In a clinical, controlled trial 55 women with a history of
pelvic inflammatory disease (PID) undergoing first-trimester abortion were randomized to either
lymecycline therapy or placebo. Twenty-four women received
lymecycline capsules 300 mg b.i.d. for 14 days starting on the morning of the abortion and 31 received similar placebo medication. In the
lymecycline group 2 women (8.3%) and in the placebo group 7 (22.6%) contracted postabortal PID, a non-significant difference (p greater than 0.2). The variables age, gestational age, number of
spontaneous abortions, births and episodes of PID, and Hegar size were not associated with the rate of postabortal PID. Women without previous
induced abortions had a significantly increased rate of postabortal
infection (p = 0.02), but the treatment did not influence this rate. Three women had a positive culture for Chlamydia trachomatis at the time of abortion and two of these had postabortal PID. None of 7 women with postabortal PID had significant increases in
IgA,
IgG or
IgM chlamydia antibody titers, but two women with uncomplicated abortions had serological evidence of
infection. The number of hospital days and amounts of
antibiotics prescribed to women with postabortal PID were not significantly different between the two treatment groups (p greater than 0.05). Women with a history of PID had an elevated risk of postabortal PID warranting the use of some sort of prophylaxis, and screening for C. trachomatis in an abortion population is recommended.