Can case reports be used to identify trends in pelvic inflammatory disease? San Francisco, 2004-2009.
BACKGROUND
Chlamydia screening programs have been shown to reduce the incidence of pelvic inflammatory disease (PID), which can lead to ectopic pregnancy, tubal infertility, and chronic pelvic pain. However, few reliable data exist on the population-level burden of PID and the utility of passive case-based surveillance of this important infertility-related outcome.


METHODS
We conducted a descriptive analysis of all case reports of PID in San Francisco from 2004 to 2009 through our passive case reporting surveillance system. We examined demographics as well as sexually transmitted disease history. Pearson χ and Fisher exact tests were used to assess significance in the trend analysis.


RESULTS
There were 245 case reports over the 6-year period examined. There were no statistically significant differences over this period based on demographics. However, an increasing proportion of cases were diagnosed at the municipal sexually transmitted disease clinic.


CONCLUSIONS
PID is an important intermediary to assess the impact in reducing infertility in areas where chlamydia screening programs have been implemented. As the locus of PID care has shifted from inpatient to outpatient settings, passive PID surveillance has not adjusted. Efforts should be made to increase provider awareness that pelvic inflammatory disease is a notifiable condition and improve reporting among providers by devoting resources to either improving current passive surveillance or to the development of new innovative ways to conduct PID surveillance.
Stephens
Sally C
SC
STD Prevention and Control, San Francisco Department of Public Health, 1360 Mission St., San Francisco, CA 94103, USA. Sally.Stephens@sfdph.org
Bernstein
Kyle T
KT
Kohn
Robert P
RP
Klausner
Jeffrey D
JD
Philip
Susan S
SS
D000328:Adult; D000554:Ambulatory Care Facilities; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology; D002692:Chlamydia trachomatis; D018563:Disease Notification / Q000706:statistics & numerical data*; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D000292:Pelvic Inflammatory Disease / Q000175:diagnosis* / Q000453:epidemiology*; D011159:Population Surveillance / Q000379:methods*; D012495:San Francisco / Q000453:epidemiology; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology; D055815:Young Adult