PID, an infection and inflammation of all or some of the pelvic organs, affects more than 1.2 million women each year. Even after successful treatment with antibiotics, women who have had PID are much more likely to have resulting infertility, chronic pelvic pain, PID recurrence and ectopic pregnancy than women who have not had the disease.
"Until now, doctors have used idiosyncratic rules to determine which patients need to be hospitalized for PID. These data are the first to help doctors make that determination more rationally," said the study's principal investigator, Roberta Ness, M.D., M.P.H., director, Epidemiology of Women's Health Program, University of Pittsburgh Graduate School of Public Health, and associate professor of epidemiology, medicine and obstetrics/gynecology.
The PID Evaluation and Clinical Health (PEACH) study was a multi-center trial that randomized 831 women with PID to either inpatient or outpatient antibiotic treatment. About 75 percent of the participants were African-American, and the same percent had an educational level of high school or less. Antibiotic treatment for both inpatients and outpatients lasted approximately 14 days. Study participants were followed up in person at five and 30 days, then subsequently by telephone every three to four months.
When comparing the outcomes of the two groups after 35 months, pregnancy rates were nearly equal (42 percent outpatient; 41.7 percent inpatient), with no significant differences in the frequency of PID recurrence (12.4 percent outpatient; 16.6 percent inpatient), chronic pelvic pain (33.7 percent outpatient; 29.8 percent inpatient), infertility (18.4 percent outpatient; 17.9 percent inpatient), ectopic pregnancy (1 percent outpatient; 0.3 percent inpatient) or tubal obstruction (41.7 percent outpatient; 33.3 percent inpatient).
The mean time required to achieve pregnancy after treatment was equal in both groups as well – 21 months.
"Consistent with the drop in hospitalization rates for many medical conditions over the past two decades, there has been a sharp decline in the number of women treated for PID on an inpatient basis. Today up to 90 percent of these women are treated as outpatients," Dr. Ness said. "This study shows clearly that these patients are not at a disadvantage as compared with those treated in the hospital."
The PEACH study was funded by the Agency for Healthcare Research and Quality. In addition to the University of Pittsburgh, the study involved researchers from Emory University, Atlanta; Magee-Womens Hospital, Pittsburgh; the Medical University of South Carolina, Charleston; the University of Alabama School of Medicine, Birmingham; the University of Pennsylvania, Philadelphia; Wayne State University, Detroit; and Women and Infants Hospital, Providence, Rhode Island.
NOTE: Dr. Ness is available for interviews Thursday and Friday, May 9 and 10. Please call Kathryn Duda at the UPMC News Bureau, (412) 624-2607, to arrange an interview.
Journal
American Journal of Obstetrics and Gynecology