title: Which sexually active young female students are most at risk of pelvic inflammatory disease? A prospective study.
abstract: OBJECTIVE
  To identify risk factors for pelvic inflammatory disease (PID) in female students.
  
  
  METHODS
  We performed a prospective study set in 11 universities and 9 further education colleges in London. In 2004-2006, 2529 sexually experienced, multiethnic, female students, mean age 20.8 years, provided self-taken vaginal samples and completed questionnaires at recruitment to the Prevention of Pelvic Infection chlamydia screening trial. After 12 months, they were followed up by questionnaire backed by medical record search and assessed for PID by blinded genitourinary medicine physicians.
  
  
  RESULTS
  Of 2004 (79%) participants who reported numbers of sexual partners during follow-up, 32 (1.6%, 95% CI 1.1% to 2.2%) were diagnosed with PID. The strongest predictor of PID was baseline Chlamydia trachomatis (relative risk (RR) 5.7, 95% CI 2.6 to 15.6). After adjustment for baseline C. trachomatis, significant predictors of PID were ≥2 sexual partners or a new sexual partner during follow-up (RR 4.0, 95% CI 1.8 to 8.5; RR 2.8, 95% CI 1.3 to 6.3), age <20 years (RR 3.3, 95% CI 1.5 to 7.0), recruitment from a further education college rather than a university (RR 2.6, 95% CI 1.3 to 5.3) and history at baseline of vaginal discharge (RR 2.7, 95% CI 1.2 to 5.8) or pelvic pain (RR 4.1, 95% CI 2.0 to 8.3) in the previous six months. Bacterial vaginosis and Mycoplasma genitalium infection were no longer significantly associated with PID after adjustment for baseline C. trachomatis.
  
  
  CONCLUSIONS
  Multiple or new partners in the last 12 months, age <20 years and attending a further education college rather than a university were risk factors for PID after adjustment for baseline C. trachomatis infection. Sexual health education and screening programmes could be targeted at these high-risk groups.
  
  
  BACKGROUND
  (ClinicalTrials.gov NCT00115388).
authors.affiliation: Department of Genitourinary Medicine, Courtyard Clinic, St George's Hospital, London, UK.
authors.forename: Phillip E
authors.initials: PE
authors.lastname: Hay
authors.affiliation: Population Health Research Institute, St George's, University of London, London, UK.
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Kerry
authors.affiliation: Population Health Research Institute, St George's, University of London, London, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Normansell
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Paddy J
authors.initials: PJ
authors.lastname: Horner
authors.affiliation: Department of Primary Care & Public Health Sciences, Kings College London, London, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Reid
authors.affiliation: Pragmatic Clinical Trials Unit, Queen Mary's, University of London, London, UK.
authors.forename: Sally M
authors.initials: SM
authors.lastname: Kerry
authors.affiliation: Department of Genitourinary Medicine, Courtyard Clinic, St George's Hospital, London, UK.
authors.forename: Katia
authors.initials: K
authors.lastname: Prime
authors.affiliation: Homerton Sexual Health Services, Homerton University Hospital, London, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Williams
authors.affiliation: Health Protection Services, Public Health England, London, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Simms
authors.affiliation: Health Protection Services, Public Health England, London, UK.
authors.forename: Adamma
authors.initials: A
authors.lastname: Aghaizu
authors.affiliation: Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Jorgen
authors.initials: J
authors.lastname: Jensen
authors.affiliation: Population Health Research Institute, St George's, University of London, London, UK.
authors.forename: Pippa
authors.initials: P
authors.lastname: Oakeshott
mesh_terms: D000293:Adolescent; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008131:London / Q000453:epidemiology; D000292:Pelvic Inflammatory Disease / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D011446:Prospective Studies; D012307:Risk Factors; D012648:Self Care; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners / Q000523:psychology; D015231:Sexually Transmitted Diseases, Bacterial / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D011795:Surveys and Questionnaires; D014626:Vaginal Smears; D055815:Young Adult
keywords: PELVIC INFLAMMATORY DISEASE; SEXUAL HEALTH; WOMEN