Sequelae/long-term outcomes
After one episode of PID, a significant proportion of women, up to one in four, will experience long-term complications including infertility, ectopic pregnancy, and chronic pelvic pain (defined as pain lasting >6 months).
After repeated episodes, this proportion increases to almost one in two. This was first shown in the seminal paper by Westrom et al. who reported on the long-term reproductive outcomes for 1844 women with abnormal laparoscopies. These individuals were followed up for a total of 13,400 woman-years, and compared to 657 women with normal laparoscopy (controls) followed for 3,958 woman-years (71). Of these women, 16% of the patients and 2.7% of controls failed to conceive. A total of 10.8% of patients and 0% of controls had confirmed tubal factor infertility. Each repeated episode of PID doubled the rate of tubal factor infertility. After one episode, the rate was 8%, increasing to 19.5% after two episodes, and 40% after three or more episodes of PID. The ectopic pregnancy rate for first pregnancy was 9.1% among patients and 1.4% in control subjects (P Charlett A. The rate of diagnosis and demography of pelvic inflammatory disease in general practice: England and Wales. Int J STD AIDS 1999;10:448-51.7. Public Health England. Rates of pelvic inflammatory disease (PID) in England (2000-2013). HPR 2015;9:22.
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