Do short-term markers of treatment efficacy predict long-term sequelae of pelvic inflammatory disease?
OBJECTIVE
This study was undertaken to assess whether short-term markers, often used to measure clinical cure after treatment for pelvic inflammatory disease, predict sequelae of lack of pregnancy, recurrent pelvic inflammatory disease, and chronic pelvic pain.


METHODS
Women with mild-to-moderate pelvic inflammatory disease were assessed after treatment initiation at 5 days for tenderness (n = 713) and at 30 days for tenderness, cervical infections and endometritis (n = 298). Pregnancy, recurrent pelvic inflammatory disease, and chronic pelvic pain were evaluated after 84 months, on average.


RESULTS
Pelvic tenderness at 5 and at 30 days significantly elevated the risk for developing chronic pelvic pain; tenderness at 30 days was also significantly associated with recurrent pelvic inflammatory disease. However, pelvic tenderness at 5 and at 30 days was only modestly clinically predictive of chronic pelvic pain or recurrent pelvic inflammatory disease (positive predictive values 22.1-66.9%). No short-term marker significantly influenced the likelihood of achieving a pregnancy.


CONCLUSIONS
Tenderness at 5 or 30 days did not accurately predict the occurrence of pelvic inflammatory disease-related reproductive morbidities.
Trautmann
Gail M
GM
University of Pittsburgh School of Public Health, Pittsburgh, PA 15261, USA.
Kip
Kevin E
KE
Richter
Holly E
HE
Soper
David E
DE
Peipert
Jeffrey F
JF
Nelson
Deborah B
DB
Trout
Wayne
W
Schubeck
Dianne
D
Bass
Debra C
DC
Ness
Roberta B
RB
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D002440:Cefoxitin / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004318:Doxycycline / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007247:Infertility, Female; D018836:Inflammation Mediators / Q000032:analysis; D007262:Infusions, Intravenous; D010147:Pain Measurement; D000292:Pelvic Inflammatory Disease / Q000175:diagnosis* / Q000188:drug therapy*; D011237:Predictive Value of Tests; D011336:Probability; D011339:Probenecid / Q000008:administration & dosage*; D016016:Proportional Hazards Models; D012008:Recurrence; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D018836:Inflammation Mediators; D002440:Cefoxitin; D004318:Doxycycline; D011339:Probenecid