-
The Journal of Emergency Medicine Apr 2016
Topics: Chlamydia Infections; Diagnosis, Differential; Female; Hepatitis; Humans; Pelvic Inflammatory Disease; Peritonitis; Tomography, X-Ray Computed; Young Adult
PubMed: 27016955
DOI: 10.1016/j.jemermed.2015.11.006 -
Annals of Emergency Medicine Jul 2019
Topics: Female; Gynecological Examination; Humans; Pelvic Inflammatory Disease; Sexually Transmitted Diseases; Uterine Cervicitis
PubMed: 31248496
DOI: 10.1016/j.annemergmed.2019.02.012 -
European Journal of Obstetrics,... Jan 2015Salpingitis isthmica nodosa (SIN) is a nodular swelling of the isthmic segment of the fallopian tube. It is of unknown aetiology and is usually an acquired pathologic... (Review)
Review
Salpingitis isthmica nodosa (SIN) is a nodular swelling of the isthmic segment of the fallopian tube. It is of unknown aetiology and is usually an acquired pathologic condition resulting from direct invasion of the muscularis layer by the endosalpinx in the isthmic portion of the fallopian tube between the lumen and the serosa. The clinical significance of SIN rests on its strong association with tubal ectopic pregnancy and subfertility. Assisted reproductive technology (ART) has improved the reproductive capability of SIN patients. Unlike ART, which bypasses pelvic pathologies, tubal surgical approaches improve fertility by correcting the pathology and can improve a patient's related symptoms of pelvic pain and abnormal menstruation, and provide a permanent cure. This paper gives an update on the epidemiology, aetiology, diagnosis and management of SIN and concludes that despite the reported successes with tubal surgery, the mainstay of treatment remains ART in (in the UK) centres recognised by the Human Fertilization and Embryology Authority (HFEA). The success of surgical infertility therapy depends on careful selection of cases using appropriate investigative techniques, with the procedures carried out in centres with sufficient expertise.
Topics: Fallopian Tubes; Female; Humans; Hysterosalpingography; Infertility, Female; Salpingitis
PubMed: 25463639
DOI: 10.1016/j.ejogrb.2014.11.014 -
Abdominal Radiology (New York) Jan 2020
Review
Topics: Endometriosis; Female; Humans; Ovary; Pelvic Inflammatory Disease; Ultrasonography
PubMed: 31559474
DOI: 10.1007/s00261-019-02242-6 -
The Journal of Infectious Diseases Jul 2017Mycoplasma genitalium is very difficult to grow in culture but has been more able to be studied for disease associations since the advent of research molecular... (Review)
Review
BACKGROUND
Mycoplasma genitalium is very difficult to grow in culture but has been more able to be studied for disease associations since the advent of research molecular amplification assays. Polymerase chain reaction (PCR) and other molecular assays have demonstrated an association with adverse disease outcomes, such as urethritis or nongonococcal urethritis in men and adverse reproductive sequelae in women-for example, cervicitis, endometritis, and pelvic inflammatory disease (PID), including an association with risk for human immunodeficiency virus. The lack of commercially available diagnostic assays has limited widespread routine testing. Increasing reports of high rates of resistance to azithromycin detected in research studies have heightened the need available commercial diagnostic assays as well as standardized methods for detecting resistance markers. This review covers available molecular methods for the diagnosis of M. genitalium and assays to predict the antibiotic susceptibility to azithromycin.
METHODS
A PubMed (US National Library of Medicine and National Institutes of Health) search was conducted for literature published between 2000 and 2016, using the search terms Mycoplasma genitalium, M. genitalium, diagnosis, and detection.
RESULTS
Early PCR diagnostic tests focused on the MPa adhesion gene and the 16S ribosomal RNA gene. Subsequently, a transcription-mediated amplification assay targeting ribosomes was developed and widely used to study the epidemiology of M. genitalium. Newer methods have proliferated and include quantitative PCR for organism load, AmpliSens PCR, PCR for the pdhD gene, a PCR-based microarray for multiple sexually transmitted infections, and multiplex PCRs. None yet are cleared by the Food and Drug Administration in the United States, although several assays are CE marked in Europe. As well, many research assays, including PCR, gene sequencing, and melt curve analysis, have been developed to detect the 23S ribosomal RNA gene mutations that confer resistance to azithromycin. One recently developed assay can test for both M. genitalium and azithromycin resistance mutations at the same time.
CONCLUSIONS
It is recommended that more commercial assays to both diagnose this organism and guide treatment choices should be developed and made available through regulatory approval. Research is needed to establish the cost-effectiveness of routine M. genitalium testing in symptomatic patients and screening in all individuals at high risk of acquiring and transmitting sexually transmitted infections.
Topics: Anti-Bacterial Agents; Azithromycin; Drug Resistance, Bacterial; Female; Humans; Macrolides; Male; Multiplex Polymerase Chain Reaction; Mutation; Mycoplasma Infections; Mycoplasma genitalium; Pelvic Inflammatory Disease; RNA, Ribosomal, 16S; Urethritis; Uterine Cervicitis
PubMed: 28838072
DOI: 10.1093/infdis/jix104 -
The Medical Clinics of North America Mar 2024Mycoplasma genitalium (MG) is an emerging sexually transmitted infection, which appears to be a cause of urethritis and cervicitis and has been associated with pelvic... (Review)
Review
Mycoplasma genitalium (MG) is an emerging sexually transmitted infection, which appears to be a cause of urethritis and cervicitis and has been associated with pelvic inflammatory disease (PID), epididymitis, proctitis, infertility, complications during pregnancy, and human immunodeficiency virus (HIV) transmission. Three Food and Drug Administration (FDA) approved tests are available. Testing should be focused to avoid inappropriate antibiotic use. The Center of Disease Control and Prevention (CDC) guidelines recommend testing for persistent male urethritis, cervicitis, and proctitis and state that testing should be considered in cases of PID. Testing is also recommended for sexual contacts of patients with MG. Testing is not recommended in asymptomatic patients, including pregnant patients, who do not have a history of MG exposure. Although resistance-guided therapy is recommended, there are currently no FDA approved tests for MG macrolide resistance, and tests are not widely available in the United States. The CDC recommends 2-step treatment with doxycycline followed by azithromycin or moxifloxacin. Moxifloxacin is recommended if resistance testing is unavailable or testing demonstrates macrolide resistance..
Topics: Pregnancy; Female; Humans; Male; Anti-Bacterial Agents; Urethritis; Mycoplasma genitalium; Moxifloxacin; Uterine Cervicitis; Macrolides; Mycoplasma Infections; Drug Resistance, Bacterial; Pelvic Inflammatory Disease; Proctitis; Primary Health Care
PubMed: 38331481
DOI: 10.1016/j.mcna.2023.07.004 -
Abdominal Radiology (New York) Mar 2017Pelvic inflammatory disease (PID) is an ascending infection of the female genital tract caused by the spread of bacteria from the vagina to the pelvic reproductive... (Review)
Review
Pelvic inflammatory disease (PID) is an ascending infection of the female genital tract caused by the spread of bacteria from the vagina to the pelvic reproductive organs and occasionally the peritoneum. The most common causative organisms are sexually transmitted. PID is a significant source of morbidity among reproductive age women both as a cause of abdominal pain and as a common cause of infertility. Its clinical presentation is often nonspecific, and the correct diagnosis may first come to light based on the results of imaging studies. MRI is well suited for the evaluation of PID and its complications due to its superior soft tissue contrast and high sensitivity for inflammation. MRI findings in acute PID include cervicitis, endometritis, salpingitis/oophoritis, and inflammation in the pelvic soft tissues. Acute complications include pyosalpinx, tuboovarian abscess, peritonitis, and perihepatitis. Hydrosalpinx, pelvic inclusion cysts and ureteral obstruction may develop as chronic sequela of PID. The pathophysiology, classification, treatment, and prognosis of PID are reviewed, followed by case examples of the appearance of acute and subclinical PID on MR images.
Topics: Female; Humans; Magnetic Resonance Imaging; Pelvic Inflammatory Disease
PubMed: 27933478
DOI: 10.1007/s00261-016-1004-4 -
Vaccine Nov 2019There is a growing public health interest in controlling sexually transmitted infections (STIs) through vaccination due to increasing recognition of the global disease... (Review)
Review
There is a growing public health interest in controlling sexually transmitted infections (STIs) through vaccination due to increasing recognition of the global disease burden of STIs and the role of STIs in women's reproductive health, adverse pregnancy outcomes, and the health and well-being of neonates. Neisseria gonorrhoeae has historically challenged vaccine development through the expression of phase and antigenically variable surface molecules and its capacity to cause repeated infections without inducing protective immunity. An estimated 78 million new N. gonorrhoeae infections occur annually and the greatest disease burden is carried by low- and middle-income countries (LMIC). Current control measures are clearly inadequate and threatened by the rapid emergence of antibiotic resistance. The gonococcus now holds the status of "super-bug" as there is currently no single reliable monotherapy for empirical treatment of gonorrhea. The problem of antibiotic resistance has elevated treatment costs and necessitated the establishment of large surveillance programs to track the spread of resistant strains. Here we review the need for a gonorrhea vaccine with respect to global disease burden and related socioeconomic and treatment costs, with an emphasis on the impact of gonorrhea on women and newborns. We also highlight the challenge of estimating the impact of a gonorrhea vaccine due to the need for more data on the burden of gonococcal pelvic inflammatory disease and related sequelae and of gonorrhea-associated adverse pregnancy outcomes and the problem of empirical diagnosis and treatment of STIs in LMIC. There is also a lack of clinical and basic science research in the area of gonococcal/chlamydia coinfection, which occurs in a high percentage of individuals with gonorrhea and should be considered when testing the efficacy of gonorrhea vaccines. Finally, we review recent research that suggests a gonorrhea vaccine is feasible and discuss challenges and research gaps in gonorrhea vaccine development.
Topics: Anti-Bacterial Agents; Antigens, Bacterial; Bacterial Vaccines; Chlamydia; Chlamydia Infections; Coinfection; Drug Resistance, Multiple, Bacterial; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Pelvic Inflammatory Disease; Pregnancy; Pregnancy Complications, Infectious; Public Health; Socioeconomic Factors
PubMed: 29680200
DOI: 10.1016/j.vaccine.2018.02.081 -
BMC Public Health Oct 2023Pelvic inflammatory disease (PID) is a widespread female public problem worldwide. And it could lead to infertility, preterm labor, chronic pelvic pain, and ectopic...
BACKGROUND
Pelvic inflammatory disease (PID) is a widespread female public problem worldwide. And it could lead to infertility, preterm labor, chronic pelvic pain, and ectopic pregnancy (EP) among reproductive-aged women. This study aimed to assess the global burden and trends as well as the chaning correlation between PID and EP in reproductive-aged women from 1990 to 2019.
METHODS
The data of PID and EP among reproductive-aged women (15 to 49 years old) were extracted from the Global Burden of Disease study 2019. The disease burden was assessed by calculating the case numbers and age-standardized rates (ASR). The changing trends and correlation were evaluated by calculating the estimated annual percentage changes (EAPC) and Pearson's correlation coefficient.
RESULTS
In 2019, the ASR of PID prevalence was 53.19 per 100,000 population with a decreasing trend from 1990 (EAPC: - 0.50), while the ASR of EP incidence was 342.44 per 100,000 population with a decreasing trend from 1990 (EAPC: - 1.15). Globally, PID and EP burdens changed with a strong positive correlation (Cor = 0.89) globally from 1990 to 2019. In 2019, Western Sub-Saharan Africa, Australasia, and Central Sub-Saharan Africa had the highest ASR of PID prevalence, and Oceania, Eastern Europe, and Southern Latin America had the highest ASR of EP incidence. Only Western Europe saw significant increasing PID trends, while Eastern Europe and Western Europe saw increasing EP trends. The highest correlations between PID and EP burden were observed in Burkina Faso, Laos, and Bhutan. General negative correlations between the socio-demographic index and the ASR of PID prevalence and the ASR of EP incidence were observed at the national levels.
CONCLUSION
PID and EP continue to be public health burdens with a strong correlation despite slightly decreasing trends detected in ASRs globally. Effective interventions and strategies should be established according to the local situation by policymakers.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Adult; Adolescent; Young Adult; Middle Aged; Pelvic Inflammatory Disease; Pregnancy, Ectopic; Reproduction; Incidence; Australasia; Global Burden of Disease; Global Health
PubMed: 37784046
DOI: 10.1186/s12889-023-16663-y -
Clinical Anatomy (New York, N.Y.) Jan 2019Pelvic pain is a common symptom that affects women worldwide and usually presents with variable range of severity, duration, and location. Several gynecological... (Review)
Review
Pelvic pain is a common symptom that affects women worldwide and usually presents with variable range of severity, duration, and location. Several gynecological conditions may result in pelvic pain, and may have a variable presentation among patients. Pelvic pain creates a significant challenge and frustration to both patients and clinicians, which also creates a significant burden on the economy. It is necessary to tailor the management of pelvic pain to each individual patient to achieve optimal outcomes. Endometriosis, adenomyosis, and fibroids result in pelvic pain and may occur simultaneously. This review highlights some of the common gynecological etiologies of pelvic pain with a focus on anatomy, diagnosis, and management. Clin. Anat. 9999:1-5, 2018. © 2018 Wiley Periodicals, Inc.
Topics: Adenomyosis; Endometriosis; Female; Humans; Leiomyoma; Pelvic Inflammatory Disease; Pelvic Pain; Uterine Neoplasms
PubMed: 30390350
DOI: 10.1002/ca.23270