Recurrent PID, Subsequent STI, and Reproductive Health Outcomes: Findings from the PID Evaluation and Clinical Health (P

1. Recurrent PID, Subsequent STI, and Reproductive Health Outcomes: Findings from the PID Evaluation and Clinical Health (PEACH) Study Maria Trent, MD, MPH Debra Bass, MS Roberta Ness, MD, MPH Catherine Haggerty, PhD, MPH Funding: Centers for Disease Control and Prevention: K01DP001128-02; Agency for Healthcare Research and Quality Development: HS08358-05

2. Disclosures • I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or providers (s) of commercial services discussed in this CME activity. • I do not intend to discuss off-label use of products in this presentation

3. Background • PID is a common reproductive health disorder • Associated with significant reproductive morbidity: • Tubal infertility • Ectopic pregnancy • Chronic pelvic pain (CPP) • Risk estimates of morbidity based on Scandinavian cohort of PID inpatients enrolled 1960 -1984 • Subsequent shifts in the biological organisms causing PID • Management shifted to outpatient setting • Re-analysis of the impact of recurrent PID and STIs warranted

4. Objective • To examine the risk of longitudinal adverse outcomes associated with recurrent STIs and PID among urban American women with mild-moderate PID • To determine the potential impact of adolescence on the observed longitudinal outcomes

5. Methods • Secondary data analysis • PID Evaluation and Clinical Health (PEACH)Study • Women 14-38 years with mild-moderate PID • Urban Settings in United States • Randomized to inpatient/outpatient treatment • Baseline interview & gynecologic exam (endometrial biopsies, STI testing) • Visits at 5 and 30 days • Telephone interview quarterly x 84 months

6. Approach to Analysis PEACH 831 Women 14-38 years Mild-Moderate PID Randomized to Inpatient/ Outpatient Arms Main PEACH Analysis No Difference in Outcomes by group Adolescent Sub-Analysis (≤19 yrs) N=209 Re-Analysis based on Recurrent PID/STI

7. Methods • Data evaluated using bivariate & multiple regression analyses • Analysis approved by Johns Hopkins IRB

8. Selected Demographics

9. 84-Month Reproductive Health Outcomes

10. Subsequent STI & Reproductive Health Outcomes: All Women

11. Outcomes by Recurrent PID Status: ALL Women

12. Subsequent STI & Reproductive Health Outcomes: Adolescent

13. Outcomes by Recurrent PID Status: Adolescents

14. Conclusions • Women with recurrent PID are more likely to report infertility and CPP at 84 months • Substantiates the relationship between recurrent PID and adverse • Modern microbiology • Outpatient and inpatient care approaches • Highlights CPP as a major adverse outcome and recurrent lower genital tract infection (STI) as a key contributor • Supports to the concept of tertiary prevention • Upper genital tract disease = smaller, well defined public health • Adolescents are also an important sub-target

15. Limitations • Limited Generalizability • Demographics • Trial Participation • Contraception • Clinical Criteria for PID • Endometrial biopsies • Mimics clinical practice • Self-Reported Longitudinal Outcomes • Supported by medical record review

16. Implications • Young women with a history of PID are a clearly defined target group for public health intervention. • Acute PID should prompt linkage of affected patients to tailored STI risk-reduction services to prevent the adverse outcomes associated with PID