Why is the incidence of pelvic inflammatory disease falling?

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1538 (Published 13 February 2014) Cite this as: BMJ 2014;348:g1538
  1. Jonathan D C Ross, professor of sexual health and HIV1,
  2. Gwenda Hughes, head of section, sexually transmitted infections2
  1. 1University Hospital Trust, Birmingham B15 2WB, UK
  2. 2HIV and Sexually Transmitted Infection Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
  1. jonathan.ross{at}uhb.nhs.uk

Early identification and treatment of chlamydial infection is important but not the whole story

Lower abdominal pain is one of the most common presentations in young women attending primary care, and pelvic inflammatory disease, with its potential to cause chronic pain and affect future fertility, is an important differential diagnosis in this group. Over the past decade the incidence of pelvic infection in England has fallen by over a half. Although welcome, it is not entirely clear what is driving such a dramatic change and what we should be doing to maintain the current downward trend.

Using data from the Clinical Practice Research Datalink, rates of definite or probable pelvic inflammatory disease in 15-44 year old women attending general practice (where most diagnoses are made) fell in England by 9% per year from about 400/100 000 to 180/100 000 between 2000 and 2011. The reduction was seen in all age groups but was most marked in women aged 15-24.1 Fewer diagnoses of pelvic inflammatory disease are made in sexually transmitted infection clinics. Although the number of cases seen in this setting in England rose by 27% between 2003 and 2012, this probably reflects an increase in clinic …

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