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Postgraduate Medical Journal Dec 2022
Topics: Female; Humans; Shoulder Pain; Pelvic Inflammatory Disease; Hepatitis; Peritonitis
PubMed: 34413178
DOI: 10.1136/postgradmedj-2021-140985 -
Contrast Media & Molecular Imaging 2022Pelvic inflammatory disease refers to a group of infectious diseases of the female upper genital tract, often caused by ascending infection of vaginitis and cervicitis,...
Pelvic inflammatory disease refers to a group of infectious diseases of the female upper genital tract, often caused by ascending infection of vaginitis and cervicitis, causing endometritis, salpingitis, tubo-ovarian abscess, pelvic connective tissue inflammation, and/or pelvic peritonitis. PID is the most common and important infectious disease in nonpregnant women of childbearing age, and inflammation in multiple parts often coexists and affects each other. The functional MRI techniques currently used in pelvic floor muscle injury are magnetic resonance diffusion tensor imaging, T2 mapping, and magnetic resonance elastography. Diffusion tensor imaging is a new imaging and postprocessing technology developed on the basis of magnetic resonance diffusion-weighted imaging. Due to the lack of specificity of clinical symptoms, many subclinical patients are often not detected and diagnosed in time, so it is very difficult to accurately estimate the incidence of PID. This article retrospectively analyzed 72 patients with pelvic inflammatory disease confirmed by surgical pathology from February 2020 to 2022, who had undergone pelvic MRI examination before surgery, including 25 patients with chronic pelvic inflammation (hydrosalpinx), 25 patients with acute pelvic inflammation, and 47 cases (including 21 cases of hydrosalpinx, 19 cases of tubo-ovarian abscess, and 7 cases of pelvic abscess). The age range was 13 to 59 years old. The clinical data and MRI findings were analyzed, the ADC value of the cystic part of the lesion was measured, and the differences in age, maximum diameter of the lesion, thickness of the vessel wall/separation, and the ADC value of the cystic part of chronic and acute pelvic inflammation were compared. In this part of the cases, there were 25 cases of chronic pelvic inflammation and 47 cases of acute pelvic inflammation. The average ADC value of the cystic component of chronic inflammation was significantly higher than that of acute inflammation, which were (2.86 ± 0.20) × 10 mm/s and (1.07 ± 0.38) ×10 mm/s, respectively, value <0.001.
Topics: Abscess; Adolescent; Adult; Diffusion Magnetic Resonance Imaging; Diffusion Tensor Imaging; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Pelvic Inflammatory Disease; Retrospective Studies; Salpingitis; Young Adult
PubMed: 35833078
DOI: 10.1155/2022/5868453 -
JAMA Sep 2021Chlamydia and gonorrhea are among the most common sexually transmitted infections in the US. Infection rates are highest among adolescents and young adults of both...
IMPORTANCE
Chlamydia and gonorrhea are among the most common sexually transmitted infections in the US. Infection rates are highest among adolescents and young adults of both sexes. Chlamydial and gonococcal infections in women are usually asymptomatic and may lead to pelvic inflammatory disease and its associated complications. Newborns of pregnant persons with untreated infection may develop neonatal chlamydial pneumonia or gonococcal or chlamydial ophthalmia. Infection in men may lead to urethritis and epididymitis. Both types of infection can increase risk of acquiring or transmitting HIV.
OBJECTIVE
To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for chlamydia and gonorrhea in sexually active adolescents and adults, including pregnant persons.
POPULATION
Asymptomatic, sexually active adolescents and adults, including pregnant persons.
EVIDENCE ASSESSMENT
The USPSTF concludes with moderate certainty that screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection has moderate net benefit. The USPSTF concludes with moderate certainty that screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection has moderate net benefit. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men.
RECOMMENDATION
The USPSTF recommends screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. (B recommendation) The USPSTF recommends screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men. (I statement).
Topics: Adolescent; Adult; Age Factors; Asymptomatic Diseases; Chlamydia Infections; Female; Gonorrhea; Humans; Male; Mass Screening; Nucleic Acid Amplification Techniques; Pelvic Inflammatory Disease; Pregnancy; Risk Factors; Sensitivity and Specificity; Sexual Behavior; Young Adult
PubMed: 34519796
DOI: 10.1001/jama.2021.14081 -
Emergency Medicine Practice Dec 2016Pelvic inflammatory disease is a common disease that is associated with significant complications including infertility, chronic pelvic pain, ruptured tubo-ovarian... (Review)
Review
Pelvic inflammatory disease is a common disease that is associated with significant complications including infertility, chronic pelvic pain, ruptured tubo-ovarian abscess, and ectopic pregnancy. The diagnosis may be delayed when the presentation has nonspecific signs and symptoms. Even when it is properly identified, pelvic inflammatory disease is often treated suboptimally. This review provides evidence-based recommendations for the diagnosis, treatment, disposition, and follow-up of patients with pelvic inflammatory disease. Arranging follow-up of patients within 48 to 72 hours and providing clear patient education are fundamental to ensuring good patient outcomes. Emerging issues, including new pathogens and evolving resistance patterns among pelvic inflammatory disease pathogens are reviewed.
Topics: Decision Making; Diagnosis, Differential; Emergency Service, Hospital; Female; Humans; Pelvic Inflammatory Disease
PubMed: 27879197
DOI: No ID Found -
Anales Del Sistema Sanitario de Navarra Apr 2021Neisseria gonorrhoeae is the second most common etiological agent of pelvic inflammatory disease and is currently un-derdiagnosed due to its asymptomatic presentation in...
Neisseria gonorrhoeae is the second most common etiological agent of pelvic inflammatory disease and is currently un-derdiagnosed due to its asymptomatic presentation in 50% of cases. When the disease presents, it may appear in the form of acute abdomen and normal imaging tests, making it a major diagnostic challenge. We present four cases of acute gonococcal peritonitis. The main symptom was acute abdominal pain, and both the gy-necological examination and complementary tests showed normal results. The only notable finding from the laparoscopy was the existence of purulent ascitic fluid. The results of the anatomical and pathological tests were all normal. Endocer-vical and ascitic fluid culture showed infection with N. gonorrhoeae, and in one case, concomitant infection with Chlamydia trachomatis. The definitive treatment applied was intravenous antibiotic therapy. When a sexually active young woman is diagnosed with peritonitis that has no apparent cause, it is important to rule out sexually transmitted diseases.
Topics: Chlamydia Infections; Chlamydia trachomatis; Female; Gonorrhea; Humans; Neisseria gonorrhoeae; Pelvic Inflammatory Disease
PubMed: 33853224
DOI: 10.23938/ASSN.0931 -
Reproductive Biomedicine Online Feb 2018The aim of this study was to ascertain the incidence of pelvic inflammatory disease (PID) after intrauterine insemination (IUI). A systematic review was conducted using... (Review)
Review
The aim of this study was to ascertain the incidence of pelvic inflammatory disease (PID) after intrauterine insemination (IUI). A systematic review was conducted using three different approaches: a search of IUI registries; a search of published meta-analyses; and a search of prospective randomized trials. Search terms were 'IUI', 'complications', 'infection' and 'PID'. Two IUI registers were identified that met the inclusion criteria, totalling 365,874 cycles, with 57 PID cases being reported. The post-IUI PID rate was 0.16/1000 (95% CI 0.2 to 0.3/1000). The frequency was higher in husband sperm cycles (0.21/1000) (28/135,839) than in donor sperm cycles (0.03/1000) (1/33,712) (P < 0.05; OR 6.95). Nineteen meta-analyses were retrieved, which included 156 trials, totalling 43,048 cycles, with no PID case being reported. Seventeen prospective clinical trials published between 2013 and 2014 were identified, totalling 4968 cycles; no PID case was reported. The reported rate of post-IUI clinical PID is low (0.16/1000), about 40% higher than reported in the general population of women during their reproductive life. No antibiotic prophylaxis should be recommended unless there is an associated risk factor.
Topics: Female; Humans; Insemination, Artificial, Heterologous; Insemination, Artificial, Homologous; Male; Meta-Analysis as Topic; Pelvic Inflammatory Disease; Registries
PubMed: 29287941
DOI: 10.1016/j.rbmo.2017.11.002 -
The Journal of Infectious Diseases Aug 2021Detection of anti-Chlamydia trachomatis (Ctr) antibodies is compromised by cross-reactivity and poor sensitivity of classic Ctr-antigens. We discovered 48 strongly... (Review)
Review
Detection of anti-Chlamydia trachomatis (Ctr) antibodies is compromised by cross-reactivity and poor sensitivity of classic Ctr-antigens. We discovered 48 strongly reactive peptide antigens of Ctr-specific B-cell epitopes from 21 immunodominant proteins. In this study, we review the utility of peptide assays for diagnosis of Ctr infections. By combining many of these Ctr-specific B-cell epitopes from several proteins in separate or mixed multipeptide assays, they achieved vastly superior assay sensitivity and specificity over standard enzyme-linked immunosorbent assays. Such multipeptide assays eliminate cross-reactivities (false positives) and correct for stochastic gaps in antibody responses (false negatives). More importantly, we developed and validated a novel microarray platform in which hundreds of peptides from many proteins are spotted in a single reaction well. This offers the possibility of high-throughput screening of many candidate peptides for routine serological fingerprinting of Ctr infections. Discovery of optimal sets of antibody responses that associate with clinical pelvic inflammatory disease (PID) may identify diagnostically useful PID biomarker antigens.
Topics: Antibodies, Bacterial; Chlamydia Infections; Chlamydia trachomatis; Enzyme-Linked Immunosorbent Assay; Epitopes, B-Lymphocyte; Female; Humans; Immunoenzyme Techniques; Pelvic Inflammatory Disease; Peptides
PubMed: 34396415
DOI: 10.1093/infdis/jiab016 -
Fertility and Sterility Nov 2019"An object in motion tends to remain in motion along a straight line unless acted upon by an outside force." -Isaac Newton.
"An object in motion tends to remain in motion along a straight line unless acted upon by an outside force." -Isaac Newton.
Topics: Fallopian Tubes; Female; Humans; Pelvic Inflammatory Disease; Sterilization Reversal; Sterilization, Tubal; Time Factors
PubMed: 31731945
DOI: 10.1016/j.fertnstert.2019.08.068 -
The Journal of Infectious Diseases Jul 2017Health consequences of sexually transmitted diseases disproportionately affect women, making it important to determine whether newly emerged pathogens cause sequelae.... (Review)
Review
Health consequences of sexually transmitted diseases disproportionately affect women, making it important to determine whether newly emerged pathogens cause sequelae. Although the pathogenic role of Mycoplasma genitalium in male urethritis is clear, fewer studies have been conducted among women to determine its pathogenic role in the female reproductive tract. Pelvic inflammatory disease (PID) is an important cause of infertility and ectopic pregnancy, and Chlamydia trachomatis and Neisseria gonorrhoeae are recognized microbial causes. Emerging data demonstrate an association between M. genitalium and PID, and limited data suggest associations with infertility and preterm birth, yet the attributable risk for female genital tract infections remains to be defined. Further investigations are needed to better define the impact of M. genitalium on women's reproductive health. Importantly, prospective studies evaluating whether screening programs and targeted treatment of M. genitalium improve reproductive outcomes in women are necessary to guide public health policy for this emerging pathogen.
Topics: Female; Humans; Infertility, Female; Male; Mycoplasma Infections; Mycoplasma genitalium; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Premature Birth; Risk Factors; Uterine Cervicitis
PubMed: 28838078
DOI: 10.1093/infdis/jix198 -
Health Technology Assessment... Mar 2016The evidence base supporting the National Chlamydia Screening Programme, initiated in 2003, has been questioned repeatedly, with little consensus on modelling... (Review)
Review
BACKGROUND AND OBJECTIVES
The evidence base supporting the National Chlamydia Screening Programme, initiated in 2003, has been questioned repeatedly, with little consensus on modelling assumptions, parameter values or evidence sources to be used in cost-effectiveness analyses. The purpose of this project was to assemble all available evidence on the prevalence and incidence of Chlamydia trachomatis (CT) in the UK and its sequelae, pelvic inflammatory disease (PID), ectopic pregnancy (EP) and tubal factor infertility (TFI) to review the evidence base in its entirety, assess its consistency and, if possible, arrive at a coherent set of estimates consistent with all the evidence.
METHODS
Evidence was identified using 'high-yield' strategies. Bayesian Multi-Parameter Evidence Synthesis models were constructed for separate subparts of the clinical and population epidemiology of CT. Where possible, different types of data sources were statistically combined to derive coherent estimates. Where evidence was inconsistent, evidence sources were re-interpreted and new estimates derived on a post-hoc basis.
RESULTS
An internally coherent set of estimates was generated, consistent with a multifaceted evidence base, fertility surveys and routine UK statistics on PID and EP. Among the key findings were that the risk of PID (symptomatic or asymptomatic) following an untreated CT infection is 17.1% [95% credible interval (CrI) 6% to 29%] and the risk of salpingitis is 7.3% (95% CrI 2.2% to 14.0%). In women aged 16-24 years, screened at annual intervals, at best, 61% (95% CrI 55% to 67%) of CT-related PID and 22% (95% CrI 7% to 43%) of all PID could be directly prevented. For women aged 16-44 years, the proportions of PID, EP and TFI that are attributable to CT are estimated to be 20% (95% CrI 6% to 38%), 4.9% (95% CrI 1.2% to 12%) and 29% (95% CrI 9% to 56%), respectively. The prevalence of TFI in the UK in women at the end of their reproductive lives is 1.1%: this is consistent with all PID carrying a relatively high risk of reproductive damage, whether diagnosed or not. Every 1000 CT infections in women aged 16-44 years, on average, gives rise to approximately 171 episodes of PID and 73 of salpingitis, 2.0 EPs and 5.1 women with TFI at age 44 years.
CONCLUSIONS AND RESEARCH RECOMMENDATIONS
The study establishes a set of interpretations of the major studies and study designs, under which a coherent set of estimates can be generated. CT is a significant cause of PID and TFI. CT screening is of benefit to the individual, but detection and treatment of incident infection may be more beneficial. Women with lower abdominal pain need better advice on when to seek early medical attention to avoid risk of reproductive damage. The study provides new insights into the reproductive risks of PID and the role of CT. Further research is required on the proportions of PID, EP and TFI attributable to CT to confirm predictions made in this report, and to improve the precision of key estimates. The cost-effectiveness of screening should be re-evaluated using the findings of this report.
FUNDING
The Medical Research Council grant G0801947.
Topics: Adolescent; Adult; Bayes Theorem; Chlamydia Infections; Chlamydia trachomatis; Female; Humans; Incidence; Mass Screening; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Prevalence; United Kingdom; Young Adult
PubMed: 27007215
DOI: 10.3310/hta20220