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Epidemiology and Infection Jan 2017Pelvic inflammatory disease (PID) and more specifically salpingitis (visually confirmed inflammation) is the primary cause of tubal factor infertility and is an...
Pelvic inflammatory disease (PID) and more specifically salpingitis (visually confirmed inflammation) is the primary cause of tubal factor infertility and is an important risk factor for ectopic pregnancy. The risk of these outcomes increases following repeated episodes of PID. We developed a homogenous discrete-time Markov model for the distribution of PID history in the UK. We used a Bayesian framework to fully propagate parameter uncertainty into the model outputs. We estimated the model parameters from routine data, prospective studies, and other sources. We estimated that for women aged 35-44 years, 33·6% and 16·1% have experienced at least one episode of PID and salpingitis, respectively (diagnosed or not) and 10·7% have experienced one salpingitis and no further PID episodes, 3·7% one salpingitis and one further PID episode, and 1·7% one salpingitis and ⩾2 further PID episodes. Results are consistent with numerous external data sources, but not all. Studies of the proportion of PID that is diagnosed, and the proportion of PIDs that are salpingitis together with the severity distribution in different diagnostic settings and of overlap between routine data sources of PID would be valuable.
Topics: Adolescent; Adult; England; Female; Humans; Incidence; Pelvic Inflammatory Disease; Prospective Studies; Recurrence; Young Adult
PubMed: 27678278
DOI: 10.1017/S0950268816002065 -
Genitourinary Medicine Feb 1993
Review
Topics: Actinomyces; Actinomycosis; Female; Genital Diseases, Female; Humans; Intrauterine Devices; Pelvic Inflammatory Disease
PubMed: 8444484
DOI: 10.1136/sti.69.1.54 -
American Family Physician Mar 2006Pelvic inflammatory disease (PID) is an infection of the upper genital tract in women that can include endometritis, parametritis, salpingitis, oophoritis, tubo-ovarian... (Review)
Review
Pelvic inflammatory disease (PID) is an infection of the upper genital tract in women that can include endometritis, parametritis, salpingitis, oophoritis, tubo-ovarian abscess, and peritonitis. The spectrum of disease ranges from subclinical, asymptomatic infection to severe, life-threatening illness; sequelae include chronic pelvic pain, ectopic pregnancy, and infertility. PID is diagnosed clinically, with laboratory and imaging studies reserved for patients who have an uncertain diagnosis, are severely ill, or do not respond to initial therapy. The Centers for Disease Control and Prevention diagnostic criteria include uterine, adnexal, or cervical motion tenderness with no other obvious cause in women at risk of PID. Empiric treatment should be initiated promptly and must cover Chlamydia trachomatis and Neisseria gonorrhoeae; the possibility of fluoroquinolone-resistant N. gonorrhoeae also should be considered. Hospitalization for initial parenteral therapy is necessary for patients with tubo-ovarian abscess and for those who are pregnant, severely ill, unable to follow a prescribed treatment plan, or unable to tolerate oral antibiotics. Patients also should be hospitalized if a surgical emergency cannot be excluded or if no clinical improvement occurs after three days. Routine screening for asymptomatic chlamydial infection can help prevent PID and its sequelae.
Topics: Anti-Bacterial Agents; Centers for Disease Control and Prevention, U.S.; Female; Guidelines as Topic; Humans; Pelvic Inflammatory Disease; United States
PubMed: 16529095
DOI: No ID Found -
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 -
BMJ Clinical Evidence Mar 2008Pelvic inflammatory disease is caused by infection of the upper female genital tract and is often asymptomatic. Pelvic inflammatory disease is the most common... (Review)
Review
INTRODUCTION
Pelvic inflammatory disease is caused by infection of the upper female genital tract and is often asymptomatic. Pelvic inflammatory disease is the most common gynaecological reason for admission to hospital in the USA and is diagnosed in almost 2% of women aged 16-45 years consulting their GP in England and Wales.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of empirical treatment compared with treatment delayed until the results of microbiological investigations are known? How do different antimicrobial regimens compare? What are the effects of routine antibiotic prophylaxis to prevent pelvic inflammatory disease before intrauterine contraceptive device (IUD)8 insertion? We searched: Medline, Embase, The Cochrane Library and other important databases up to May 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 9 systematic reviews, RCTs or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics (oral, parenteral, empirical treatment, treatment guided by test results, different durations, outpatient, inpatient), and routine antibiotic prophylaxis (before intrauterine device insertion in women at high risk or low risk).
Topics: Acute Disease; Administration, Oral; Anti-Bacterial Agents; Anti-Infective Agents; Hospitalization; Humans; Pelvic Inflammatory Disease
PubMed: 19450319
DOI: No ID Found -
Sexually Transmitted Infections Feb 1999Further research is necessary to elucidate the pathogenesis of chlamydial PID. It is hoped that these endeavours will eventually lead to a vaccine to prevent not only... (Review)
Review
Further research is necessary to elucidate the pathogenesis of chlamydial PID. It is hoped that these endeavours will eventually lead to a vaccine to prevent not only chlamydia infection, but also chlamydia associated infertility, ectopic pregnancy, and chronic pelvic pain. In the meantime we need to develop strategies to prevent primary and secondary chlamydia infection and its sequelae. Recently, Scholes et. al demonstrated that a population based approach to identify and test women at high risk for cervical C trachomatis infection effectively reduced risk of PID. Hopefully, through the use of public health measures, we can see similar decreases of chlamydia associated genital tract disease worldwide.
Topics: Antibodies; Chlamydia Infections; Chlamydia trachomatis; Female; Heat-Shock Proteins; Humans; Immunity, Cellular; Pelvic Inflammatory Disease; Risk Factors
PubMed: 10448337
DOI: 10.1136/sti.75.1.21 -
International Journal of Epidemiology Apr 2009Screening programmes are promoted to control transmission of and prevent female reproductive tract morbidity caused by genital chlamydia. The objective of this study was... (Review)
Review
BACKGROUND
Screening programmes are promoted to control transmission of and prevent female reproductive tract morbidity caused by genital chlamydia. The objective of this study was to examine the effectiveness of register-based and opportunistic chlamydia screening interventions.
METHODS
We searched seven electronic databases (Cinahl, Cochrane Controlled Trials Register, DARE, Embase, Medline, PsycINFO and SIGLE) without language restrictions from January 1990 to October 2007 and reference lists of retrieved articles to identify studies published before 1990. We included studies examining primary outcomes (pelvic inflammatory disease, ectopic pregnancy, infertility, adverse pregnancy outcomes, neonatal infection, chlamydia prevalence) and harms of chlamydia screening in men and non-pregnant and pregnant women. We extracted data in duplicate and synthesized the data narratively or used random effects meta-analysis, where appropriate.
RESULTS
We included six systematic reviews, five randomized trials, one non-randomized comparative study and one time trend study. Five reviews recommended screening of women at high risk of chlamydia. Two randomized trials found that register-based screening of women at high risk of chlamydia and of female and male high school students reduced the incidence of pelvic inflammatory disease in women at 1 year. Methodological inadequacies could have overestimated the observed benefits. One randomized trial showed that opportunistic screening in women undergoing surgical termination of pregnancy reduced post-abortal rates of pelvic inflammatory disease compared with no screening. We found no randomized trials showing a benefit of opportunistic screening in other populations, no trial examining the effects of more than one screening round and no trials examining the harms of chlamydia screening.
CONCLUSION
There is an absence of evidence supporting opportunistic chlamydia screening in the general population younger than 25 years, the most commonly recommended approach. Equipoise remains, so high-quality randomized trials of multiple rounds of screening with biological outcome measures are still needed to determine the balance of benefits and harms of chlamydia screening.
Topics: Adolescent; Chlamydia Infections; Chlamydia trachomatis; Female; Genital Diseases, Female; Humans; Male; Mass Screening; Pelvic Inflammatory Disease; Program Evaluation; Research Design; Young Adult
PubMed: 19060033
DOI: 10.1093/ije/dyn222 -
BMC Women's Health Jan 2017Chlamydia infection in acute pelvic inflammatory disease (PID) is associated with serious complications including ectopic pregnancy, tubal infertility, Fitz-Hugh-Curtis...
BACKGROUND
Chlamydia infection in acute pelvic inflammatory disease (PID) is associated with serious complications including ectopic pregnancy, tubal infertility, Fitz-Hugh-Curtis syndrome and tubo-ovarian abscess (TOA). This study compared clinical and laboratory data between PID with and without chlamydia infection.
METHODS
The medical records of 497 women who were admitted with PID between 2002 and 2011 were reviewed. The patients were divided into two groups (PID with and without chlamydia infection), which were compared in terms of the patients' characteristics, clinical presentation, and laboratory findings, including inflammatory markers.
RESULTS
The chlamydia and non-chlamydia groups comprised 175 and 322 women, respectively. The patients in the chlamydia group were younger and had a higher rate of TOA, a longer mean hospital stay, and had undergone more surgeries than the patients in the non- chlamydia group. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and CA-125 level were higher in the chlamydia group than in the non-chlamydia group, but there was no significant difference in the white blood cell count between the two groups. The CA-125 level was the strongest predictor of chlamydia infection, followed by the ESR and CRP level. The area under the receiving operating curve for CA-125, ESR, and CRP was 0.804, 0.755, and 0.663, respectively.
CONCLUSIONS
Chlamydia infection in acute PID is associated with increased level of inflammatory markers, such as CA-125, ESR and CRP, incidence of TOA, operation risk, and longer hospitalization.
Topics: Abscess; Adult; CA-125 Antigen; Chlamydia; Chlamydia Infections; Female; Hepatitis; Humans; Infertility; Pelvic Inflammatory Disease; Peritonitis; Pregnancy; Pregnancy, Ectopic; Republic of Korea
PubMed: 28086838
DOI: 10.1186/s12905-016-0356-9 -
The Journal of Infectious Diseases Aug 2021Pelvic inflammatory disease (PID) is an infection of the upper genital tract that has important reproductive consequences to women. We describe the burden of and trends...
BACKGROUND
Pelvic inflammatory disease (PID) is an infection of the upper genital tract that has important reproductive consequences to women. We describe the burden of and trends in PID among reproductive-aged women in the United States during 2006-2016.
METHODS
We used data from 2 nationally representative probability surveys collecting self-reported PID history (National Health and Nutrition Examination Survey, National Survey of Family Growth); 5 datasets containing International Classification of Diseases, Ninth/Tenth Revision codes indicating diagnosed PID (Healthcare Utilization Project; National Hospital Ambulatory Medical Care Survey, emergency department component; National Ambulatory Medical Care Survey; National Disease Therapeutic Index; MarketScan); and data from a network of sexually transmitted infection (STI) clinics (Sexually Transmitted Disease Surveillance Network). Trends during 2006-2016 were estimated overall, by age group and, if available, race/ethnicity, region, and prior STIs.
RESULTS
An estimated 2 million reproductive-aged women self-reported a history of PID. Three of 4 nationally representative data sources showed overall declines in a self-reported PID history, and PID emergency department and physician office visits, with small increases observed in nearly all data sources starting around 2015.
CONCLUSIONS
The burden of PID in the United States is high. Despite declines in burden over time, there is evidence of an increase in recent years.
Topics: Adolescent; Adult; Cost of Illness; Emergency Service, Hospital; Female; Humans; Nutrition Surveys; Pelvic Inflammatory Disease; Sexual Behavior; United States; Young Adult
PubMed: 34396411
DOI: 10.1093/infdis/jiaa771 -
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