title: Lower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease.
abstract: OBJECTIVE
  To investigate the association between lower genital tract infections and subclinical PID. Fallopian tube damage is a common complication of acute symptomatic pelvic inflammatory disease (PID), yet most women with tubal factor infertility do not have a history of acute PID. Subclinical PID is believed to be an important cause of tubal factor infertility.
  
  
  METHODS
  We conducted a cross-sectional study among women attending a sexually transmitted diseases or ambulatory gynecology clinic. A convenience sample of 556 women with bacterial vaginosis, gonorrhea, or chlamydia, or women at risk for gonorrhea or chlamydia were enrolled. Women diagnosed with acute PID were not eligible to participate. The main outcome was subclinical PID, as defined by the presence of histologic endometritis.
  
  
  RESULTS
  Subclinical PID was more common in women with lower genital tract infection than in uninfected women. Subclinical PID was present in 27% of women with Chlamydia trachomatis (odds ratio 3.4; 95% confidence interval [CI] 1.8, 6.3) and in 26% of women infected with Neisseria gonorrhoeae (odds ratio 2.4; 95% CI 1.1, 5.1). Among women with bacterial vaginosis, 15% had endometritis (odds ratio 2.7; 95% CI 1.02, 7.2).
  
  
  CONCLUSIONS
  Subclinical PID is common among women with lower genital tract infections. Additional prospective studies are necessary to determine the reproductive impact of these asymptomatic upper genital tract infections.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Research Institute, Pennsylvania 15213, USA. hwiesenfeld@mail.magee.edu
authors.forename: Harold C
authors.initials: HC
authors.lastname: Wiesenfeld
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Hillier
authors.forename: Marijane A
authors.initials: MA
authors.lastname: Krohn
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Amortegui
authors.forename: R Phillips
authors.initials: RP
authors.lastname: Heine
authors.forename: Daniel V
authors.initials: DV
authors.lastname: Landers
authors.forename: Richard L
authors.initials: RL
authors.lastname: Sweet
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004716:Endometritis / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005831:Genital Diseases, Female / Q000175:diagnosis / Q000453:epidemiology; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D000292:Pelvic Inflammatory Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D011336:Probability; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014626:Vaginal Smears; D016585:Vaginosis, Bacterial / Q000175:diagnosis / Q000453:epidemiology