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Women's Health

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PEACH study examines the causes of upper genital tract infection in women with pelvic inflammatory disease

Women develop pelvic inflammatory disease (PID) when bacteria from the lower genital tract infects and inflames upper genital tract structures including the endometrium, tubes, ovaries, and peritoneum. Women with PID have higher rates of infertility, ectopic pregnancy, and chronic pelvic pain. Researchers involved in the PID Evaluation and Clinical Health (PEACH) study interviewed and took endometrial samples from women 14 to 37 years of age who were seeking treatment for PID at 13 clinical sites in various U.S. regions from 1996 to 1999. About 60 percent of the women were 24 years of age or younger, and nearly 63 percent were black.

Two PEACH studies, supported by the Agency for Healthcare Research and Quality (HS08358) and led by Roberta B. Ness, M.D., M.P.H., of the University of Pittsburgh, are summarized here. They examined the link between hormonal and barrier contraception as well as douching on development of upper genital tract gonorrhea or chlamydia. Both are sexually transmitted bacterial infections. The first study found that inconsistent use of condoms was related to a two to three times greater risk of upper genital tract infection (UGTI), but no contraceptive method reduced UGTI among women with PID. The second study linked frequent and recent douching to upper genital tract inflammation (endometritis) and UGTI.

Ness, R.B., Soper, D.E., Holley, R.L., and others. (2001, July). "Hormonal and barrier contraception and risk of upper genital tract disease in the PID evaluation and clinical health (PEACH) study." American Journal of Obstetrics and Gynecology 185, pp. 121-127.

The researchers compared contraceptive use within the prior 4 weeks among women enrolled in the PEACH study who had baseline upper genital tract gonorrhea or chlamydia (UGTI), women with endometritis without UGTI, and women with neither condition. They asked the women about use of oral contraceptives, birth control implants or shots, intrauterine device use, and barrier methods including the diaphragm, condoms, spermicides, cervical cap, or female condom. Condoms constituted 92 percent of all barrier methods used by the women. The researchers found that inconsistent condom use during the month prior to study enrollment increased a woman's risk of UGTI by two to three times over no condom use.

Condom use in 5 or fewer of 10 sexual encounters elevated the risk of UGTI 2.3-fold; use in 6 to 9 of 10 sexual encounters elevated UGTI risk 2.1-fold. No contraception compared with any contraception also was associated with nearly double the risk of UGTI. Medroxyprogesterone was associated with 2.2 times higher risk for endometritis without UGTI. However, neither use of oral contraceptives, use of medroxyprogesterone, consistent use of condoms, nor use of other barrier methods significantly reduced UGTI. These results were not affected by adjustment for age, race, education, new partner, smoking, or cocaine use.

Ness, R.B., Soper, D.E., Holley, R.L., and others. (2001, April). "Douching and endometritis: Results from the PID evaluation and clinical health (PEACH) study." Sexually Transmitted Diseases 28(4), pp. 240-245.

Vaginal douching is a common practice among American women, particularly black women. An association between douching and PID has been suspected for decades. This study adds evidence to that suspicion. It demonstrated that frequent and recent douching was associated with endometritis and UGTI among a group of predominantly black young women with PID. The researchers interviewed 654 women with signs and symptoms of PID and obtained cultures from the upper genital tract. They compared use of douching among women with endometritis and/or UGTI with women who had neither condition.

Women with endometritis or UGTI were more likely to have douched more than once a month or within 6 days of study enrollment than women who never douched. In fact, douching more than once a month and douching within 6 days of study enrollment versus no douching were associated with a 60 percent and 80 percent increased risk, respectively, of endometritis and UGTI. These associations remained after adjustment for other factors. Most of the women douched for cleansing, and no particular product was associated with excess risk. Douching may alter the number and type of microorganisms inhabiting the vagina and may initiate endometritis by boosting the ascension of vaginal bacteria into the upper genital tract.

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