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Chlamydia Antibodies, Chlamydia Heat Shock Protein, and Adverse Sequelae After Pelvic Inflammatory Disease: The PID Evaluation and Clinical Health (PEACH) Study

Ness, Roberta B. MD, MPH*; Soper, David E. MD; Richter, Holly E. PhD, MD; Randall, Hugh MD§; Peipert, Jeffrey F. MD, MPH; Nelson, Deborah B. PhD; Schubeck, Diane MD#; McNeeley, S Gene MD**; Trout, Wayne MD††; Bass, Debra C. MS*; Hutchison, Katherine PhD*; Kip, Kevin PhD*; Brunham, Robert C. MD‡‡

doi: 10.1097/OLQ.0b013e3181557c25
Article

Background: Among women with pelvic inflammatory disease (PID), we assessed the associations among antibodies to Chlamydia trachomatis elementary bodies (EB), antibodies to chlamydia heat shock protein (Chsp60), rates of pregnancy, and PID recurrence.

Methods: Four hundred forty-three women with clinical signs and symptoms of mild to moderate PID enrolled in the PID Evaluation and Clinical Health Study were followed for a mean of 84 months for outcomes of time-to-pregnancy and time-to-PID recurrence. Antibodies to EB and Chsp60 were assessed in relation to these long-term sequelae of PID.

Results: Rates of pregnancy were significantly lower (adj. hazard ratio 0.47, 95% confidence interval 0.28–0.79) and PID recurrence higher (adj. hazard ratio 2.48, 95% confidence interval 1.00–6.27) after adjusting for confounding factors among women whose antibody titers to chlamydia EB measured in the final year of follow-up were in the highest tertile.

Conclusion: Among women with mild to moderate PID, antibodies to C. trachomatis were independently associated with reduced rates of pregnancy and elevated rates of recurrent PID.

Among women with mild to moderate pelvic inflammatory disease, antibodies to Chlamydia trachomatis were independently associated with reduced rates of pregnancy and elevated rates of recurrent pelvic inflammatory disease.

From the *Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; †Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina; ‡Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; §Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia; ∥Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; ¶Department of Public Health and Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania; #Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio; **Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan; ††Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio; and ‡‡Department of Medicine and Infectious Diseases, University of British Columbia Center for Disease Control, Vancouver, Canada

Supported by HS08358-05 from the Agency for Healthcare Research and Quality; AI 48909-07 from the National Institutes of Allergy and Infectious Disease.

Correspondence: Roberta B. Ness, MD, MPH, University of Pittsburgh, Graduate School of Public Health, 130 DeSoto Street, A530 Crabtree Hall, Pittsburgh, PA 15261. E-mail: repro@edc.pitt.edu.

Received for publication May 10, 2007, and accepted July 12, 2007.

© Copyright 2008 American Sexually Transmitted Diseases Association