Assessing Trends in Chlamydia Positivity and Gonorrhea Incidence and Their Associations with the Incidence of Pelvic Inflammatory Disease and Ectopic Pregnancy in Washington State, 1988-2010
BACKGROUND:
Chlamydia
and gonorrhea screening for women is beneficial if it prevents serious reproductive
sequelae, such as pelvic inflammatory disease (PID) and ectopic pregnancy (EP).
We assessed trends in PID and EP among women in Washington and their
association with gonorrhea incidence and chlamydia positivity in a screened
population of women over a 23 year period.
METHODS:
Using
data on chlamydia positivity from the Infertility Prevention Project, gonorrhea
incidence from state surveillance, and PID and EP hospitalizations from
hospital discharge records, we assessed trends in each condition over time. In
addition, we estimated total incidence of PID and EP by incorporating
information on outpatient-treated cases in alternative populations using a
Bayesian approach that accounted for uncertainty in the estimates. We assessed
associations between each infection and PID/EP using a linear regression model
that accounts for year-to-year correlation in data points.
RESULTS:
We
observed substantial declines in both infections and in each outcome over time.
For every 2% decrease in chlamydia positivity, there was a 35.7/100,000
decrease in estimated total PID incidence (P = 0.058) and 184.4/100,000
decrease in estimated total EP (P = 0.149). For every 32/100,000 decline in
gonorrhea incidence, there was a 16.5/100,000 decrease in total PID (P = 0.292)
and 159.8/100,000 decrease in total EP (P = 0.020). The associations with
inpatient PID and EP were highly significant for both chlamydia and gonorrhea.
CONCLUSIONS:
These
ecological data note concurrent and substantial declines in chlamydia
positivity and gonorrhea incidence, and in PID and EP incidence in Washington
from 1988 to 2010 during a time when widespread chlamydia screening was ongoing.
- 1From the *Department of Epidemiology, University of Washington School of Public Health, Seattle, WA; †Public Health-Seattle & King County, Seattle, WA; ‡Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, WA; and §Group Health Research Institute, Group Health Cooperative, Seattle, WA.
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