Assessing risk for pelvic inflammatory disease and its sequelae
A. E. Washington, S. O. Aral, P. Wolner-Hanssen, D. A. Grimes and K. K. Holmes
Center for Reproductive Health Policy Research, University of California School of Medicine, San Francisco 94143.
To assess the risk for pelvic inflammatory disease (PID), a practitioner
must evaluate the likelihood that a woman has PID or will be exposed to a
sexually transmitted disease causing PID. Successful risk assessment
depends on accurate information about variables influencing risk of PID. To
determine the current state of knowledge about PID risk variables, we
examined data in published reports. Data on each risk variable were
scrutinized to discern which link(s) in the PID risk chain it affects
(acquisition of a sexually transmitted disease, development of PID, or
development of PID sequelae) and whether it is a risk marker or a risk
factor. Most PID risk variables, particularly sexual behaviors, are
associated with acquisition of a sexually transmitted disease, rather than
development of PID itself. With the exception of age, demographic and
social indicators of risk appear to be risk markers, while contraceptive
practices appear more often to be risk factors than risk markers.
Additional data are needed for most PID risk variables confidently to
categorize them as risk factors. Enough information is available, however,
to begin assessing risk for PID, so that appropriate counseling can ensue
and timely diagnosis can be made.
