Epidemiology (continued)

Risk Factors

The following are risk factors for PID:

Adolescence is a major risk factor because of the high age-related chlamydia and gonorrhea rates in adolescents. In addition, cervical cellularity (ectopy), which is often present in adolescents, allows for greater adherence of infectious organisms in the cervix. The risk of acquiring acute salpingitis for a sexually active 15-year-old is 1:8 compared to 1:80 for women 24 and older.

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History of having had PID increases the risk for developing PID. The damage that occurs to fallopian tube mucosa during an episode of PID makes women more susceptible to recurrent infection.

Having a history of a gonorrheal or chlamydial infection increases the likelihood of recurrent disease, which, in turn, increases the risk for PID. A woman’s risk also increases if her male partner has gonorrhea or chlamydia, or if she has multiple sex partners.

Douching increases the risk for PID because it contributes to vaginal flora changes, epithelial damage, and disruption of the cervical mucous barrier, all of which can increase the likelihood of developing PID.

The insertion of an intrauterine device (IUD) is a risk factor within the first 21 days of placement, but after 21 days, the risk returns to baseline.

Bacterial vaginosis (BV) has been associated with the development of PID.

Oral contraceptive (OC) use may increase the risk of cervical chlamydial infection due to cervical ectopy associated with OC use. OC use also causes thickening of the cervical mucous, which may be protective against lower genital tract organisms ascending into the upper genital tract. Socioeconomic status is also seen as a risk marker that may be related to access of care.

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