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Am J Gynecol Health. 1989 May-Jun;3(3-S):19-22.

Fallout from the STD epidemic: salpingitis, ectopic pregnancy, and infertility.



Recent trends in sexually transmitted diseases (STDs) in the U.S., and their bearing on pelvic inflammatory disease (PID) and infertility are evaluated. STDs have increased 12-fold in the last decade, in comparison with a 200-fold rise in AIDS. While the total gonorrhea rate fell 10% last year, the incidence of gonorrhea resistant to penicillin or to all drugs is mounting. Syphilis increased 25% last year, probably because resources for contact-tracing were devoted to HIV infection, because of increasing incidence in crack users, and because new drugs, such as spectinomycin, used for resistant gonorrhea, are not effective against early syphilis. Chancroid, an easily diagnosed, treated, and traced disease, is appearing in the U.S. Genital herpes now infects 40 million, and attacks 400,000 new Americans yearly. Pelvic infections in the form of salpingitis, endometritis, and peritonitis were thought to be caused by gonorrhea in 90% of cases 10 years ago. Now a third are due to gonorrhea, a third are due to chlamydia, and the rest are due to mycoplasma and anaerobes. PID is so difficult to diagno se that 35% of diagnoses are false positives, and perhaps 25% of asymptomatic infertility patients have subclinical chlamydia. Yet the rate of PID seems constant, while STDs multiply. Reported infertile couples are also higher than ever. Whether this increased infertility is a result of tubal infections with STD organisms is not known. Physicians should be aware of the possibility of STD infection in any sexually active patient, and recommend that all women use spermicides. Spermicides are possibly more effective than condoms against STDs, and are under the control of women who suffer the consequences of STDs.

[Indexed for MEDLINE]

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