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Diagnostics (Basel, Switzerland) Feb 2023Endometriosis is a common inflammatory disease characterized by the presence of endometrial cells outside of the uterine cavity. Endometriosis affects 10% of women of... (Review)
Review
BACKGROUND
Endometriosis is a common inflammatory disease characterized by the presence of endometrial cells outside of the uterine cavity. Endometriosis affects 10% of women of reproductive age and significantly reduces their quality of life as a result of chronic pelvic pain and infertility. Biologic mechanisms, including persistent inflammation, immune dysfunction, and epigenetic modifications, have been proposed as the pathogenesis of endometriosis. In addition, endometriosis can potentially be associated with an increased risk of pelvic inflammatory disease (PID). Changes in the vaginal microbiota associated with bacterial vaginosis (BV) result in PID or a severe form of abscess formation, tubo-ovarian abscess (TOA). This review aims to summarize the pathophysiology of endometriosis and PID and to discuss whether endometriosis may predispose to PID and vice versa.
METHODS
Papers published between 2000 and 2022 in the PubMed and Google Scholar databases were included.
RESULTS
Available evidence supports that women with endometriosis are at increased risk of comorbid PID and vice versa, supporting that endometriosis and PID are likely to coexist. There is a bidirectional relationship between endometriosis and PID that shares a similar pathophysiology, which includes the distorted anatomy favorable to bacteria proliferation, hemorrhage from endometriotic lesions, alterations to the reproductive tract microbiome, and impaired immune response modulated by aberrant epigenetic processes. However, whether endometriosis predisposes to PID or vice versa has not been identified.
CONCLUSIONS
This review summarizes our current understanding of the pathogenesis of endometriosis and PID and discusses the similarities between them.
PubMed: 36900012
DOI: 10.3390/diagnostics13050868 -
Women's Health (London, England) 2022We aimed to better understand factors associated with pelvic inflammatory disease in an outpatient setting.
BACKGROUND
We aimed to better understand factors associated with pelvic inflammatory disease in an outpatient setting.
METHODS
We analysed the characteristics of pelvic inflammatory disease cases diagnosed in an outpatient setting during 2018. There were 72 cases included in the final analysis.
RESULTS
Of the pelvic inflammatory disease cases analysed, 55% were idiopathic, 22.2% were related to a sexually transmitted infection, and 22.2% had onset of symptoms within 6 weeks of a gynaecological procedure. Of the sexually transmitted infection-positive pelvic inflammatory disease cases, was present in 56%, was present in 38%, and was present in 12.5% of cases. Many pelvic inflammatory disease cases had evidence of vaginal dysbiosis or features associated with vaginal flora disruption (recent antibiotic usage and/or vulvovaginal candidiasis).
CONCLUSION
This case series highlights the burden of pelvic inflammatory disease, and clinicians should be aware to include testing for this when diagnosing pelvic inflammatory disease. Our findings also support the hypothesis that host dysbiotic microbiota may contribute to pelvic inflammatory disease pathogenesis, with further research required to explore this proposition.
Topics: Chlamydia Infections; Chlamydia trachomatis; Family Planning Services; Female; Humans; Mycoplasma genitalium; Pelvic Inflammatory Disease; Sexually Transmitted Diseases
PubMed: 35819075
DOI: 10.1177/17455057221112263 -
Sexually Transmitted Diseases Jan 2022Pelvic inflammatory disease (PID) is an infection of the upper female reproductive organs that can lead to infertility and ectopic pregnancies. It is a reportable...
BACKGROUND
Pelvic inflammatory disease (PID) is an infection of the upper female reproductive organs that can lead to infertility and ectopic pregnancies. It is a reportable condition in North Carolina (NC) but is likely underreported. We aimed to quantify PID diagnoses in NC emergency department (ED) visits.
METHODS
The NC Disease Event Tracking and Epidemiology Collection Tool tracks all ED visits in NC. We identified PID diagnoses among women of reproductive age (15-44 years) between 2008 and 2017 using International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification codes, and calculated the yearly proportion with PID diagnoses. We assessed the number of PID visits per patient each year, and the proportion of ED visits with a PID diagnosis by age, proportion of the patient's ZIP code living below the poverty line, insurance coverage, and NC provider region.
RESULTS
The percent of women with PID decreased from 6189 (1.0%) in 2008 to 4337 (0.58%) in 2016 before increasing slightly to 4371 (0.61%) in 2017. We identified 54,502 (0.45%) ED visits among 51,847 (0.76%) women with ≥1 PID diagnosis code. Most (95.5%) women with PID had one ED visit during the calendar year. Each year, the proportion with PID was highest among women aged 20 to 24 years, covered under public insurance, from the most impoverished areas, and whose provider was in the Coastal region of NC.
CONCLUSIONS
The percent with PID among women visiting EDs decreased between 2008 and 2017 in NC. Although this decline was observed across all demographics, disparities associated with PID continued to persist over time.
Topics: Adolescent; Adult; Emergency Service, Hospital; Female; Humans; Insurance Coverage; North Carolina; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Young Adult
PubMed: 34264903
DOI: 10.1097/OLQ.0000000000001514 -
International Journal of Molecular... Sep 2023Seminal plasma (SP) accounts for more than 90% of semen volume. It induces inflammation, regulates immune tolerance, and facilitates embryonic development and... (Review)
Review
Seminal plasma (SP) accounts for more than 90% of semen volume. It induces inflammation, regulates immune tolerance, and facilitates embryonic development and implantation in the female reproductive tract. In the physiological state, SP promotes endometrial decidualization and causes changes in immune cells such as macrophages, natural killer cells, regulatory T cells, and dendritic cells. This leads to the secretion of cytokines and chemokines and also results in the alteration of miRNA profiles and the expression of genes related to endometrial tolerance and angiogenesis. Together, these changes modulate the endometrial immune microenvironment and contribute to implantation and pregnancy. However, in pathological situations, abnormal alterations in SP due to advanced age or poor diet in men can interfere with a woman's immune adaptation to pregnancy, negatively affecting embryo implantation and even the health of the offspring. Uterine pathologies such as endometriosis and endometritis can cause the endometrium to respond negatively to SP, which can further contribute to pathological progress and interfere with conception. The research on the mechanism of SP in the endometrium is conducive to the development of new targets for intervention to improve reproductive outcomes and may also provide new ideas for semen-assisted treatment of clinical infertility.
Topics: Pregnancy; Male; Humans; Female; Semen; Endometrium; Uterus; Embryo Implantation; Endometritis
PubMed: 37834087
DOI: 10.3390/ijms241914639 -
The Journal of Infectious Diseases Aug 2021Chlamydia trachomatis (CT) causes pelvic inflammatory disease, which may result in tubal factor infertility (TFI) in women. Serologic assays may be used to determine the... (Review)
Review
Chlamydia trachomatis (CT) causes pelvic inflammatory disease, which may result in tubal factor infertility (TFI) in women. Serologic assays may be used to determine the proportion of women with and without TFI who have had previous CT infection and to generate estimates of infertility attributable to chlamydia. Unfortunately, most existing CT serologic assays are challenged by low sensitivity and, sometimes, specificity for prior CT infection; however, they are currently the only available tests available to detect prior CT infection. Modeling methods such as finite mixture modeling may be a useful adjunct to quantitative serologic data to obtain better estimates of CT-related infertility. In this article, we review CT serological assays, including the use of antigens preferentially expressed during upper genital tract infection, and suggest future research directions. These methodologic improvements, coupled with creation of new biomarkers for previous CT infection, should improve our understanding of chlamydia's contribution to female infertility.
Topics: Antibodies, Bacterial; Biomarkers; Chlamydia Infections; Chlamydia trachomatis; Female; Humans; Infertility, Female; Pelvic Inflammatory Disease; Serology
PubMed: 34396401
DOI: 10.1093/infdis/jiab047 -
Japanese Journal of Radiology Apr 2024This review focuses on inflammatory diseases of female and male genital organs and discusses their epidemiology, pathogenesis, clinical presentation, and imaging... (Review)
Review
This review focuses on inflammatory diseases of female and male genital organs and discusses their epidemiology, pathogenesis, clinical presentation, and imaging findings. The female section covers pelvic inflammatory disease (PID) primarily caused by sexually transmitted infections (STIs) that affect the uterus, fallopian tubes, and ovaries. Unusual causes such as actinomycosis and tuberculosis have also been explored. The male section delves into infections affecting the vas deferens, epididymis, testes, prostate, and seminal vesicles. Uncommon causes such as tuberculosis, and Zinner syndrome have also been discussed. In addition, this review highlights other conditions that mimic male genital tract infections such as vasculitis, IgG4-related diseases, and sarcoidosis. Accurate diagnosis and appropriate management of these inflammatory diseases are essential for preventing serious complications and infertility. Imaging modalities such as ultrasound, magnetic resonance imaging, and computed tomography play a crucial role in diagnosis. Understanding the diverse etiologies and imaging findings is vital for the effective management of inflammatory diseases of the genital organs.
Topics: Male; Humans; Female; Pelvic Inflammatory Disease; Genitalia; Uterus; Prostate; Tuberculosis
PubMed: 38165529
DOI: 10.1007/s11604-023-01518-8 -
Evidence-based Complementary and... 2022Pelvic inflammatory disease (PID), a common infectious disease of the female reproductive tract, is mainly characterized by abdominal/pelvic pain and tenderness of the... (Review)
Review
Pelvic inflammatory disease (PID), a common infectious disease of the female reproductive tract, is mainly characterized by abdominal/pelvic pain and tenderness of the uterus, cervix, or adnexa on physical exam. In recent years, its incidence has gradually increased yearly due to numerous factors, including sexually transmitted diseases and intrauterine operations. Based on self-report of PID in the National Health and Nutrition Examination Survey (NHANES) 2013-2014 survey, PID impacts approximately 2.5 million women in the US during their reproductive age. Although empiric treatments such as antibiotics or surgery could alleviate the related symptoms of PID, its unsatisfactory obstetric outcome and high relapse bring heavy physical and psychological burden to women. Complementary and alternative medicine (CAM), a complementary therapy other than Western medicine with a complete theoretical and practical system, has been attached to importance in the world due to its remarkable efficacy. More people are accepting and trying to use CAM to treat gynecological diseases, including infertility, polycystic ovary syndrome, and PID, but its efficacy and mechanism are still controversial. This article reviews the previous literature systematically focusing on the effectiveness, safety, and mechanism of CAM in the treatment of PID to provide an evidence-based basis for the clinical application of CAM in patients with PID.
PubMed: 35096102
DOI: 10.1155/2022/1364297 -
International Journal of Molecular... Jan 2023Chronic endometritis (CE) is a local mucosal inflammatory disorder of the uterine lining, which is histopathologically recognized as the unusual infiltration of CD138(+)... (Review)
Review
Chronic endometritis (CE) is a local mucosal inflammatory disorder of the uterine lining, which is histopathologically recognized as the unusual infiltration of CD138(+) plasmacytes into the endometrial stromal compartment. Accumulating body of research documented that CE is associated with female infertility and several obstetric/neonatal complications. The major cause of CE is thought to be intrauterine infection represented by common bacteria (, , , and ), , and . Additionally, local dysbiosis in the female reproductive tract may be involved in the onset and development of CE. Antibiotic treatments against these microorganisms are effective in the elimination of endometrial stromal plasmacytes in the affected patients. Meanwhile, endometriosis is a common female reproductive tract disease characterized by endometriotic tissues (ectopic endometrium) growing outside the uterus and potentially causes chronic pelvic symptoms (dysmenorrhea, dyspareunia, dyschezia, and dysuria), infertility, and ovarian cancers. Endometriosis involves endocrinological, genetic, and epigenetic factors in its etiology and pathogenesis. Recent studies focus on immunological, inflammatory, and infectious aspects of endometriosis and demonstrate several common characteristics between endometriosis and CE. This review aimed to better understand the immunological and microbial backgrounds underlying endometriosis and CE and look into the therapeutic potential of the novel antibiotic treatment strategy against endometriosis in light of endometrial infectious disease.
Topics: Pregnancy; Infant, Newborn; Humans; Female; Endometritis; Endometriosis; Anti-Bacterial Agents; Endometrium; Infertility, Female; Escherichia coli
PubMed: 36768381
DOI: 10.3390/ijms24032059 -
Medicine Oct 2023Pelvic inflammatory disease (PID) is an upper genital tract infection caused by a variety of aerobic and anaerobic microorganisms ascending from the cervix or vagina....
Pelvic inflammatory disease (PID) is an upper genital tract infection caused by a variety of aerobic and anaerobic microorganisms ascending from the cervix or vagina. Though PID is mainly a sexually transmitted disease; 15% are non-sexually transmitted.[1] In our study, we aim to assess gynecologists' understanding and awareness of PID; as it presents an important health issue affecting the Jordanian community and similar communities with the same cultural and religious backgrounds. A cross-sectional study was conducted using an online questionnaire that received responses from 172 gynecologists in Jordan. The questionnaire aimed at testing gynecologists' knowledge of different aspects of PID starting with diagnosis and ending with management. 68.6% of gynecologists acknowledged that PID is a problem in Jordan. However, obvious confusion was observed in the scopes of clinical presentation, choosing the most reliable PID investigations, and treatment. PID is not being addressed properly in a sexually conservative community that has low rates of sexually transmitted diseases like Jordan, which is misleading and dangerous. In addition, we think there is a lack of certain standards on how to define PID and acknowledge its effect on the community as well as the disappointing level of knowledge about different aspects of PID gynecologists show, starting with its prevalence and ending with treatment policy. Clearer guidelines for the diagnosis, management, and prevention of PID should be adopted. These findings should be acknowledged by all doctors from neighboring countries as well as those within similar communities to Jordan.
Topics: Female; Humans; Pelvic Inflammatory Disease; Cross-Sectional Studies; Jordan; Gynecologists; Sexually Transmitted Diseases
PubMed: 37800796
DOI: 10.1097/MD.0000000000035014 -
Cell Transplantation 2023Chronic endometritis (CE) is closely linked to the reproductive failure. Exosome (Exo)-based therapy is proposed as an encouraging strategy in inflammation-related...
Chronic endometritis (CE) is closely linked to the reproductive failure. Exosome (Exo)-based therapy is proposed as an encouraging strategy in inflammation-related disorders; however, little work has been devoted to its usage in CE therapy. An CE was established by administration of lipopolysaccharide (LPS) in human endometrial stromal cells (HESCs). The cell proliferation, cell apoptosis, and inflammatory cytokine assays were performed , and the efficacy of Exos derived from adipose tissue-derived stem cells (ADSCs) was evaluated in a mouse model of CE. We found that Exos isolated from ADSCs could be taken up by HESCs. Exos elevated the proliferation and inhibited apoptosis in LPS-treated HESCs. Administration of Exos to HESCs suppressed the content of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β). Moreover, Exos exposure repressed the inflammation stimulated by LPS . Mechanistically, we demonstrated that Exos exerted their ant-inflammatory effect via miR-21/TLR4/NF-kB signaling pathway in endometrial cells. Our findings suggest that ADSC-Exo-based therapy might serve as an attractive strategy for the treatment of CE.
Topics: Mice; Animals; Female; Humans; Endometritis; Exosomes; Lipopolysaccharides; Stem Cells; Inflammation; MicroRNAs
PubMed: 37191253
DOI: 10.1177/09636897231173736