Cause Of Pelvic Inflammatory Disease Research Articles

The Territorial Distribution of Incidence with Urogenital Chlamydia, Gonorrhea, and their Associated Complications in the Russian Federation

Relevance. Urogenital chlamydia is one of the most common sexually transmitted infections. Chlamydia often presents with minimal or no symptoms. However, it can be a major cause of pelvic inflammatory disease (PID), infertility, and ectopic pregnancy in women, as well as epididymitis, orchitis, and infertility in men. Aim. To study the territorial patterns of incidence of urogenital chlamydia, gonorrhea, and their associated complications in the Russian Federation in 2011 to 2019. Materials and methods. Official statistics on the incidence of urogenital chlamydia, gonorrhea, PID, female and male infertility in the Russian Federation were analyzed. Statistical analysis, graphing, table creation, data visualization, and research results analysis were conducted using Microsoft Excel 2010 and IBM SPSS Statistics 22 software. GIS mapping was performed using the GIS «Axioma». Results and discussion. From 2011 to 2019, the Russian Federation observed a decrease in the incidence of urogenital chlamydia, gonorrhea, and PID, while there was an increase in the incidence of male and female infertility. The geographical distribution remained stable, with areas characterized by consistently low and high incidence rates. A correlation was found between the incidence of urogenital chlamydia, gonorrhea, and their complications. The association between gonorrhea and PID was found to be more significant than the association between chlamydia and PID, possibly due to the higher risk of complications associated with gonorrhea. However, no correlation was found between gonorrhea and infertility, possibly because this complication manifests with a time delay and has multifactorial causes. Conclusions. Based on the presented data, it can be concluded that the incidence of urogenital chlamydia and gonorrhea affects the frequency of male and female infertility. Therefore, the implementation of screening examinations for sexually active individuals of reproductive age using appropriate laboratory diagnostic methods, along with the development of preventive measures for sexually transmitted infections, including urogenital chlamydia, is justified and should be widely practiced.

Pelvic Inflammatory Disease: updates from diagnosis to treatment

Pelvic inflammatory disease (PID) is a clinical syndrome caused by several microorganisms, mainly those related to sexually transmitted infections (STIs), which ascend the female genital tract towards the upper genital organs. It is a disease that affects young women, who have an active sex life and have a history of chlamydia, for example. Its clinical picture may be symptomatic, with pain in the lower abdomen being the main complaint, or in some cases the patient may be asymptomatic. The disease is confirmed by classifying the symptoms into major, minor or elaborate criteria, and by complementary laboratory and imaging tests. Its treatment can be outpatient or hospital, depending on the degree of symptoms and should be started as soon as possible, even empirically, using broad-spectrum antimicrobials. The importance of a quick diagnosis and treatment is due to the possible consequences that PID can cause, such as infertility. This literature review aims to disclose the causes and symptoms of the disease, which is one of the most important sexually transmitted infections, since the lack of a quick diagnosis and treatment, or even an inadequate treatment, increases the chances of complications for the women's health. This is a literature review on Pelvic Inflammatory Disease. A search was carried out for scientific articles in the databases Google Scholar, Scielo and indexed journals between the years 2020 to 2023, in Portuguese and English, with the following descriptors: Pelvic Inflammatory Disease, Sexually Transmitted Infections and Chlamydia trachomatis. Even though it is a condition that affects many young women, PID is an underreported disease, therefore, it is necessary to have more teaching about sex education, since the main cause of PID is STIs.

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...

Prevalence of Gonorrhea Among Pregnant Women in Nigeria: Reproductive Health Implication

Sexually transmitted diseases (STDs) including gonorrhea are a major reproductive health issue. Gonorrhea is a disease caused by Neisseria gonorrhea bacteria and is the one of the causes of PID in women. The global prevalence of gonorrhea is estimated to be at 0.9% which is high. This paper sought to provide updated information on the prevalence of gonorrhea infection and to discuss the reproductive health implications. Methods: literature search using PubMED, Google Scholar and Medline was conducted. Studies included were cross sectional studies reporting the prevalence of gonorrhea in Nigeria, conducted from 2000 to 2021. The population from the various studies analyzed was 1725 women of reproductive age between 15 and 45 years. Findings: the prevalence of gonorrhea was found to be 2.0% in the East, 5.2%, 5.0% and 0.7% in the South, 3.4% in the West and 16.3% in the North. The reproductive health implication is that untreated STIs leads to pelvic inflammatory disease (PID) and may further result to infertility and part of the goal for most couple is to reproduce. Treating PID is one of the most difficult task for clinicians thus except gonorrhea is combated the problem of infertility will not be ameliorated and thereby achieving safer birth and better reproductive health outcomes will almost be near impossible.

Gonococcal Pelvic Inflammatory Disease: Placing Mechanistic Insights Into the Context of Clinical and Epidemiological Observations.

While infection by Neisseria gonorrhoeae is often asymptomatic in women, undetected infections can ascend into the upper genital tract to elicit an inflammatory response that manifests as pelvic inflammatory disease, with the outcomes depending on the intensity and duration of inflammation and whether it is localized to the endometrial, fallopian tube, ovarian, and/or other tissues. This review examines the contribution of N. gonorrhoeae versus other potential causes of pelvic inflammatory disease by considering new insights gained through molecular, immunological, and microbiome-based analyses, and the current epidemiological burden of infection, with an aim to highlighting key areas for future study.

The negative impact of most relevant infections on fertility and assisted reproduction technology.

Infections may act with variable impact on the physiopathology of the reproductive organs, determining infertility or reducing the outcomes of assisted reproduction technology. The aim of this narrative review is to describe the existing evidence regarding the pathogens with a supposed or recognized role in reproductive medicine. Viral hepatitis, as well as HIV, can reduce sperm quality. Syphilis carries a risk of erectile dysfunction and increased endometrial thickness. Chlamydia is the main cause of pelvic inflammatory disease. In relation to Mycoplasma and Ureaplasma spp., only few species seem to show a correlation with infertility and poor in-vitro fertilization outcomes. There is evidence of a role for bacterial vaginosis in early pregnancy loss. HPV infection in males seems to determine infertility. Herpesviruses are more a risk for fetuses than for fertility itself. Zika virus is responsible for altered early embryo development and waiting to conceive is recommended in suspected or confirmed cases. The impact of SARS-CoV-2 is yet to be elucidated. Rubella and toxoplasmosis can provoke important congenital defects and therefore screening is mandatory before conception; a vaccine for Rubella is recommended. Further and well-designed studies are still needed to better elucidate the role of some infectious agents, to improve fertility and its treatments.

The Impact of Selected Bacterial Sexually Transmitted Diseases on Pregnancy and Female Fertility.

Sexually transmitted infections (STIs) caused by Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium are a common cause of pelvic inflammatory disease (PID) which can lead to tubal factor infertility (TFI). TFI is one of the most common causes of infertility, accounting for 30% of female fertility problems. STIs can also have an impact on pregnancy, leading to adverse pregnancy outcomes. Escalating antibiotic resistance in Neisseria gonorrhoeae and Mycoplasma genitalium represents a significant problem and can be therapeutically challenging. We present a comprehensive review of the current treatment options, as well as the molecular approach to this subject. We have given special attention to molecular epidemiology, molecular diagnostics, current and new treatments, and drug resistance.

Clinical Background and Detection of Chlamydia trachomatis Antigen among Infertile Women Attending University of Maiduguri Teaching Hospital, Nigeria

Background: Chlamydia trachomatis infection is an established cause of pelvic inflammatory disease (PID), ectopic pregnancy, chronic pelvic pain and infertility among women. It is the most common bacterial sexually transmitted disease in the world. The infection is largely asymptomatic.
 Aim: The study was carried out to determine the Clinical background as well as detect the Chlamydia trachomatis antigen among infertile women attending University of Maiduguri Teaching Hospital (UMTH).
 Methods: A survey on the Clinical background and antigens to Chlamydia trachomatis was carried out among infertile and post natal women attending fertility Clinic UMTH. A total of 65 endocervical swab samples were collected from the aforementioned group of subjects within the age of 18-47 years, out of which 45 were collected from infertile women while the remaining 20 were obtained from post-natal women to serve as control subjects. The samples were analysed by using Chlamydia Rapid Test device swab/urine (Abon Biopharm(Hangzhou), Co., Ltd) that work on the principle of immunochromatographic technique.
 Results: Highest number of infertility was observed on women within the age of 30-35 years (33.3%). The result shows that those that attained tertiary educational level have the highest number of infertility (60%). The study demonstrated highest number of infertility among female civil servants (53.3%) followed by full-time house wife (33.3%). More infertility was observed among women who are not engaged in the use of contraceptive measures (95.6%). The overall result from this study shows no prevalence (0.0%) of C. trachomatis genital infection among infertile women in UMTH.
 Conclusion: Further research using more sensitive and specific procedures for the detection of C. trachomatis from clinical specimens such as nucleic acid amplification tests and cell culture are recommended among infertile women in Borno State, Nigeria.

Self-Reported Infertility and Associated Pelvic Inflammatory Disease Among Women of Reproductive Age-National Health and Nutrition Examination Survey, United States, 2013-2016.

Sexually transmitted diseases, including chlamydia and gonorrhea, cause of pelvic inflammatory disease (PID) and infertility. We estimated the prevalence of infertility and infertility health care seeking. We analyzed self-reported lifetime infertility and infertility health care-seeking in women aged 18 to 49 years in the 2013 and 2015 National Health and Nutrition Examination Surveys. Weighted prevalence of infertility and infertility health care seeking, prevalence ratios (PRs), and 95% confidence intervals (CIs) were calculated. Among 2626 eligible women, 13.8% had self-reported infertility (95% CI, 12.3-15.3) with higher prevalence by age: 960, 18 to 29 years (PR, 6.4%; 95% CI, 4.8-8.0); 799, 30 to 39 years (PR, 14.8%; 95% CI, 12.2-17.3); and 867, 40 to 49 years (PR, 20.8%; 95% CI, 17.2-24.4). Non-Hispanic white women (PR, 15.4%; 95% CI, 13.0-17.8; n = 904) and non-Hispanic black women (PR, 12.9%; 95% CI, 10.3-15.5; n = 575) had the highest infertility prevalences. Women reporting PID treatment (n = 122) had higher infertility prevalence (PR, 24.2%; 95% CI, 16.2-32.2) than women without PID treatment (PR, 13.3%; 95% CI, 11.6-15.0; n = 2,485), especially among 18- to 29-year-old women (PR, 3.8; 95% CI, 1.8-8.0). Of 327 women with infertility, 60.9% (95% CI, 56.1-65.8) sought health care. Women without health care insurance sought care less frequently than women with insurance. In a nationally representative sample, 13.8% of reproductive-age women reported a history of infertility, of whom 40% did not access health care. Self-reported PID was associated with infertility, especially in young women. Annual chlamydia and gonorrhea screening to avert PID may reduce the burden of infertility in the United States.

Risk of Ectopic Pregnancy and Tubal Infertility Following Gonorrhea and Chlamydia Infections.

Gonorrhea and chlamydia are important causes of pelvic inflammatory disease. Chlamydia also causes long-term sequelae, but the role of gonorrhea is unclear. We followed 300 000 reproductive-aged women for 10 years for ectopic pregnancy and tubal infertility; our findings suggest both infections confer similar increases in risk of these outcomes.

Prevalence of genital Chlamydia trachomatis infection among patients attending a gynecological clinic in a tertiary hospital

Background: Chlamydia trachomatis is the most common cause of sexually transmitted infections in the world. The organism causes silent infection in women and could remain unnoticed for a very long time. Nearly 80% of women are asymptomatic. It is an established and recognized cause of pelvic inflammatory disease, ectopic pregnancy, and infertility among women. In most parts of Nigeria, including the study area, the organism is not routinely screened for, hence the paucity of information about its prevalence. Objectives: The objectives of this study were to determine the prevalence and risk factors associated with genital C. trachomatis infection among women attending the Gynaecological Clinic of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. Materials and Methods: A prospective study was carried out among new patients attending the Gynaecological Clinic of UDUTH, Sokoto. The women were consecutively recruited as they presented to the clinic until the desired sample size was achieved. A structured questionnaire was administered, and related information and consent were obtained. Endocervical swab was collected and tested using Eugene Chlamydia Rapid Test Device following manufacturer's instructions. Results: Samples were collected from a total of 400 women aged between 15 and 49 years. The prevalence of genital C. trachomatis among gynecological patients was 3.5%. The risk factors identified include age of patients below 29 years, early age of onset of sexual activity, and marital status. Conclusion: The study showed that the prevalence of genital C. trachomatis was low. The rate was higher among respondents with infertility. There is a need for routine screening of patients with infertility.

In Vitro Assessment of Estrogenic Potential of Biofield Energy Treatment using Human Endometrial Adenocarcinoma Cell Line

The objective of the study was to investigate the effect of Consciousness Energy Healing based DMEM medium on the level of alkaline phosphatase enzyme (ALP) activity in Ishikawa cells. The test item, DMEM medium was divided into two parts. One part of the test item received Consciousness Energy Healing Treatment by a renowned Biofield Energy Healer, Mahendra Kumar Trivedi and was labeled as the Biofield Energy Treated DMEM, while the other part did not receive any treatment, and defined as the untreated DMEM group. The cell viability using MTT assay of the Biofield Energy Treated DMEM group was observed as 108%, which indicated that the test item was safe and non-toxic. The estrogenic potential using ALP level showed a significantly increase by 73.21% in the Biofield Energy Treated DMEM group as compared to the untreated DMEM group. Overall, the experimental data suggested that the Biofield Energy Treated DMEM has significantly improved ALP level, which play a vital role for the promotion and maintenance of estrogen level. Based on the study outcomes, it is concluded that Biofield Energy Healing Treatment showed a significant improved ALP level, which can be used in various estrogenic disorders such as hypophosphatasia, osteoporosis, severe anemia, malnutrition, hypothyroidism, magnesium deficiency, heart surgery, aplastic anemia, chronic myelogenous leukemia, enteritis in children, Wilson’s disease, pernicious anemia, bacterial infection and intrauterine infection is a leading cause of pelvic inflammatory disease, subfertility, infertility, endometritis, early pregnancy loss, fetal defects, and preterm birth.

CPAF, HSP60 and MOMP antigens elicit pro-inflammatory cytokines production in the peripheral blood mononuclear cells from genital Chlamydia trachomatis-infected patients

BackgroundPersistent inflammation caused by Chlamydia trachomatis in the female genital compartment represents one of the major causes of pelvic inflammatory disease (PID), ectopic pregnancy and infertility in females. Here, we examined the pro-inflammatory cytokine response following stimulation with three different types of C. trachomatis antigens, viz. chlamydial protease-like factor (CPAF), heat shock protein 60 (HSP60) and major outer membrane protein (MOMP). MethodsA total of 19 patients with genital C. trachomatis infection and 10 age-matched healthy controls were recruited for the study. Peripheral blood mononuclear cells (PBMCs) isolated from genital C. trachomatis-infected females were cultured in the presence of CPAF, HSP60 and MOMP antigens, and cytokines were measured by ELISA assay. ResultsWe reported that pro-inflammatory cytokines (TNF-α, IL-1β and IL-6) were robustly secreted following antigenic exposure. Notably, CPAP and MOMP were more potent in triggering IL-1β, as compared to HSP60. Elevated levels of the proinflammatory cytokines were also noted in the samples infected with plasmid-bearing C. trachomatis as compared to those infected with plasmid-free strains. ConclusionsOur study highlights distinct ability of chlamydial antigens in triggering pro-inflammatory response in the host immune cells.

The role of Chlamydia trachomatis in the pathogenesis of female reproductive organs cancers

Chlamydia trachomatis (C. trachomatis) is an intracellular obligate bacterium. It is the most common cause of pelvic inflammatory disease (PID) amongst a spectrum of diseases. Chlamydia infection is of a major public health concern especially in developing countries. It is estimated that about 600 million people are infected worldwide annually yet its roles in the pathogenesis of gynecological cancers are poorly understood and has not been fully elucidated. An understanding of the mechanisms underlying cancer development following PID due to C. trachomatis will be essential in prevention and providing more rational treatments. This review discusses the mechanisms and sequence of events linking Chlamydial infections to carcinogenesis in the female reproductive organs. Possible links between C. trachomatis infection and cancer development in the female reproductive organs are proposed. C. trachomatis infection as a co factor is also re-examined in light of these possible mechanisms.

Abstract 4942: Serologic markers of infectious agents and ovarian cancer: Markers of prior Chlamydia trachomatis infection associated with increased ovarian cancer risk in two independent populations

Abstract Background: Pelvic inflammatory disease (PID) has been associated with ovarian cancer and Chlamydia trachomatis (chlamydia) is the leading cause of PID in the developed world. Primary infection with chlamydia is often asymptomatic and may persist for several months/years, thus ascertainment of PID in epidemiologic studies is challenging due to pervasive misclassification and under-reporting. To improve our understanding of the role of chlamydia and other infectious agents in developing ovarian cancer, we evaluated serologic markers of infection with incident ovarian cancer using a staged approach in two independent populations. Methods: Studies included: 1) a case-control study conducted in Poland of 278 ovarian cancer cases diagnosed from 2000 to 2003 and age- and study site-matched controls (n=556) and 2) a nested case-control study from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial including 160 women who eventually developed ovarian cancer and 159 matched controls. We calculated odds ratios (OR) and 95% confidence intervals (CI) for the association between serologic marker titers and ovarian cancer risk using logistic regression adjusted for matching factors and potential confounders. We evaluated laboratory cutpoints indicative of prior chlamydia infection and tested more stringent marker thresholds, identified in Poland and applied in PLCO, that could be relevant for a PID-like infection. Results: In the Polish study, positivity for the chlamydia plasmid-encoded Pgp3 protein was associated with increased ovarian cancer risk [OR (95% CI): 1.63 (1.20-2.22)]; when a positive result was redefined at a higher titer, ovarian cancer risk increased [cutpoint 2: 2.00 (1.38-2.89); cutpoint 3 (max OR): 2.19 (1.29-3.73)]. All other chlamydia markers measured were associated with increased risk at the more stringent positivity threshold in Poland. In the prospective PLCO study, Pgp3 was associated with elevated risk at the laboratory cutpoint [1.43 (0.78-2.63)]; using higher thresholds, Pgp3 was associated with increased ovarian cancer risk [cutpoint 2: 2.25 (1.07-4.71); cutpoint 3: 2.53 (0.63-10.08)]. In both studies, markers of other infections (i.e., Mycoplasma genitalium, herpes simplex virus-2, human papillomavirus, herpes simplex virus-1, polyomavirus, hepatitis B, hepatitis C, Epstein Barr virus, cytomegalovirus) measured were not associated with risk. Conclusions: In two independent populations, the gold standard serologic marker of prior/current chlamydia infection (Pgp3) was associated with a doubling in ovarian cancer risk, whereas markers of other infectious agents were unrelated. Although these findings need to be replicated, they suggest potential ovarian cancer risk reduction through targeted treatment of chlamydia infections. Citation Format: Britton Trabert, Tim Waterboer, Sally B. Coburn, Louise A. Brinton, Mark E. Sherman, Jolanta Lissowska, Beata Peplonska, Patricia Hartge, Michael Pawlita, Nicolas Wentzensen. Serologic markers of infectious agents and ovarian cancer: Markers of prior Chlamydia trachomatis infection associated with increased ovarian cancer risk in two independent populations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4942.

Polymerase chain reaction versus enzyme-linked immunosorbent assay in detection of <i>Chlamydia trachomatis</i> infection among gynaecological patients in southwestern Nigeria

Background: Chlamydia trachomatis ( C. trachomatis ), is the most common bacterial Sexually Transmitted Infection, a major cause of Pelvic Inflammatory Disease and female infertility. Since C. trachomatis infections are frequently asymptomatic with higher prevalence in developing countries, highly sensitive and affordable methods are desirable for routine screening and diagnosis. This study aimed to evaluate the performance of C. trachomatis -specific IgG antibody by ELISA as a screening tool for C. trachomatis infection, by comparing the performance of ELISA with the gold standard Polymerase Chain Reaction (PCR). Method: In this cross sectional study, we enrolled 150 women attending infertility clinic at Ibadan between January and November, 2015. ELISA for detection of IgG antibodies specific to C. trachomatis major outer membrane protein (MOMP) was performed on the blood samples using third generation indirect Enzyme Linked Immunosorbent Assay (ELISA) and endocervical samples were analyzed for presence of C. trachomatis nucleic acid using PCR. Socio-demographic bio-data and gynaecological history were obtained with questionnaire; data was analyzed using SPSS version 20.0. Results: Overall, 58 (38.7%) were positive for C. trachomatis specific IgG antibody by ELISA and 11 (7.3%) for C. trachomatis nucleic acid by PCR. Using PCR as the gold standard, ELISA had a sensitivity of 81.8% specificity of 64.8%, positive predictive value of 15.5% negative predictive value of 97.8% and accuracy of 66%. Conclusion: The high sensitivity of the ELISA indicates that over 80% of patients identified as being positive in the screened population are truly infected. Also, the negative predictive value approaches 100% amongst those screened out as being negative. Thus its use as a screening tool for C. trachomatis infection is warranted particularly in developing countries where cheaper and easier to use alternatives to PCR are in dire need. Keywords: C. trachomatis , infertility, polymerase chain reaction, ELISA, sexually transmitted infections

Treating chlamydial infections in pregnancy and preventing adverse birth outcomes

Chlamydia trachomatis is one of the most common sexually transmitted infections globally; WHO estimates that there are more than 130 million new cases of chlamydia annually. Because chlamydial infections are often asymptomatic, screening programmes are imperative to control infection and to prevent adverse sequelae. Chlamydial infections are important causes of pelvic inflammatory disease and tubal infertility and can lead to ectopic pregnancies. 1 Adachi K Nielsen-Saines K Klausner JD Chlamydia trachomatis infection in pregnancy: the global challenge of preventing adverse pregnancy and infant outcomes in Sub-Saharan Africa and Asia. Biomed Res Int. 2016; : 9315757 PubMed Google Scholar Additionally, chlamydial infections increase the risk of acquiring HIV infection. 2 Boily MC Baggaley RF Wang L et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis. 2009; 9: 118-129 Summary Full Text Full Text PDF PubMed Scopus (619) Google Scholar Most, but not all, observational studies 1 Adachi K Nielsen-Saines K Klausner JD Chlamydia trachomatis infection in pregnancy: the global challenge of preventing adverse pregnancy and infant outcomes in Sub-Saharan Africa and Asia. Biomed Res Int. 2016; : 9315757 PubMed Google Scholar , 3 Hammerschlag MR Chlamydial and gonococcal infections in infants and children. Clin Infect Dis. 2011; 53: S99-S102 Crossref PubMed Scopus (67) Google Scholar , 4 Silva MJ Florencio GL Gabiatti JR Amaral RL Eleutério Júnior, J Gonçalves AK Perinatal morbidity and mortality associated with chlamydial infection: a meta-analysis study. Braz J Infect Dis. 2011; 15: 533-539 Crossref PubMed Google Scholar and meta-analyses have shown that chlamydial infection is associated with adverse obstetric outcomes in pregnancy and increased morbidity and mortality of neonates. Chlamydia trachomatis and the risk of spontaneous preterm birth, babies who are born small for gestational age, and stillbirth: a population-based cohort studyA genital chlamydia infection that is diagnosed and, presumably, treated either during or before pregnancy does not substantially increase a woman's risk of having a spontaneous preterm birth, having a baby who is small for gestational age, or having a stillbirth. Full-Text PDF

2017 European guideline for the management of pelvic inflammatory disease.

The European guideline for the management of pelvic inflammatory disease includes evidence-based advice on the investigation and treatment of pelvic inflammatory disease (PID). It has been updated to acknowledge the role of Mycoplasma genitalium as an important cause of PID with testing now recommended for women presenting with possible PID and for the male partners of women with confirmed M. genitalium infection. Recent evidence suggests that serious adverse events are uncommon when using moxifloxacin and its use is now recommended as a first-line therapy, especially in those women with M. genitalium PID. The potential utility of MRI scanning of the pelvis in excluding differential diagnoses has been highlighted. The use of doxycycline is now suggested as empirical treatment for male partners of women with PID to reduce exposure to macrolide antibiotics, which has been associated with increased resistance in M. genitalium.

Chlamydia trachomatis: the Persistent Pathogen.

Chlamydia trachomatis is an obligate intracellular bacterium whose only natural host is humans. Although presenting as asymptomatic in most women, genital tract chlamydial infections are a leading cause of pelvic inflammatory disease, tubal factor infertility, and ectopic pregnancy. C. trachomatis has evolved successful mechanisms to avoid destruction by autophagy and the host immune system and persist within host epithelial cells. The intracellular form of this organism, the reticulate body, can enter into a persistent nonreplicative but viable state under unfavorable conditions. The infectious form of the organism, the elementary body, is again generated when the immune attack subsides. In its persistent form, C. trachomatis ceases to produce its major structural and membrane components, but synthesis of its 60-kDa heat shock protein (hsp60) is greatly upregulated and released from the cell. The immune response to hsp60, perhaps exacerbated by repeated cycles of productive infection and persistence, may promote damage to fallopian tube epithelial cells, scar formation, and tubal occlusion. The chlamydial and human hsp60 proteins are very similar, and hsp60 is one of the first proteins produced by newly formed embryos. Thus, the development of immunity to epitopes in the chlamydial hsp60 that are also present in the corresponding human hsp60 may increase susceptibility to pregnancy failure in infected women. Delineation of host factors that increase the likelihood that C. trachomatis will avoid immune destruction and survive within host epithelial cells and utilization of this knowledge to design individualized preventative and treatment protocols are needed to more effectively combat infections by this persistent pathogen.

Current perspectives in the USA on the diagnosis and treatment of pelvic inflammatory disease in adolescents.

In this review, the epidemiology, diagnosis, and treatment of pelvic inflammatory disease (PID) are discussed from a USA perspective and the difficulties that USA adolescents face in recognizing and seeking care for PID and other sexually transmitted infections (STIs) are emphasized. Females aged 15–24 years have the highest incidence of cervical infection with Chlamydia trachomatis and Neisseria gonorrheae, the principal causes of PID. PID is common in this age group. However, the incidence of PID in the USA is not known, because it is not a reportable disease, and because clinicians vary in the criteria used for the diagnosis. The Centers for Disease Control and Prevention (CDC) recommended the following diagnostic criteria that include lower abdominal or pelvic pain and at least one of the following: adnexal tenderness or cervical motion tenderness or uterine tenderness. Because PID can have serious sequelae, the criteria emphasize sensitivity (few false-negatives) at the expense of specificity (some false-positives). Patients who have PID are usually treated in the outpatient setting, following the CDC’s Guidelines for the Treatment of Sexually Transmitted Diseases 2015. They receive one dose of an intramuscular cephalosporin, together with 2 weeks of oral doxy cycline, and sometimes oral metronidazole. Improvement should usually be evident in 3 days. The USA does not offer comprehensive sex education for adolescents in public or private schools. Adolescents are unlikely to recognize the symptoms of PID and seek medical treatment. Confidentiality is important to adolescents, and low cost or free sources of confidential care are uncommon, making it unlikely that an adolescent would seek care even if she suspected an STI. The CDC has concluded that screening programs for chlamydia and gonorrhea infection help prevent PID; however, the lack of appropriate sources of care makes adolescents’ participation in screening programs unlikely.