Estimating the effect of chlamydia and gonorrhea screening programs on the incidence of pelvic inflammatory disease and ectopic pregnancy in Washington State, 1988-2010

Abstract

Chlamydia and gonorrhea infection can cause serious sequelae in women, including pelvic inflammatory disease (PID) and ectopic pregnancy. We assessed how trends in chlamydia positivity and gonorrhea incidence corresponded to trends in PID and ectopic pregnancy incidence in Washington State between 1988 and 2010 when large-scale screening programs for these infections were in place. We used various sources of surveillance data to capture trends in each condition over time. Without direct information on outpatient-treated cases of PID and ectopic pregnancy in Washington State, we estimated these cases based on outpatient data from surrogate or sentinel populations. Chlamydia positivity and gonorrhea incidence significantly declined from 1988 to 1997 before gradually increasing. Inpatient and estimated total PID and ectopic pregnancy incidence also declined. Associations in trends between the infection rates and each outcome were strong. These results support the conclusion that chlamydial screening has diminished serious reproductive health outcomes in Washington women.