, Toni Darville
1Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15213, USA. depaolib@edc.pitt.edu
Objective:
We studied the microbial correlates of time to care and long-term outcomes among pelvic inflammatory disease (PID) patients, as delayed care may increase the risk for reproductive sequelae.
Methods:
Mean days of pain before care were compared by microbial pathogen (Chlamydia trachomatis only, Neisseria gonorrhoeae only, Mycoplasma genitalium only, coinfection with 2 or more pathogens, or no pathogens) among 298 women with histologically confirmed endometritis from the PID Evaluation and Clinical Health study. Times to pregnancy and recurrent PID were assessed over a mean of 84 months and compared between women who delayed care (≥14 days) and women who sought early care, in the entire cohort and in subsets defined by microbial infection. Analyses were adjusted for age and race, additionally time to pregnancy was adjusted for self-reported baseline infertility.
Results:
Patients waited a mean of 7 days before seeking care for symptoms. Time to care was longest among women infected by C. trachomatis only (12.3 ± 9.4 days) and M. genitalium only (10.9 ± 8.9 days) and the shortest among women infected by N. gonorrhoeae only (4.6 ± 5 days) or coinfection (5.6 ± 5.1 days, P < 0.001). Rates of infertility, recurrent PID, and chronic pelvic pain were frequent overall (17%, 20%, and 36%) and tended to be higher, albeit nonsignificantly, after delayed care.
Conclusions:
Among women with clinically suspected PID, time to care was generally high. C. trachomatis and M. genitalium positive women had the longest times to care. Although reproductive morbidity was high in this cohort, associations with delayed care were nonsignificant.
Insights
Pelvic inflammatory disease (PID) patients infected with Chlamydia trachomatis or Mycoplasma genitalium experienced longer delays in seeking care. While reproductive morbidity was high, delayed care did not significantly increase these risks.
Area of Science:
- Reproductive infectious disease
- Microbiology
- Clinical outcomes research
Background:
- Delayed medical care for pelvic inflammatory disease (PID) can lead to severe reproductive health complications.
- Understanding the microbial causes of PID is crucial for identifying risk factors associated with delayed diagnosis and treatment.
- The PID Evaluation and Clinical Health (PEACH) study provides a valuable cohort for investigating the long-term effects of PID and its microbial correlates.
Purpose of the Study:
- To investigate the relationship between specific microbial pathogens and the time to seek care among women diagnosed with PID.
- To assess the association between delayed care for PID and long-term reproductive outcomes, including infertility, recurrent PID, and chronic pelvic pain.
Main Methods:
- A cohort of 298 women with histologically confirmed endometritis from the PID Evaluation and Clinical Health study was analyzed.
- Mean days to care were compared based on the identified microbial pathogen: Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, coinfection, or no pathogen.
- Long-term outcomes (time to pregnancy, recurrent PID) were assessed over a mean of 84 months and compared between women with delayed care (≥14 days) and early care, with adjustments for relevant covariates.
Main Results:
- The average delay in seeking care for PID symptoms was 7 days.
- Women infected solely with Chlamydia trachomatis (12.3 days) or Mycoplasma genitalium (10.9 days) experienced the longest delays in seeking care.
- Infertility (17%), recurrent PID (20%), and chronic pelvic pain (36%) were prevalent, with a trend towards higher rates after delayed care, though not statistically significant.
Conclusions:
- Women with clinically suspected PID often experienced significant delays in seeking care.
- Chlamydia trachomatis and Mycoplasma genitalium infections were associated with the longest durations of delayed care.
- Despite high rates of reproductive morbidity in the cohort, the association between delayed care and these adverse outcomes did not reach statistical significance.
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