Pelvic inflammatory disease and other sexually transmitted diseases.

Many women who suffer from tubal factor infertility (TFI) had earlier had asymptomatic pelvic inflammatory disease (PID). Chlamydia trachomatis is often isolated from their fallopian tubes and endometrial cavity. A study in Canada provides some evidence however that the culture technique is not as sensitive as antigen detection techniques when tissue samples with low numbers of chlamydial elementary bodies are used. Some studies show that the antibody to Chlamydia is found more often in TFI women than women with other causes of infertility. Animal studies indicate that the immunologic defense mechanisms in cases of repeated Chlamydia infections play a key role in tubal fibrosis. Another animal study suggests that interferon-gamma which C. trachomatis induces has a cytotoxic effect on infected tubal epithelial cells. In a study of PID women who tried to get pregnant all of the 10 women with gonorrhea associated PID got pregnant while >50% of those with nongonococcal PID did not have. Except for the Dalkon Shield and immediately after insertion IUD use is not significantly associated with increased PID risk. Combined oral contraceptives appear to have a protective effect against PID and in those women who do indeed get a PID against infertility. PID treatment with several antibiotics is generally appropriate since the etiology of PID is polymicrobial. In instances where surgery is required such as drainage of abscesses physicians can use laparoscopy rather than invasive surgery. A study in Sweden shows that partner examination and treatment is efficacious in preventing repeated PID episodes. (In cases with chlamydial PID repeated episodes fell by a factor of 6.5.) The most effective means of controlling STD epidemics other than changes in sexual behavior and attitudes is to trace the infection to its origin and treat all those infected.