Oral Contraceptives, Chlamydia trachomatis Infection, and Pelvic Inflammatory Disease
A Word of Caution About Protection
- A. Eugene Washington, MD, MSc;
- Sandra Gove, MD, MPH;
- Julius Schachter, PhD;
- Richard L. Sweet, MD
- From the Division of Sexually Transmitted Diseases, Center for Prevention Services, Centers for Disease Control, Atlanta (Dr Washington); and the Andrew W. Mellon Program in Clinical Epidemiology, Institute for Health Policy Studies (Drs Gove and Washington), and the Departments of Laboratory Medicine (Dr Schachter) and Obstetrics, Gynecology, and Reproductive Sciences (Dr Sweet), University of California School of Medicine, San Francisco.
Abstract
Management of pelvic inflammatory disease (PID) and decisions about contraception are being influenced by reports that oral contraceptives decrease the risk of PID. To evaluate the validity of this association, we have examined published epidemiologic evidence and reviewed relevant information from other disciplines. Current information does not permit the generalization that oral contraceptives protect against all forms of PID. Most studies conducted (1) have been limited to hospitalized women, who represent less than 25% of all PID cases and are likely to have relatively severe forms of the disease, and (2) have failed to distinguish between gonococcal and nongonococcal PID. While oral contraceptives may provide some protection against gonococcal PID, no basis exists for assuming similar protection is provided against chlamydial PID. In fact, epidemiologic and biologic evidence suggests that infection with Chlamydia trachomatis, the leading cause of nongonococcal PID, is enhanced by oral contraceptives. We judge the conclusion that oral contraceptives protect against all PID to be premature, and urge caution in its application in health policy and clinical decisions.
(JAMA 1985;253:2246-2250)
Footnotes
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