Chlamydial and Gonococcal Infections and Adverse Reproductive Health Conditions among Patients Assigned Female at Birth in the Veterans Health Administration

Abstract

Abstract Background Reproductive age females comprise the fastest growing segment of Veterans Health Administration patients, but little is known about rates of reproductive health outcomes among those with chlamydia or gonorrhea infections. Our aim was to estimate the risk of pelvic inflammatory disease, ectopic pregnancy, infertility, and pelvic pain in female Veterans tested for chlamydia or gonorrhea. Methods We performed a retrospective cohort analysis of female Veterans tested for chlamydia or gonorrhea between January 1, 2010 and December 31, 2020. We calculated rates of pelvic inflammatory disease, ectopic pregnancy, infertility, and pelvic pain per 100,000 person-years and used Cox proportional hazards regression models to estimate risk of these reproductive health conditions according to infection status after adjustment for age, race, ethnicity, military sexual trauma, mental health diagnoses, and substance use disorder. Results Of female Veterans, 232,614 were tested at least once for chlamydia or gonorrhea, with total of 1,665,786 person-years of follow up. Of these, 12,971 had positive chlamydia or gonorrhea results (5.8%, 796 cases per 100,000 person-years). Compared with people who tested negative, those testing positive had double the risk of pelvic inflammatory disease (aHR 1.94; 95% CI 1.81-2.07), 11% increased risk of infertility (aHR 1.11; 95% CI 1.04-1.18), 12% increased risk of pelvic pain (aHR 1.12; 95% CI 1.08-1.17), and 21% increased risk of any of these conditions (aHR 1.21; 95% CI 1.17-1.25). People with positive chlamydia or gonorrhea testing tended to have increased risk of ectopic pregnancy (aHR 1.14, 95% CI 1.0-1.30). Among those with a positive test, 2,218 (17.1%) people had one or more additional positive tests. Compared to those with one positive test, people with more than one positive test had significantly increased risk of pelvic inflammatory disease (aHR1.37; 95% CI 1.18-1.58), infertility (aHR 1.20; 95% CI 1.04-1.39), and pelvic pain (aHR1.16; 95% CI 1.05-1.28), but not ectopic pregnancy (aHR 1.09; 95% CI 0.80-1.47). Conclusion Female Veterans with positive chlamydia or gonorrhea results experience significantly higher risk of pelvic inflammatory disease, infertility, and pelvic pain, especially among those with repeat infection.