9 percent of women with laparoscope-confirmed pelvic inflammatory disease experience an ectopic pregnancy for their first pregnancy subsequent to their episode of pelvic inflammatory disease (Weström et al., 1992). In 1992, the estimated number of ectopic pregnancies was 108,800, or 1 in 50 pregnancies (CDC, 1995a). In addition, in the same year, approximately 9 percent of all pregnancy-related deaths were a result of ectopic pregnancy (NCHS, 1994), making ectopic pregnancy one of the leading and most preventable causes of maternal death during pregnancy (Marchbanks et al., 1988). In fact, ectopic pregnancy is the leading cause of first-trimester deaths among African American women (CDC, DSTD/HIVP, 1995).

Infertility

Infertility can occur when the fallopian tubes become blocked or damaged by STDs. Of all infertile American women, at least 15 percent are infertile because of tubal damage caused by pelvic inflammatory disease. This type of infertility is treated by tubal microsurgery (which attempts to repair the damaged tubes) or by in vitro fertilization (in which an egg is surgically removed from the ovary, mixed with sperm and fertilized outside the body, and then placed directly into the uterus, thus bypassing the blocked fallopian tubes). Of all women infertile because of tubal damage, no more than one-half have previously been diagnosed and treated for acute pelvic inflammatory disease. The remaining half have also had pelvic inflammatory disease but had symptoms that were presumably so mild or a typical that they were never treated for the disease. A large prospective study of women who had laparoscopy because of clinical evaluation for pelvic inflammatory disease showed that approximately 16 percent of women with abnormal laparoscopic findings consistent with this disease tried but failed to conceive during the follow-up period, compared to 3 percent of women with normal laparoscopic findings (Weström et al., 1992). Eleven percent of women with abnormal laparoscopic findings became infertile as a result of tubal factor infertility (5 percent were infertile because of other reasons). After one episode of laparoscope-confirmed pelvic inflammatory disease, approximately 8 percent of women developed tubal-factor infertility, with the risk increasing with the severity of the episode. Each subsequent episode roughly doubled the rate of tubal-factor infertility (20 percent after two episodes and 40 percent after three or more episodes). Ectopic pregnancy also substantially increases the risk of tubal-factor infertility. STDs rarely produce infertility in men.

Health Consequences for Pregnant Women and Infants

STDs are associated with multiple acute complications for pregnant women and their infants (Brunham et al., 1990) (Table 2-3). Pregnant women with STDs may transmit the infection to the fetus, newborn, or infant through the placenta



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