Deaths due to sexually transmitted diseases. The forgotten component of reproductive mortality

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Abstract
Reproductive mortality has three principal components: deaths related to pregnancy, contraception, and sexually transmitted diseases (STDs). The last component is usually overlooked. In 1955, deaths due to STDs constituted a minimum of 32% of all reproductive mortality in the United States; in 1965 and 1975, the percentages were 32% and 20%, respectively. Pelvic inflammatory disease and syphilis account for most deaths due to STDs. In 1979, the mortality rate due to pelvic inflammatory disease was 0.29 deaths per 100,000 women aged 15 to 44 years; the corresponding figure for syphilis was 0.17. If cervical cancer is viewed as an STD, then deaths due to this cause alone (approximately 6,800 per year) would far outnumber deaths due to all other reproductive causes combined. Surveillance of reproductive mortality in the United States should be expanded to encompass deaths due to STDs. (JAMA 1986;255:1727-1729)