Sequelae of STD: Pelvic Inflammatory Disease and Ectopic Pregnancy

[Table of Contents]

Volume: 25S1 - May 1999

Sexually Transmitted Diseases in Canada: 1996 Surveillance Report
(with Preliminary 1997 Data)

It was estimated in 1993 that approximately 30-50% of pelvic inflammatory disease (PID) in Canada is attributable to either gonorrhea, chlamydia or both⁽²⁾. In Figure 13, estimates for age-specific rates of hospitalizations for PID in Canada from 1983/94 to 1994/95 are compared with incidence rates of chlamydial and gonococcal infections during the same period. However, these rates were calculated from hospital separation records (ICD-9 Code 614), so only the more severe cases are represented. Current surveillance systems do not account for outpatient PID or asymptomatic ("silent") PID. The trend in PID hospitalizations tends to mirror the trends in chlamydia and gonorrhea: that is, a gradual annual decrease in the incidence rates. In 1983-84 the incidence rate of PID for women of child-bearing age (15-44) was 281.8 cases per 100,000 age-specific population, which decreased to 110.8 in 1994-95 (Appendix 4).

FIGURE 13 Rates¹ of Hospital Discharges for Pelvic Inflammatory Disease and Incidence of Chlamydia and Gonorrhea in Canada, 1983/84 to 1994/95

xFIGURE 13 Rates1 of Hospital Discharges for Pelvic Inflammatory Disease and Incidence of Chlamydia and Gonorrhea in Canada, 1983/84 to 1994/95

¹ Rates per 100,000 females. Population estimates provided by Statistics Canada. Hospital discharge data from Canadian Institute for Health Information. Data are reported for fiscal year.

As with PID, ectopic pregnancy rates correlate strongly with chlamydial infection rates. A recent Swedish study found evidence that "chlamydial infections seem to be the main cause of ectopic pregnancy in young women"⁽⁸⁾. Ectopic pregnancy data were retrieved from Statistics Canada, as were the population (live births, stillbirths, therapeutic abortions) estimates. The rates of ectopic pregnancies increased from 11.7 to 16.9 per 1,000 pregnancies from 1986 to 1993 (Table 4). Both PID and ectopic pregnancies can have severe implications for future fertility in women.

Table 4 Ectopic pregnancies in Canada, 1986-1994

Year	Number of cases	Number of pregnancies*	Rate per 1,000 pregnancies
1986	5,132	440,607	11.65
1987	6,206	437,797	14.18
1988	7,039	449,154	15.67
1989	7,702	470,794	16.36
1990	8,314	486,057	17.10
1991	8,210	481,128	17.06
1992	8,313	477,783	17.40
1993	7,920	468,976	16.89
1994**	5,649	464,628	12.16
* The denominator (1000 pregnancies) is calculated by adding live births, still births, therapeutic, abortions and ectopic pregnancies. There is no data included for spontaneous or illegal abortions. Quebec data were not available and are not included. Source: Statistics Canada, Health Statistics Division. © 1999**

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