Mild Pelvic Inflammatory Disease Research Articles

The Continued Challenges in the Diagnosis of Acute Pelvic Inflammatory Disease: Focus on Clinically Mild Disease.

Many women with lower genital tract infections associated with sexually transmitted pathogens have evidence of upper genital tract inflammation despite the absence of symptoms and signs traditionally associated with pelvic inflammatory disease (PID). New biomarkers are needed to identify these women with clinically mild PID or subclinical PID (silent salpingitis) to facilitate initiation of early treatment and ameliorate the sequelae associated with upper genital tract infection and inflammation.

Association Between Reduced Risk of Intracerebral Hemorrhage and Pelvic Inflammatory Disease.

This study examines whether pelvic inflammatory disease (PID) facilitates the development of intracerebral hemorrhage (ICH).By using outpatient claims data from the National Health Insurance Research Database (NHIRD) of Taiwan, we included the data of 25,508 patients who were newly diagnosed with PID between 1999 and 2004, and also from the Taiwan NHIRD, we randomly selected 102,032 women without PID, who were frequency-matched by age and entry-year and with 4 times the number of the PID patients, as the control cohort. We measured ICH risks associated with PID and comorbidities, including hyperlipidemia, diabetes, hypertension, ischemic heart disease, and atrial fibrillation, by the end of 2011.In comparison with the controls, the ICH hazard was less in the PID group with an adjusted hazard ratio (aHR) of 0.67 (95% confidence interval [CI]:0.50–0.90), which was noted by calculation with the Cox proportional regression model. The ICH risk in the PID patients reduced progressively with the advance of age, with aHRs of 0.75 (95% CI:0.41–1.39) and 0.50 (95% CI:0.29–0.88), respectively, in the age <35-year and age ≥50-year groups. ICH risk lowered gradually with the progress of PID severity, from mild PID with an aHR of 0.72 (95% CI:0.53–0.98) to severe PID with that of 0.30 (95% CI:0.10–0.92). PID patients without any comorbidites had lower ICH risk (aHR = 0.63, 95% CI:0.42–0.94) than the controls without any comorbidites did.Our findings revealed that PID is associated with reduced ICH development, especially for older patients.

Relationships between transvaginal colour Doppler findings, infectious parameters and visual analogue scale scores in patients with mild acute pelvic inflammatory disease

Objective To investigate the relationships between colour Doppler findings, infectious parameters and visual analogue scale (VAS) scores in patients with mild acute pelvic inflammatory disease (PID). Study design Twenty-seven patients diagnosed with PID were enrolled in the study. Resistance index (RI) and pulsatility index (PI) of uterine, arcuate and utero-ovarian arteries were measured, as well as VAS score, erythrocyte sedimentation rate, C-reactive protein, white blood cell count and body temperature at hospital admission. After the initial visit, all measurements were repeated and recorded on days 7, 15 and 30. Results PI and RI values of uterine arteries showed significant increases between days 1 and 7. However, PI and RI values of uterine arteries, RI values of arcuate arteries and RI values of utero-ovarian arteries showed significant increases between days 1 and 30. Statistically significant decreases in infectious parameters and VAS scores were observed between days 1 and 7, days 1 and 15 and days 1 and 30. Conclusion Infectious parameters and VAS scores showed concordant changes with clinical recovery in mild PID. Significant changes were also observed in PI and RI values of uterine arteries, but Doppler measurements of arcuate and utero-ovarian arteries showed a slower and later response to treatment.

Comparing Ceftriaxone Plus Azithromycin or Doxycycline for Pelvic Inflammatory Disease

To evaluate the equivalence of ceftriaxone plus doxycycline or azithromycin for cases of mild pelvic inflammatory disease (PID). Patients with PID received an intramuscular injection of 250 mg of ceftriaxone, and were randomly assigned to receive 200 mg/d of doxycycline for 2 weeks, or 1 g of azithromycin per week, for 2 weeks. The degree of pain was assessed on days 2, 7, and 14 and clinical cure was assessed on day 14. From 133 patients eligible for the study, 13 were excluded for having conditions other than PID, 11 were lost on follow-up, and three had oral intolerance to the antibiotics, yielding 106 for protocol analysis. No significant difference was observed regarding the degree of pain between the doxycycline and azithromycin groups. Clinical cure per protocol was 98.2% (56 of 57; 95% confidence interval [CI], 0.9-0.99) with azithromycin, and 85.7% (42 of 49; 95% CI, 0.72-0.93) with doxycycline (P=0.02). In a modified intention to treat analysis, clinical cure was 90.3% (56 of 62; 95% CI, 0.80-0.96) with azithromycin, and 72.4% (42 of 58; 95% CI, 0.58-0.82) with doxycycline (P=.01); a relative risk of 0.35, and a number needed to treat of six for benefit with azithromycin. When combined with ceftriaxone, 1g of azithromycin weekly for 2 weeks is equivalent to ceftriaxone plus a 14-day course of doxycycline for treating mild PID.

Enhanced Erythrocyte Aggregation in Clinically Diagnosed Pelvic Inflammatory Disease

Enhanced erythrocyte aggregation, revealed using a simple bedside test, has been found recently in several inflammatory conditions. The diagnosis of pelvic inflammatory disease (PID) is at times difficult because of the vague symptoms and signs, but is crucial because even mild PID can have future reproductive consequences. Our objective was to determine the degree of erythrocyte aggregation in PID. The demonstration of an increase in aggregation could be of additive value in cases in which the diagnosis is difficult. A prospective case-control study was conducted. Fifteen consecutive women diagnosed clinically as having PID based on Centers for Disease Control and Prevention criteria, and 15 matched controls were enrolled. Blood samples were drawn for hematologic indices, C-reactive protein, fibrinogen levels, and red cell aggregation. We studied the degree of red cell aggregation using a simple slide test and image analysis. The variable measured was the erythrocyte percent (EP), equivalent to the slide area covered by erythrocytes. Erythrocyte percent was 59.6 +/- 4.2 and 80.0 +/- 3.6 for the study group and controls, respectively (P <0.001). A significant difference was noted also for the other hematologic and biochemical markers of inflammation between patients and the controls. We conclude that the degree of erythrocyte aggregation is increased in PID. Its simplicity, rapidity, and low cost should be further evaluated as a diagnostic tool in the context of this frequent disease.

Severity of pelvic inflammatory disease as a predictor of the probability of live birth

OBJECTIVE: Our aim was to study the association between severity of pelvic inflammatory disease at laparoscopy and the probability of achieving a live birth, while accounting for subsequent episodes of pelvic inflammatory disease. STUDY DESIGN: Beginning in 1960 a cohort of 1288 women in Lund, Sweden, who had clinical symptoms of acute pelvic inflammatory disease and who desired pregnancy was followed for up to 24 years. All participants underwent laparoscopy and were categorized by degree of salpingitis: mild ( n = 371), moderate ( n = 580), or severe ( n = 337) pelvic inflammatory disease. Cumulative live birth rates, obtained by life-table analysis, and proportional hazards ratios were compared among women by severity of pelvic inflammatory disease, while accounting for subsequent episodes. RESULTS: The cumulative proportion of women achieving a live birth after 12 years was 90% for women with mild, 82% for women with moderate, and 57% for women with severe pelvic inflammatory disease. The occurrence of subsequent episodes in women with mild pelvic inflammatory disease did not diminish their long-term probability of live birth, whereas it significantly lowered the probability of live birth in women with severe pelvic inflammatory disease. Women with severe disease and subsequent episodes were eight times more likely to fail to achieve live birth compared with women with a single pelvic inflammatory disease episode with mild disease (relative risk 8.1; 95% confidence interval 3.0 to 22.2). CONCLUSIONS: Increasing severity of pelvic inflammatory disease correlates with a lower long-term probability of live birth. Subsequent episodes have a greater impact on women with severe pelvic inflammatory disease at the index episode compared with those with milder disease. (Am J Obstet Gynecol 1998;178:977-81.)

Laparoscopic study on the microbiology and severity of acute pelvic inflammatory disease

Objective: To study the microbiologic findings in relation to the severity of acute pelvic inflammatory disease (PID). Study design: Of 72 women with acute PID verified and graded by laparoscopy and endometrial histopathology, 37 had mild PID and 35 had severe PID. Cervical, endometrial and tubal cultures were obtained for Chlamydia trachomatis, Neisseria gonorrhoeae, genital mycoplasmas, facultative and anaerobic bacteria and herpes simplex virus. Results: C. trachomatis was the primary pathogenic agent in 44% of patients with acute PID. C. trachomatis and N. gonorrhoeae were as common in both severity groups, although C. trachomatis was isolated significantly more frequently from the fallopian tubes among cases with severe PID. Where aerobic or facultative bacteria other than C. trachomatis or N. gonorrhoeae were concerned, Escherichia coli and Haemophilus influenzae were the most important aerobic bacteria isolated from the fallopian tubes. Anaerobic bacteria were recovered from the fallopian tubes significantly more frequently in cases with severe PID than in those with mild PID, whereas their presence in the endometrium was not related to the severity of PID. Conclusions: The role of C. trachomatis as the leading cause of PID was confirmed in both laparoscopically mild and severe PID. Severe PID with abscess is invariably a polymicrobial infection with anaerobic bacteria involved, whereas their role in affecting the outcome of mild PID as well as the need of antianaerobic antimicrobial therapy in mild PID remains questionable.

Laparoscopic evaluation of apparently normal infertile women.

Laparoscopy was used to evaluate 130 women whose basic infertility survey revealed no abnormalities. Overall 75 (57.7%) patients were found to have evidence of pelvic disease while the remainder were completely normal. Pelvic endometriosis was the most common pathology accounting for 27.7%, pelvic adhesions 20.8% and mild pelvic inflammatory disease 6.2%. Appropriate treatment of the pelvic conditions resulted in 31 (42.5%) pregnancies compared with 7 (12.3%) pregnancies in the no treatment group. The outcome of this study suggests that additional pregnancies do occur as a direct result of laparoscopic examination and subsequent therapy. We believe that laparoscopy should be performed on all women to search for a tubal or pelvic cause of infertility when all other examinations have been normal.

Outpatient parenteral antibiotic therapy. Management of serious infections, Part II: Amenable infections and models for delivery. Pelvic inflammatory disease.

Due to its polymicrobial origins and potential for causing infertility and ectopic pregnancy, pelvic inflammatory disease (PID) is a particularly challenging infection to treat. Treatment of mild PID has long been standardized: a single dose of an IM antibiotic followed by oral therapy. Patients with advanced PID requiring long-term therapy may be candidates for outpatient parenteral therapy.

Pelvic inflammatory disease: Findings during inpatienttreatment of clinically severe, laparoscopy-documented disease

We evaluated the relationship between clinically severe pelvic inflammatory disease and laparoscopic diagnosis and grading, comparative treatment with clindamycin plus cefamandole or doxycycline, and a management protocol for inpatient pelvic inflammatory disease treatment. Thirty-three patients who met our clinical criteria for severe pelvic inflammatory disease underwent diagnostic laparoscopy. Pelvic inflammatory disease patients were randomized to double-blind treatment with clindamycin plus cefamandole or doxycycline within our management protocol; postdischarge oral antibiotics were omitted. Laparoscopy confirmed pelvic inflammatory disease in 23 (70%) patients; 10 (44%) had mild pelvic inflammatory disease by laparoscopic grading. Laparoscopic grade alone predicted necessary duration of therapy to response: mild pelvic inflammatory disease, 2.3 +/- 0.5 days; moderate pelvic inflammatory disease, 2.7 +/- 1.5 days; and severe pelvic inflammatory disease, 3.9 +/- 1.5 days (p less than 0.05). Using the management plan presented, response rates for both antibiotic regimens were 100%. Clinical diagnosis and grading of severe pelvic inflammatory disease has poor specificity. Laparoscopic grading of severity of pelvic inflammatory disease seems accurate. Both clindamycin plus cefamandole and clindamycin plus doxycycline are equally effective regimens for treatment of pelvic inflammatory disease and did not require supplementation after discharge. Our management plan is objective and practical; daily bimanual examination is the most sensitive indicator of persistent disease.

Acute pelvic inflammatory disease in outpatients: association with Chlamydia trachomatis and Neisseria gonorrhoeae.

Among 830 women attending a clinic for sexually transmitted disease, Chlamydia trachomatis was isolated from 180 (22%) and Neisseria gonorrhoeae from 84 (10%). Retrospective analysis showed that 43 of the women were given outpatient treatment for acute pelvic inflammatory disease because they had low abdominal pain, deep dyspareunia, or unusual vaginal bleeding, or all of these, for less than 2 months in association with cervical motion or adnexal tenderness, or both. None had adnexal masses. C. trachomatis was isolated from 22 and N. gonorrhoeae from 15 of this subgroup of 43 women. This presentation of pelvic inflammatory disease occurred in 10 of the 37 women in the whole study with both C. trachomatis and N. gonorrhoeae, 12 of 143 women with C. trachomatis alone, five of 47 women with N. gonorrhoeae alone, and 16 of 603 women with neither organism. Thus, in North America, C. trachomatis is associated with a syndrome usually diagnosed as mild pelvic inflammatory disease and managed on an outpatient basis.

Bacterial cultures from intrauterine devices removed from patients with pelvic inflammatory disease.

Bacterial cultures were obtained from intrauterine devices (IUD) removed from 274 patients admitted to the Department of Obstetrics and Gynecology of the University Central Hospital of Helsinki because of suspected pelvic inflammatory disease (PID), meno-metrorrhagia, pain or other conditions potentially caused by an IUD. A diagnosis of serious PID was made in 42 patients, mild PID in 119 patients, while 113 were found to have no infection. An association between positive cultures of beta-hemolytic streptococci and Escherichia coli and PID was found. Positive cultures of Neisseria gonorrhoeae were significantly correlated with PID. The risk of developing PID was significantly greater during the first month after insertion of the IUD than when more than 30 days had elapsed from insertion of the IUD. The significance of the microbes cultured from removal IUDs as causal agents of pelvic inflammatory disease is discussed.

Microbiology of specimens obtained by laparoscopy from controls and from patients with pelvic inflammatory disease or infertility with tubal obstruction: Chlamydia trachomatis and Ureaplasma urealyticum

We cultured for Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis and performed chlamydial serologic studies in 99 women undergoing laparoscopy. These women included patients with acute salpingitis, infertile women with and without mild pelvic inflammatory disease, and controls. C. trachomatis infection was significantly more common in patients than in controls. We also identified low-grade “silent” PID among women with infertility resulting from tubal obstruction and suggest this may be caused by chlamydiae.