Acute Pelvic Inflammatory Disease Research Articles

How to differentiate acute pelvic inflammatory disease from acute appendicitis ? A decision tree based on CT findings.

To construct a decision tree based on CT findings to differentiate acute pelvic inflammatory disease (PID) from acute appendicitis (AA) in women with lower abdominal pain and inflammatory syndrome. This retrospective study was approved by our institutional review board and informed consent was waived. Contrast-enhanced CT studies of 109 women with acute PID and 218 age-matched women with AA were retrospectively and independently reviewed by two radiologists to identify CT findings predictive of PID or AA. Surgical and laboratory data were used for the PID and AA reference standard. Appropriate tests were performed to compare PID and AA and a CT decision tree using the classification and regression tree (CART) algorithm was generated. The median patient age was 28 years (interquartile range, 22-39 years). According to the decision tree, an appendiceal diameter ≥ 7 mm was the most discriminating criterion for differentiating acute PID and AA, followed by a left tubal diameter ≥ 10 mm, with a global accuracy of 98.2 % (95 % CI: 96-99.4). Appendiceal diameter and left tubal thickening are the most discriminating CT criteria for differentiating acute PID from AA. • Appendiceal diameter and marked left tubal thickening allow differentiating PID from AA. • PID should be considered if appendiceal diameter is < 7 mm. • Marked left tubal diameter indicates PID rather than AA when enlarged appendix. • No pathological CT findings were identified in 5 % of PID patients.

Comparison of Azithromycin and Doxycycline in Treatment of Acute Uncomplicated Pelvic Inflammatory Disease

Introduction: Pelvic inflammatory disease (PID) refers to an infectious and inflammatory disorder of the female upper genital tract. It is common among young sexually active individuals and is a major health problem both in the developed and developing countries. It is usually a polymicrobial infection, however, Chlamydia trachomatis (serovars D-K) is the commonest causative agent transmitted sexually. PID is diagnosed basically by history and clinical examination and the treatment is initially empiric. Doxycycline is a good old drug in use for PID and Azithromycin is a new macrolide with promising effects for same. This comparative study aimed to measure efficiency and compliance of once daily for five days Azithromycin with twice a day for 14 days Doxycycline in the treatment of mild, uncomplicated acute PID. Methods: A descriptive cross-sectional study was conducted in randomly selected 100 consecutive outpatients with mild uncomplicated acute PID. Comparative outcome of Azithromycin and Doxycycline in correlation with reduction of amount, consistency and malodor of vaginal discharge along with reduction in fornical tenderness, compliance and frequency of adverse drug reactions was done. Comparison of categorical variables was done by chi-square test with p-value &lt;0.05 as statistically significant. Results: Among 100 cases 50 (50%) were treated with tablet Azithromycin and 50 (50%) with tablet Doxycycline. Comparative analysis on reduction of amount, consistency, malodor of vaginal discharge and reduction of fornical tenderness were statistically significant (p &lt; 0.05), showing Azithromycin more effective than Doxycycline. Besides, compliance was better and there were less adverse drug reactions with Azithromycin. Conclusion: Azithromycin has better efficiency and compliance over Doxycycline in the treatment of mild, uncomplicated, acute PID.

Embarazo ectópico abdominal secundario a perforación uterina por interrupción voluntaria del embarazo: presentación de caso

Secondary abdominal ectopic pregnancy is rare in clinical practice, but may lead to an increased maternal mortality. We present the case of a patient with an abdominal pregnancy secondary to a uterine perforation caused by a voluntary attempt to interrupt pregnancy that presented with nine weeks of abdominal pain and minimal vaginal bleeding which was mistakenly diagnosed as acute pelvic inflammatory disease, urinary tract infection, and post-abortion products of conception. Finally, the abdominal ultrasound test found an abdominal ectopic pregnancy. An exploratory laparotomy was performed and the fetus and placenta were removed without difficulties with a favorable postoperative course. It was concluded that uterine perforation during curettage of the cavity went unnoticed, leading to secondary abdominal implantation of pregnancy with a inconclusive clinical presentation, where ultrasound plays a fundamental diagnostic role. Laparotomy is indicated in most of these cases.

TERAPIA MANUAL NO TRATAMENTO DA DISMENORREIA PRIMÁRIA: REVISÃO SISTEMÁTICA

Introdução: No decorrer do período fértil, aproximadamente mais de um milhão de mulheres apresentam um episódio de doença inflamatória pélvica aguda e mais de 100.000 mulheres desenvolvem a infertilidade como consequência desta. A dismenorreia primária é um fenômeno fisiológico doloroso, espasmódico, descrito como cólicas na parte inferior do abdome, pouco antes e/ou durante o período menstrual. Dentre as práticas não farmacológicas, as técnicas da terapia manual, apresentam efeitos significativos no tratamento da dismenorreia primária. Este estudo tem como objetivo reunir evidências científicas a fim de identificar os possíveis impactos da Terapia Manual no tratamento da dismenorreia primária. Materiais e Métodos: Revisão Sistemática de Literatura incluindo ensaios clínicos controlados randomizados das Bases de Dados LILACS, PubMed, PEDro, Bireme e Cochrane. Resultados: Foram encontrados 55 artigos, dos quais 3 corresponderam aos critérios de inclusão. As variáveis de interesse do estudo foram: intensidade da dor, duração da dor, nível de ansiedade, percepção de dor na região lombar, limiar de dor a pressão, níveis de adrenalina, noradrenalina, serotonina, dopamina e descompressão da articulação sacrilíaca. Conclusão: Esta pesquisa sugere que a terapia manual atua de maneira benéfica no tratamento da dismenorreia primária, apresentando melhora em todas as variáveis estudadas.

Antibiotic therapy for pelvic inflammatory disease.

Antibiotic therapy for pelvic inflammatory disease.

Tubal Disease and Impersonators/Masqueraders.

Ultrasound is considered the first-line imaging modality in the evaluation of the fallopian tubes. This chapter reviews both the physiologic and pathologic sonographic findings of the fallopian tubes and how to recognize characteristic entities. Specifically, it describes how to use ultrasound techniques to distinguish between pathologic processes including chronic versus acute pelvic inflammatory disease, as well as infertility, torsion, and malignancy. It also describes how to employ modern ultrasound techniques, such as color Doppler, three-dimensional imaging, and salpingocentesis in clinical practice.

Status of vaccine research and development of vaccines for Chlamydia trachomatis infection

Genital infection with Chlamydia trachomatis, a gram-negative obligate intracellular bacterium, is the most common bacterial sexually transmitted infection globally. Ascension of chlamydial infection to the female upper genital tract can cause acute pelvic inflammatory disease, tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. Shortcomings of current chlamydia control strategies, especially for low- and middle-income countries, highlight the need for an effective vaccine. Evidence from animal models, human epidemiological studies, and early trachoma vaccine trials suggest that a C. trachomatis vaccine is feasible. Vaccine development for genital chlamydial infection has been in the preclinical phase of testing for many years, but the first Phase I trials of chlamydial vaccine candidates are underway, and scientific advances hold promise for additional candidates to enter clinical evaluation in the coming years. We describe the clinical and public health need for a C. trachomatis vaccine, provide an overview of Chlamydia vaccine development efforts, and summarize current vaccine candidates in the development pipeline.

Clinical characteristics of genital chlamydia infection in pelvic inflammatory disease

BackgroundChlamydia 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.MethodsThe 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.ResultsThe 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.ConclusionsChlamydia 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.

Comparing the Frequency of Endometritis in Unexplained Infertility and Anovulatory Infertility.

Background:Acute pelvic inflammatory disease (PID) is a common reason for infertility. This study aimed to evaluate the frequency distribution of endometritis in women with unexplained infertility and comparison with frequency distribution of endometritis in anovulatory infertility to identify the importance of endometritis due to subacute PID evaluation in the case of infertility.Materials and Methods:This case–control study was done on 100 women with unexplained infertility and ovulatory infertility who referred to Shahid Beheshti clinic in 2013 in Isfahan, Iran. They were divided into two groups of unexplained infertility and anovulatory infertility. Endometrial samples were given from all the patients by Pipelle biopsy under sterile conditions, and then prepared samples were sent to the pathology laboratory to evaluate the existence of plasma cells by a pathologist to diagnose endometritis.Results:Frequency distribution of acute PID history among the patients in both groups showed a significant difference (P < 0.05). Prevalence of endometritis in unexplained infertility group was 34% and in anovulatory group was 21% (P < 0.05). Prevalence of vaginitis was 46% in unexplained group and 40% in anovulatory group (P < 0.05), and prevalence of PID was 4% in unexplained infertility group and 0% in anovulatory infertility group.Conclusion:The prevalence of endometritis and vaginitis was more in the unexplained infertility group rather than the anovulatory infertility group that may reveal the importance of endometritis evaluation in the cases of unexplained infertility.

MRI in pelvic inflammatory disease: a pictorial 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.

25: Mycoplasma genitalium and acute pelvic inflammatory disease

25: Mycoplasma genitalium and acute pelvic inflammatory disease

Fallopian tube carcinoma complicated with acute pelvic inflammatory disease: A case report

Fallopian tube carcinoma complicated with acute pelvic inflammatory disease: A case report

Usefulness of Serum Procalcitonin Levels in Predicting Tubo-Ovarian Abscess in Patients with Acute Pelvic Inflammatory Disease

We aimed to investigate the clinical importance of serum procalcitonin (PCT) levels in the diagnosis of tubo-ovarian abscess (TOA). Patients diagnosed with pelvic inflammatory disease (PID; n = 36) and patients diagnosed with TOA (n = 42) were included in the study. Sociodemographic characteristics, laboratory and clinical parameters were compared between the 2 groups. Mean PCT level was higher in the TOA group (p = 0.004). Mean length of stay in hospital was longer in patients with TOA (p < 0.001). White blood cell count, neutrophil count, percentage of neutrophils and C-reactive protein levels were higher than normal limits in all patients; however, no differences in these parameters were observed between the groups. A cutoff level of 0.330 ng/ml for PCT revealed 62% sensitivity and 75% specificity in predicting TOA. Serum PCT is a promising inexpensive marker for the diagnosis of TOA in PID patients.

Recruitment of Minority Adolescents and Young Adults Into Randomised Clinical Trials: Testing the Design of the Technology Enhanced Community Health Nursing (Tech-N) Pelvic Inflammatory Disease Trial

Purpose: Pelvic inflammatory disease (PID) disproportionately affects adolescent and young adult (AYA) females and can negatively impact their short and long-term reproductive health. Few randomised controlled trials (RCTs) have focussed on strategies to improve outpatient adherence, or to reduce reproductive morbidity in this population. This paper describes the research methods and preliminary effectiveness of recruitment, retention, and intervention strategies employed in a novel RCT designed to test a technology-enhanced community health nursing (TECH-N) intervention among urban AYA females with PID. Methods: AYAs aged 13–25 years were recruited during acute PID visits in outpatient clinics and emergency departments to participate in this trial, approved by an International Review Board. Participants completed an audio-computerised self-interview, provided vaginal specimens, and were randomised to either standard treatment or intervention. Intervention participants received SMS messaging support for 30 days and a community health nurse interventionist performed a home visit with clinical assessment within 5 days of enrolment. All patients received a full course of medications and completed research visits at 14 days (adherence), 30 days, and 90 days with an outreach worker. Sexually transmitted infection testing was performed at the 30 and 90-day visits. Exploratory analyses using descriptive statistics were conducted to examine recruitment, retention, and follow-up data to test the overall design of the intervention. Results: In the first 48 months, 63.3% of 463 patients were eligible for the study (293), 81.2% of the eligible patients were recruited for the study (N=238). Most participants were African American (95.6%) with a mean age of 18.6 (standard deviation: 2.3). Of those individuals assigned to the TECH-N intervention, 94% completed the nursing visits. All completed visits were within the 5-day window and over 90% of patients in both arms have been retained over the 3-month follow-up period. Biological data suggests a shift in the biological milieu with the predominance of Chlamydia trachomatis , Mycoplasma genitalium , and Trichomonas vaginalis infections. Conclusions: Preliminary data from the TECH-N study demonstrated that urban, low-income, minority AYA females with PID can effectively be recruited and retained to participate in sexual and reproductive health RCTs with sufficient investment in the design and infrastructure of the study. Community-based sexual health interventions appear to be both feasible and acceptable in this population.

Pelvic inflammatory disease: improving awareness, prevention, and treatment.

PurposePelvic inflammatory disease (PID) is a common disorder of the reproductive tract that is frequently misdiagnosed and inadequately treated. PID and its complications, such as infertility, ectopic pregnancy, and chronic pelvic pain, are preventable by screening asymptomatic patients for sexually transmitted infections (STIs) and promptly treating individuals with STIs and PID.Recent findingsThe rates of adverse outcomes in women with PID are high and disproportionately affect young minority women. There are key opportunities for prevention including improving provider adherence with national screening guidelines for STIs and PID treatment recommendations and patient medication adherence. Nearly half of all eligible women are not screened for STIs according to national quality standards, which may increase the risk of both acute and subclinical PID. Moreover, in clinical practice, providers poorly adhere to the Centers for Disease Control and Prevention recommendations for treatment of PID. Additionally, patients with PID struggle to adhere to the current management strategies in the outpatient setting.ConclusionNovel evidence-based clinical and public health interventions to further reduce the rates of PID and to improve outcomes for affected women are warranted. We propose potential cost-effective approaches that could be employed in real-world settings.

Value of ultrasound in obstetrics and gynecology emergency in diagnosis and differential diagnosis

Objective To explore the value of ultrasonography in the diagnosis and identification of Obstetrics and Gynecology in accident and emergency. Methods A retrospective method was taken to 80 cases of obstetrics and gynecology emergency patients with ultrasound diagnosis data analysis in the hospital from June 2014 to June 2015, and compared to surgical and pathological diagnosis, to observe the ultrasonic diagnosis value. Results The correct rate of the ultrasound diagnosis of ectopic pregnancy, ovarian cyst torsion, inevitable abortion, threatened abortion, corpus luteum rupture, trophoblastic disease, and acute pelvic inflammatory disease was 90.9%, 94.1%, 100.0%, 100.0%, 85.7% , 75.0%, and 100.0%, and the overall diagnostic accuracy was 93.8%. Conclusions The Emergency Department of obstetrics and gynecology patients used ultrasound has a better diagnosis effect, and high diagnostic accuracy. At the same time, the ultrasound examination is gynecology and obstetrics emergency check the preferred way, strong repeatability, and better observed lesions, high application value. Key words: Ultrasonography; Emergencies; Genital diseases, female/US; Pregnancy complications/US; Diagnosis, differential

Progress in nursing methods for chronic pelvic inflammatory disease

Abstract Chronic pelvic inflammatory disease is a highly common gynecological disease. It is often caused by the failure to completely treat acute pelvic inflammatory disease or persistent disease due to the poor physique of patients. This paper provides a summary of the recent research studies on chronic pelvic inflammatory disease.

Association Between Endometriosis and Tubo-Ovarian Abscess

Background: Tubo-ovarian abcesses (TOAs) are complicating factors in approximately one-fourth of hospitalized cases of acute pelvic inflammatory disease (PID). However, many women with TOAs have no antecedent history of PID or sexually transmitted diseases. Moreover, it has not been fully elucidated that which risk factors are associated with TOA and TOAs will develop at whom. In recent studies, it has been questioned whether endometriosis is a risk factor for TOA. The purpose of the study was to identify the incidence of endometriosis in patients who have been surgically treated due to TOA and to search clinical-demographical differences among the groups with and without endometriosis. Methods: A total of 118 patients were divided into two groups according to pathologic results, whether endometriosis with TOAs was confirmed histologically, or not, and demographical-clinical characteristics were investigated. Results: The mean age of patients was 40.9 ± 8.5 years and 21 (17.8%) were postmenopausal. The intrauterine device was in situ at the time of TOA diagnosis in 49 (41.5%) patients. Concomitant disease and previous pelvic surgery history were identified in 16 (13.6%) and 43 (36.4%) patients, respectively. Final histopathological analyses revealed endometriosis with TOA in 21 (17.8%) patients. When all patients were divided into two groups with and without endometriosis and compared according to clinical and demographical characteristics, there were not any significant differences identified (P > 0.05), except hemoglobin values (P = 0.039). Conclusion: Endometriosis with TOA is not only in reproductive period but also in menopause, more prevalent than expected for normal population. J Clin Gynecol Obstet. 2016;5(1):17-22 doi: http://dx.doi.org/10.14740/jcgo388w

Infecciones en gineco-obstetricia. Endometritis salpingitis pelviperitonitis aguda

La endometritis salpingitis pelviperitonitis aguda (ESP), llamada anteriormente enfermedad pélvica inflamatoria aguda, se presenta en la etapa menstrual y preferentemente durante la 3ra y 4ta. década de la vida, que es la etapa fundamental de vida sexual activa; raramente es diagnosticada en mujeres sin vida sexual activa.

SÍFILIS SECUNDÁRIA E DOENÇA INFLAMATÓRIA PÉLVICA NA ATENÇÃO PRIMÁRIA

We present the case of a young woman who was attended to in a family health clinic. The patienthad genital lesions and lower abdominal pain, and was diagnosed with syphilis and acute pelvicinflammatory disease. Our aim is to share this experience, which occurred in a basic health unit.