1560. Retrospective review of gonococcal and chlamydial cases of pelvic inflammatory disease in two Canadian STI Clinics, 2004-2014
Session: Poster Abstract Session: Clinical Infectious Diseases: Sexually Transmitted Infections
Saturday, October 10, 2015
Room: Poster Hall
Background: Pelvic inflammatory disease (PID) commonly affects women of reproductive age. No Canadian data exists on the treatment and outcomes of gonococcal (GC) and chlamydial (CT) infections complicated by PID. Our study sought to examine cases in two Canadian Sexually Transmitted Infections (STI) Clinics.

Methods: GC and CT PID cases reported by the Calgary and Edmonton STI Clinics from January 1, 2004 to September 30, 2014 were reviewed. Clinical criteria for PID diagnosis were cervical motion tenderness +/- adnexal tenderness. Improved disposition was defined as no worsening of symptoms at the follow-up visit. Treatment failures were defined as those with persistent symptoms requiring additional treatment and no sexual contact between the start of treatment and follow-up visit. Descriptive analysis was completed using IBM SPSS Statistics version 19.0 (IBM, Armonk, NY, USA). Ethics approval was obtained from the University of Alberta’s Health Research Ethics Board.

Results: One hundred PID cases were reviewed. The median age of cases was 20 years (IQR: 18-26). Most cases were Caucasian (n=56) and 6 cases were pregnant. The majority of cases (n=81) were diagnosed with CT alone, 12 cases with GC alone and 7 cases were co-infected with GC and CT. Co-infections with bacterial vaginosis (n=32) and trichomoniasis (n=3) also occurred. Most cases (n=73) were treated with ceftriaxone 250 mg IM and doxycycline 100 mg bid for 14 days +/- metronidazole 500 mg bid for 14 days, 17 cases were treated with ofloxacin 400 mg bid for 14 days +/- metronidazole, and the remaining cases (n=10) were treated with other drug regimens. Over one-half of (n=58) cases returned for follow-up, of which 10 cases (17.2%) had not improved. Six of the cases that did not improve were due to re-exposure (n=4), non-adherence (n=1), and intolerance of medications (n=1); one case was lost to follow up. The remaining 3 cases were treatment failures; all were treated with ofloxacin, resulting in a 30% treatment failure rate for ofloxacin treated cases who returned for follow-up (3/10 cases). 

Conclusion: The majority of PID cases were treated according to Alberta STI guidelines.  All cases treated with ceftriaxone and doxycycline +/- metronidazole responded to treatment while all treatment failures were treated initially with ofloxacin.

Justin Chen, MD1, Jennifer Gratrix, RN, MSc2, Judith Brandley, RN, BN3, Petra Smyczek, MD4, Penny Parker, RN, BN3, Ron Read, MD5 and Ameeta Singh, BMBS, MSc, FRCPC6, (1)University of Alberta Hospital, Edmonton, AB, Canada, (2)Edmonton STD Centre, Alberta Health Services, Edmonton, AB, Canada, (3)Edmonton STI Clinic, Alberta Health Services, Edmonton, AB, Canada, (4)Medicine, University of Alberta, Edmonton, AB, Canada, (5)Medicine, University of Calgary and Alberta Health Services-Calgary STI Clinic, Calgary, AB, Canada, (6)Medicine/Infectious Diseases, University of Alberta, Edmonton, AB, Canada

Disclosures:

J. Chen, None

J. Gratrix, None

J. Brandley, None

P. Smyczek, None

P. Parker, None

R. Read, None

A. Singh, None

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