Cases Of Pelvic Inflammatory Disease Research Articles

Ovarian Tube Abscess in an Intrauterine Contraceptive Device User for 5 Years: A Case Report

A tubo-ovarian abscess (TOA) is one of the late complications of untreated Pelvic Inflammatory Disease (PID) and can be life-threatening if the abscess ruptures and results in sepsis.1 It most commonly affects women of reproductive age and nearly 60% of women with TOA are nulliparous.2 The association between tubo-ovarian abscess formation and the presence of an intrauterine device (IUD) is well recognized. It has been suggested that the risk of upper genital tract infection is highest during the immediate period following the insertion of an IUD. We report a case of pelvic inflammatory disease in a 44-year-old woman using an intrauterine contraceptive device (IUD) for more than 5 years, who complained of lower abdominal pain and lumbar pain without fever, and also had a thick-white vaginal discharge. The clinical diagnosis was performed by anamnesis and ultrasound (we found an hypo- hyperechoic mass on the right adnexa size 4.4 x 3.6 x 4.0 cm) and then the patient was treated with triple antibiotics for 3 days. Afterward, the patient was performed using exploring laparoscopy to continue to right salpingo-oophorectomy adhesiolysis left tubectomy, and IUD removal as well. Long-term users of IUDs remain at risk for serious pelvic infections. Every IUD user's patient should be routinely counseled by their gynecologist and tubo-ovarian abscess should be strongly considered in the differential diagnosis of an IUD user who presents with an adnexal mass, abdominal pain, and lumbar pain. The treatment must be a combination of antibiotics and surgery.

Does vaginal cleansing with iodine decreases infection rate in office hysteroscopy?

To determine whether preoperative vaginal cleansing with iodine-based solution prior to hysteroscopy, reduces postoperative infection rate compared to no vaginal cleansing. A retrospective study at a single tertiary, university affiliated hospital of all individuals who have had an office hysteroscopy. Study group consisted of patients who have had preoperative vaginal cleansing with iodine-based solution and were compared to those who have not. Any procedural related complaints at the 30days following the hysteroscopy were recorded. A total of 505 were available for analysis, 183 in the study group and 322 in the control group. The most common indications for operation were infertility evaluation (33.9% vs. 28.6%) and retained products of conception (33.3% vs. 29.2%), and most common procedures were diagnostic only (49.7% vs. 42.5%) followed by adhesiolysis (12% vs. 14.3%). No statistical differences were noted with regards to postoperative infections, as only one case of pelvic inflammatory disease was noted, in the iodine cleansing group (0.19% for postoperative infection). Our comparative study may suggest that the use of preoperative iodine solution prior to office hysteroscopy does not decrease the postoperative infection rate up to 30days, thus can be avoided.

Costs, Health Benefits, and Cost-Effectiveness of Chlamydia Screening and Partner Notification in the United States, 2000-2019: A Mathematical Modeling Analysis.

Chlamydia remains a significant public health problem that contributes to adverse reproductive health outcomes. In the United States, sexually active women 24 years and younger are recommended to receive annual screening for chlamydia. In this study, we evaluated the impact of estimated current levels of screening and partner notification (PN), and the impact of screening based on guidelines on chlamydia associated sequelae, quality adjusted life years (QALYs) lost and costs. We conducted a cost-effectiveness analysis of chlamydia screening, using a published calibrated pair formation transmission model that estimated trends in chlamydia screening coverage in the United States from 2000 to 2015 consistent with epidemiological data. We used probability trees to translate chlamydial infection outcomes into estimated numbers of chlamydia-associated sequelae, QALYs lost, and health care services costs (in 2020 US dollars). We evaluated the costs and population health benefits of screening and PN in the United States for 2000 to 2015, as compared with no screening and no PN. We also estimated the additional benefits that could be achieved by increasing screening coverage to the levels indicated by the policy recommendations for 2016 to 2019, compared with screening coverage achieved by 2015. Screening and PN from 2000 to 2015 were estimated to have averted 1.3 million (95% uncertainty interval [UI] 490,000-2.3 million) cases of pelvic inflammatory disease, 430,000 (95% UI, 160,000-760,000) cases of chronic pelvic pain, 300,000 (95% UI, 104,000-570,000) cases of tubal factor infertility, and 140,000 (95% UI, 47,000-260,000) cases of ectopic pregnancy in women. We estimated that chlamydia screening and PN cost $9700 per QALY gained compared with no screening and no PN. We estimated the full realization of chlamydia screening guidelines for 2016 to 2019 to cost $30,000 per QALY gained, compared with a scenario in which chlamydia screening coverage was maintained at 2015 levels. Chlamydia screening and PN as implemented in the United States from 2000 through 2015 has substantially improved population health and provided good value for money when considering associated health care services costs. Further population health gains are attainable by increasing screening further, at reasonable cost per QALY gained.

Report of Two Cases of Pelvic Inflammatory Disease Complicating Transcervical Frozen Embryo Transfer

Background: Pelvic inflammatory disease (PID) complicating transcervical embryo transfer, not related to previous oocyte aspiration, is an extremely rare event. However, it can lead to severe complications. Case: We report two cases of pelvic infection related to transcervical frozen embryo transfer. The case of one patient was complicated by a pelvic abscess, which required percutaneous drainage, and the case of the other patient was complicated by ascites, which was positive for chlamydia. Conclusions: Despite there not being enough evidence to recommend cervical cultures or antibiotic prophylaxis in all cases of embryo transfer, it would be advisable in those cases with a personal history of PID.

RUPTURED TUBO-OVARIAN ABSCESS: RARE PRESENTATION OF PELVIC INFLAMMATORY DISEASE - A CASE REPORT

Background: Infection of the endometrium, fallopian tubes, ovaries, pelvic peritoneam, and adjacent structures is known as Pelvic Inflammatory Disease (PID). Pelvic inflammatory disease and its consequences are still at epidemic levels, Despite the availability of effective broad-spectrum antibiotics. Tubo-ovarian abscess (TAO) may be difficult to identify since the clinical signs are comparable to those of other pelvic and abdominal illnesses. Case Description: Here we are reporting a case, 34 years nulligravida came to emergency department with acute abdomen, she was a known case of chronic PID, Emergency laparotomy was performed, per operatively ruptured tubo-ovarian abscess was present. Conclusion: The clinical diagnosis of PID and TAO is similar, imaging evidence from ultrasonography (US) or magnetic resonance (MR) should be used to supplement the clinical diagnosis. Clinical Significance: To avoid complications and resultant emergency surgeries and their consequences, a vigilant eye must be kept to promptly diagnose, and manage PID at the earliest.

Gonococcal Pelvic Inflammatory Disease with Sepsis Criteria: Review of 2 Cases

Background: Infection caused by Neisseria Gonorrhoeae increases the risk of pelvic inflammatory disease (PID). Gonococcal PID tends to be clinically more severe than non-gonococcal ones. The main is to present two cases of gonococcal PID, with rapid clinical and analytic progression, leading to severe sepsis, but without imaging manifestations. Clinical presentation: 1. 41-year-old patient with replacement of intrauterine releasing levonorgestrel device (IUD), presented abdominal pain and green vaginal discharge. Abdominal examination revealed signs of peritoneal irritation and blood test showed leukocytosis, increased C Reactive Protein and procalcitonin, as well as coagulation abnormalities. Imaging tests (vaginal ultrasound/tomography) revealed no structural pathology, without collections. Given the criteria of severe sepsis, broadspectrum intravenous (iv) antibiotic therapy was started and laparoscopy and IUD removal were performed. Cervical and IUD cultures were positive for Neisseria gonorrhoeae. 2. 20-year-old woman, with an IUD, consulted for abdominal pain, low-grade fever and green vaginal discharge. Abdominal examination suggested peritoneal sensitivity and laboratory tests leukocytosis, increased C Reactive Protein and procalcitonin with coagulation abnormalities. Imaging tests (vaginal ultrasound/tomography) showed no structural pathology, without collections. Despite analgesia and broad-spectrum iv antibiotics, the patient worsened, proceeding to remove the IUD. Given the criteria compatible with severe sepsis, laparoscopy was decided. Endocervical and IUD cultures revealed Neisseria gonorrhoeae. Conclusions: Facing the situation of an acute PID with severe and fast clinical worsening even without findings in imaging tests, we should consider gonococcal ethiology as a possible cause. Surgical approach shouldn’t be delayed in order to control the infection and rule out other possible diagnosis.

A study on histopathological changes in ectopic tubal gestation

Background: Ectopic pregnancy is a serious cause of maternal morbidity and mortality. Fallopian tube is the most common site. Ectopic pregnancy is often the consequence of chronic salpingitis. The aim of the study was to identify the various histopathological changes in the fallopian tube, which are removed following an ectopic tubal gestation. The prevalence of various risk factors in ectopic tubal pregnancy was also investigated. Methods: This descriptive study included 160 cases of ectopic tubal gestation received in the department during the study period. Slides were studied for various changes like chronic salpingitis, acute salpingitis, salpingitis isthmica nodosa, endometriosis, tuberculosis etc. Patient’s clinical details were obtained from the medical records.Results: The most frequent pathological finding was chronic salpingitis followed by salpingitis isthmica nodosa. It was noted that all cases with a positive history of pelvic inflammatory disease (PID), showed evidence of chronic salpingitis during histopathological examination. Chronic salpingitis was also noted in 45% cases who did not give a history of PID. Among the risk factors, a history of tubal sterilization was the most frequent one.Conclusions: Even though the mortality has reduced, ectopic pregnancy causes significant morbidity and affects the fertility of women. The rise in incidence could be due to increase in prevalence of sexually transmitted diseases, increase in tubal sterilization practices and frequent use of assisted reproduction technology. It is evident from the study that many cases of PIDs are left unidentified.

Remote Health Interventions: Effectiveness, Cost, and Cost-Effectiveness Considerations.

Remote Health Interventions: Effectiveness, Cost, and Cost-Effectiveness Considerations.

Successful Provision of Long-Acting Reversible Contraception in a Sexual Health Clinic.

Women who attend sexual health clinics are at high risk for sexually transmitted infections and unintended pregnancy. Long-acting reversible contraceptives (LARC) are very effective contraceptive methods, but the provision of LARC in such clinics is not well described in the literature. We conducted a retrospective chart review of women who presented to Denver Sexual Health Clinic for any reason and received family planning services between April 1, 2016, and October 31, 2018. We assessed demographic and clinical factors associated with contraceptive method received and conducted a subanalysis of those with intrauterine device (IUD) insertions on the same-day versus delayed insertion. Among those who received an IUD, we assessed rates of pelvic inflammatory disease (PID) 30 days after insertion. Of the 5064 women who received family planning services in our clinic, 1167 (23%) were using a LARC method at the time of their visit. Of the 3897 who were not using a LARC, fewer women, 12.6%, chose LARC (IUD and progestin implant), compared with 33.3% who chose new short-acting reversible contraceptives. Further analysis of the 270 IUD initiators revealed 202 (74.8%) received the IUD on the same day, whereas 68 (25.2%) had delayed IUD insertion. There were 9 incident cases of gonorrhea or chlamydia in those who received same-day IUD and 1 incident case among those who had delayed IUD insertion. There were no cases of PID at 30 days after insertion in either group. Study findings support IUD provision in a sexual health clinic on the day of initial visit without increased risk of PID.

Pelvic inflammatory disease in postmenopausal women: Diagnostic difficulties and management in an underprivileged environment, a case report from the University Hospital of Yaoundé – Cameroon (Update)

Pelvic Inflammatory Disease (PID), or more specifically upper genital infections, includes uterine and adnexal infections. These are infections secondary to the ascent of germs from the vagina through the cervix. Their particularity is their paucisymptomatic or even asymptomatic character. Although quite common in women of childbearing age, they remain exceptional in postmenopausal women. We report a case of PID in an elderly postmenopausal patient who responded favourably to probabilistic antibiotic therapy. Our aim is to explain its epidemiological, clinical and therapeutic particularities

Vaginal microbiota in ethnically diverse young women who did or did not develop pelvic inflammatory disease: community-based prospective study

ObjectivesA lactobacilli-dominated vaginal microbiome may protect against pelvic inflammatory disease (PID), but one dominated by Gardnerella species might increase susceptibility. Not all lactobacilli are equally protective. Recent research suggests that...

Factors associated with pelvic inflammatory disease: A case series analysis of family planning clinic data.

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, Chlamydia trachomatis was present in 56%, Mycoplasma genitalium was present in 38%, and Neisseria gonorrhoeae 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 Mycoplasma genitalium 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.

A case of pelvic inflammatory disease requiring laparoscopic surgery in a patient with uncontrolled severe diabetes: A case report

A case of pelvic inflammatory disease requiring laparoscopic surgery in a patient with uncontrolled severe diabetes: A case report

Association of pelvic inflammatory disease (PID) with ovarian cancer: a nationwide population-based retrospective cohort study from Taiwan

BackgroundPelvic inflammatory disease (PID) is an important health issue for women. Infection and inflammation play an important role in carcinogenesis and PID has been reported to be associated with ovarian cancer in some small scale studies.AimWe sought to determine whether PID is associated with an elevated risk of ovarian cancer in Asian women.MethodsUsing data from Taiwan’s National Health Insurance Research Database (NHIRD), our retrospective cohort study included women diagnosed with PID (cases) between the years of 2000 till 2012. Each case was matched with two women without PID (controls) by age and the year of first entry into the database. Both study cohorts were followed-up until the first event of ovarian cancer, withdrawal from the NHI program, death, or the end of the study period (December 31, 2012). Cox proportional hazards regression models were used to estimate crude and adjusted hazard ratios (HRs and aHRs) with their corresponding 95% confidence intervals (95% CIs) for the association of PID and ovarian cancer risk, with and without adjusting for potential confounders.ResultsDuring an approximate 10 years of follow-up, cases were significantly more likely than controls to develop ovarian cancer (incidence rates of 0.27 and 0.16 per 1,000 person-years, respectively; P < 0.001). Women with a history of PID had a 1.49-fold elevated risk for ovarian cancer (aHR, 1.49; 95% CI, 1.21–1.84; P < 0.001).ConclusionOur study evidence supports the contention that PID increases the risk of developing ovarian cancer among Taiwanese women. Gynecologists should undertake careful assessments and closely follow patients with PID, who are at long-term risk of developing ovarian cancer. Our findings need further verification in other international cohorts.

Cost-Effectiveness Analysis of Michigan’s School-Wide Sexually Transmitted Disease Screening Program in Four Detroit High Schools

PurposeThe Michigan Department of Health and Human Services, in collaboration with St. John Providence Health System, initiated voluntary school-wide sexually transmitted disease (STD) screenings in four Detroit public high schools. We sought to assess the cost-effectiveness of the STD screening program from 2010 to 2015, with a focus on chlamydia. MethodsThe costs and effectiveness of the school-based screening were compared with those of a “no school screening” scenario using a healthcare system perspective. A decision tree model was constructed to project cases of chlamydia, epididymitis, and pelvic inflammatory disease (PID) in each of the two scenarios among students tested positive and their partners. Health effects were measured as cases of PID prevented, and quality-adjusted life-years (QALYs) gained. Cost estimates included program costs, chlamydia testing/treatment costs in the absence of school screening, and treatment costs for epididymitis, PID, and PID sequelae. The incremental cost-effectiveness ratio (ICER) was measured as cost/QALY gained. Multivariate sensitivity analyses were conducted on key parameter estimates and assumptions used. ResultsUnder base-case assumptions, at a total program cost of $333,848 over 5 years, the program prevented an estimated 1.9 cases of epididymitis and 17.3 cases of PID, resulting in an ICER of $38,235/QALY gained (yearly ICER ranging from $27,417 to $50,945/QALY). Of 10,000 Monte Carlo simulation runs, the yearly ICER remained ≤$50,000/QALY in 64%–98% of the simulation runs. ConclusionsWe found favorable cost-effectiveness ratios for Michigan's school-wide STD screening program in Detroit. School-based STD screening programs of this type warrant careful considerations by policy makers and program planners.

A study on role of cartridge based nucleic acid amplification test (CBNAAT) in diagnosis of genital tuberculosis among patients of infertility and pelvic inflammatory disease

Female genital TB (FGTB)– referring to TB of the uterus, fallopian tubes and/or Ovaries. It poses a diagnostic dilemma because of its varied presentations and lack of sensitive and specific methods of diagnosis, though CBNAAT gives rapid result. To study the role of CBNAAT in the Diagnosis of Genital Tuberculosis among infertility and Pelvic Inflammatory Disease (PID) Patients. 102 patient of infertility (52) and chronic PID (50) were enrolled for our cross-sectional study. Mantoux, ESR, Histopathology, CBNAAT was performed in all 102 cases and Hysterosalpingography (HSG), Laparoscopy, Hysteroscopy in selected cases. Patient with clinical features of genital TB, supported with TB suggestive test were diagnosed as high suspicious genital TB (GTB+) and rest Low suspicious GTB (GTB-) cases. 14/ 52 cases of infertility and 18/ 50 cases of chronic PID were clinically diagnosed as High suspicious genital TB (GTB+). In our study, overall Prevalance of GTB was 31.37%, among infertility patient prevalence was 26.92% and among chronic PID was 36%. 16/32 (50%) mantoux positive, 25/32 (78.13%) had increased ESR. On HSG, 10/52 (19.23%) infertility cases, on laparoscopy 24/32 (75%), on endometrial histopathology only 3/32 (9.37%) cases had finding suggestive of TB. CBNAAT could detect tubercular bacilli only in 25% (8/32) TB cases. High index of suspicion for FGTB is must for diagnosis. Unlike Pulmonary TB, role of CBNAAT in the diagnosis of female genital TB is limited. PPV of CBNAAT for diagnosis of GTB is almost 100%.

The Diagnostic Value of Hysterosalpingography and Hysterolaparoscopy for Evaluating Uterine Cavity and Tubal Patency in Infertile Patients.

Background and objectiveHysterosalpingography (HSG) is a common radiologic modality employed for the initial workup of female infertile patients to evaluate for tubal patency or any gross intrauterine pathology. HSG is a relatively cheap and easily available outpatient procedure but bears the risk of radiation exposure. The purpose of the study was to compare the diagnostic value of HSG with that of diagnostic hysterolaparoscopy in infertile women and to evaluate their role in the diagnosis and management of infertility.MethodologyThis study was carried out from February 2018 to January 2019. All women attending our outpatient department (OPD) for the treatment of infertility who were aged between 20-40 years were included in the study. Those with acute vaginal and cervical infection and those having an allergic reaction to the dye used in HSG were excluded from the study. Known cases of pelvic inflammatory disease and those who achieved pregnancy before the performance of hysteroscopy were also excluded from the study.ResultsA total of 172 women with primary or secondary infertility were enrolled in the study. Out of these, 13 women became pregnant, and two were lost to follow-up and were excluded from our study. Thus, a total of 157 infertile women were analysed. The agreement between HSG and hysteroscopy was 71.3% for the evaluation of the uterine cavity, and this was considered a fair strength of agreement between the procedures (k value=0.302).ConclusionCompared to HSG, the incidental findings detected by hysteroscopy amounted to 19.14%. Our study results depict the advantage of hysterolaparoscopy over HSG. Although the sensitivity of HSG is as good as that of diagnostic hysterolaparoscopy for the detection of tubal patency, a significant number of important incidental findings can be missed by it. Hence, diagnostic hysterolaparoscopy should be offered as the first-line modality for the evaluation of infertility wherever the procedure is available.

Efficacy and Tolerability of Thermocoagulation Treatment of High-Grade Cervical Intraepithelial Neoplasia

Purpose: Cervical cancer is still one of the main causes of cancer and mortality in women, especially in low- and middle-income countries, although it is a completely preventable disease through the detection and treatment of pre-cancer lesions. We evaluated the efficacy and tolerability of thermocoagulation treatment of high-grade cervical intraepithelial neoplasia (CIN 2 and 3). Methods: We evaluated 115 women with high-grade cervical intraepithelial neoplasia, 54 with CIN 2 and 61 with CIN 3, confirmed by biopsy and without previous treatment, from January 2016 to December 2018, undergoing thermocoagulation treatment at the Lower Genital Tract Pathology and Colposcopy Service of the Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil. Results: The mean age was 33.11 years (SD = 9.83) for CIN 2 and 35.28 years (SD = 7.97) for CIN 3 patients. Treatment efficacy was 90.8% in CIN 2 and 94.9% in CIN 3 cases. Pain was the main symptom reported at the time of treatment, occurring more frequently in the CIN 3 group (49.1% versus 27.8% in the CIN 2 group). As the more important long-term complication, there were 3 cases of pelvic inflammatory disease in CIN 2 (5.6%) and 3 in CIN 3 group (5.0%). The percentage of residual lesion was very low in both groups, 5 in CIN 2 group (9.2%) and 2 in CIN 3 group (3.4%). Conclusion: Thermocoagulation is an effective method for the treatment of cervical pre-cancer lesions (CIN 2 and CIN 3), with a low risk of adverse events and complications.

La malattia infiammatoria pelvica

The paper describes a case of Pelvic Inflammatory Disease (PID) in a fourteen-year-old girl who presented with salpingitis, low abdominal pain, fever, high inflammation indexes and infection by Chlamydia trachomatis and Gardnerella. As guidelines suggest, she was treated with doxycycline, metronidazole and ceftriaxone and her clinical conditions rapidly improved. PID can develop also in teenagers, especially if sexually active, and it must be differentiated from other causes of acute abdomen. The diagnosis can be based on the presence of pain and on at least one criterion between clinical objectivity (fever, vaginal secretions) and laboratory data (vaginal swab, blood exams, vaginal secretion microscopic analysis). Instrumental exams can support the diagnosis but sometimes only laparoscopy and biopsy can reveal a condition of PID. Adequate antibiotic treatment should be performed to avoid complications over future reproductive life.

An analysis of pelvic inflammatory disease cases experienced at our hospital

An analysis of pelvic inflammatory disease cases experienced at our hospital