Diagnosis Of Pelvic Inflammatory Disease Research Articles

Evolving trends in the management of pelvic inflammatory disease (PID) during SARS-CoV-2 pandemic: A multicenter retrospective cohort study.

Pelvic inflammatory disease (PID) is usually managed by conservative treatment, but in selected cases, especially in the presence of a tubo-ovarian abscess (TOA), surgical management is a recognized treatment option. We compared the trends in managing PID and short-term outcomes before and during the SARS-CoV-2 pandemic. This is a retrospective study performed in three Italian gynecological centers. We included patients admitted to hospital with a diagnosis of PID. Demographic characteristics, management, time to diagnosis, and time to treatment were compared before versus during the SARS-CoV-2 pandemic. One hundred nineteen PID patients were screened, eighty-one before the SARS-CoV-2 pandemic, and thirty-eight after the onset. At admission, leukocytosis (median 19.73 vs. 13.99 WBC/mm3, p-value = 0.02) was significantly higher in patients who underwent surgery after the onset of the pandemic. TOA incidence was higher in patients who underwent surgery during the SARS-CoV-2 pandemic, but the difference did not reach statistically significance (p = 0.06). The proportion of patients treated with surgery dropped to 26.3% after the onset from 46% of patients before the onset of pandemic (p = 0.03). Furthermore, a higher percentage of emergency surgical procedures on day 0 of hospital admission were performed after the onset of the pandemic (50% vs. 13.1%, p = 0.01). In this retrospective cohort study, we found that the SARS-CoV-2 pandemic influenced the clinical presentation and management of PID in favor of conservative treatment. Patients who underwent surgery during the SARS-CoV-2 pandemic had higher inflammatory markers.

3D Sonographic Diagnosis of Hydrosalpinx: Implications for the Non-Laparoscopy Confirmation of Pelvic Inflammatory Disease

Introduction: As Pelvic Inflammatory Disease (PID) has many clinical and radiographic features, the specific utility of sonographic imaging for its diagnostic confirmation may be helpful with its non-invasive approach, rather than the common reliance on the operative procedure of laparoscopy for this purpose. Since the presence of hydrosalpinx is commonly associated with PID, its associated three-dimensional transvaginal sonography (3DTVS) appearance may offer helpful diagnostic certainty. Although Timor-Tritsch introduced a sonographic technique for its display previously in 2005, the technique used in this current imaging project may be somewhat simpler to employ and possibly even more revealing. A case series was investigated for the possible diagnosis of deep invasive endometriosis (DIE), for which patients presented with pelvic pain presumed to represent DIE. A separate case series was investigated for the possible value of the O-RADS app for the diagnosis of ovarian malignancy. Since the sonographic diagnosis of hydrosalpinx was made in each dataset, and some of those patients underwent exploratory surgery, the veracity of the sonographic diagnosis could be calculated. As pelvic pain could also represent possible PID, the cases in which hydrosalpinx were found were specifically examined for it. The present investigation was performed in order to detail the value of 3D surface rendering imaging for hydrosalpinx and its ultimate diagnosis. Some patients underwent operative intervention and thus histologic confirmation, in addition to the sonographic evaluation which all patients had performed. It is the intent of this investigation to display the value of 3DTVS to diagnostically determine some cases of chronic pelvic pain as being due to PID. Methods: A series of 32 patients were sonographically evaluated with 3DTVS for complaints of pelvic pain, and when a hydrosalpinx was observed, a particular technique was employed (described below). Nine of those patients had a surgical intervention in addition to the ultrasound evaluation. The technique that was used can be described as follows. The 3D volume of the region of interest (ROI) was obtained, and it was manipulated to produce the best image of the hydrosalpinx. A large Ultrasound rendering box was created to demonstrate the external surface of the resultant 3D hydrosalpinx image. Results: A total of 32 patients underwent the described rendering imaging with 3DTVS. Of those patients, 9 (27 %) also underwent surgical exploration. 78 % of those cases revealed surgical findings consistent with the presurgical sonographic diagnosis. Conclusion: From the review of this case series, it appears that the sonographic diagnosis of chronic PID can virtually be relied upon with 3DTVS, rather than subject all patients to laparoscopy for whom this diagnosis may be considered. One can consider the described technique as a method of performing a partial “Virtual Laparoscopy”. After sonographically confirming the diagnosis of chronic PID, a gynecologist can confidently use the available medical therapeutic methods for its treatment, and if such treatment fails improvement of the patient’s symptoms, surgical extirpation can be considered (e.g. TAH-BSO). In this way, 3DTVS can be considered as an important gynecologic diagnostic tool for the described purpose. The rendered images increased the confidence in diagnosing hydrosalpinx.

Investigating possibilities for surveillance of long term chlamydia complications in the Netherlands: A qualitative study.

Chlamydia trachomatis (chlamydia) is one of the most reported bacterial sexually transmitted infections (STI) worldwide. Chlamydia can cause long term complications such as pelvic inflammatory disease (PID), ectopic pregnancy (EP) and tubal factor infertility (TFI). Changing testing strategies, for example reduced asymptomatic testing, influence chlamydia surveillance, highlighting the need for exploring alternative ways of monitoring chlamydia. We investigated the possibility of introducing routine surveillance of chlamydia related long term complications. A qualitative study including 15 in-depth interviews with a purposive sample of gynaecologists, general practitioners (GP), sexual health and emergency doctors was conducted in the Netherlands in 2021-2022. A semi-structured interview guide focused on experiences with diagnosis and registration of PID, EP and TFI and how a change in asymptomatic chlamydia testing strategy might influence this. Interviews were transcribed and analysed using a thematic approach. Analysis showed that gynaecologists most frequently reported diagnosing PID, EP and TFI. Other professions rarely diagnose these complications, with emergency doctors only diagnosing EP. Most respondents reported unique registration codes for PID and EP, but the coding for TFI is more ambiguous. They reflected that diagnosis and registration of PID, EP and TFI are handled differently within their professions. Most respondents acknowledged registration in diagnostic codes as a useful surveillance tool. They expressed concerns in representativeness (e.g. differences in interpretation of diagnosis criteria) and data quality for surveillance. Patient files of gynaecologists are likely to be most complete for monitoring trends of diagnosed chlamydia related long term complications in the Netherlands. However, when establishing a chlamydia complication surveillance system, professionals should be engaged in further standardizing diagnosis and registration practices. This will improve the quality and interpretability of complication surveillance and facilitate comparison between countries.

A New Marker for the Diagnosis of Acute Pelvic Inflammatory Disease: Immature Granulocyte.

The goal is to assess the role of immature granulocytes (IG) in the diagnosis of acute pelvic-inflammatory-disease (PID) and to determine whether they are useful for discriminating mild/moderate and severe PID. Patients admitted with the diagnosis of acute PID were retrospectively assessed. Diagnosis was based on CDC criteria. Patients were grouped as severe and mild/moderate PID based on need for hospitalization. Control group consisted of patients in whom PID was excluded by laparoscopy. Sample size was calculated with statistical methods. IGs were compared within the groups. Cutoff values were determined for prediction of diagnosis and severity of acute PID. There were 74 severe, 32 mild/moderate acute PID, and 41 control patients. Thirty patients had surgery following no response to antibiotic treatment or tubo-ovarian abscess. IGs were significantly higher in the severe group compared to mild/moderate and control groups. ROC analysis showed IG counts (≥ 0.035 µL) and percentages (≥ 0.35%) were significantly effective in predicting acute PID and were associated with severity when they were ≥ 0.055 µL and ≥ 0.42%, respectively. IG count ≥ 0.085 was found to have 58.6% sensitivity and 63.1% speci-ficity for prediction of surgical intervention need. IGs are components of simple CBC tests and are easily obtainable, cheap markers. They were found to be elevated in acute PID and correlated significantly with the severity of the disease. These markers may serve as adjunctive markers for the diagnosis of acute PID and may be useful in discrimination between mild/moderate and severe PID.

Intrauterine devices are a safe form of contraception in users with solid organ transplantation: A single-center experience.

Patients who undergo organ transplantation are advised to use contraception for health optimization, yet limited data exists on safe contraceptive options for this population. This study investigates the infection risk of intrauterine devices (IUDs) in patients who have received a solid organ transplant by evaluating the incidence of pelvic inflammatory disease (PID). We performed a retrospective chart review of subjects with a solid organ transplant who used an IUD between the years of January 2007 to February 2021. We included subjects ages 22-55 years at the time of IUD placement. We abstracted demographic information, transplant type, IUD type, immunosuppressive medications, screening for sexually transmitted infections, and diagnosis of PID. We identified 29 subjects that met the inclusion criteria. Six subjects had a copper IUD (21%) and 23 had a levonorgestrel IUD (79%). The most common organ transplanted was a kidney (n = 10) and liver (n = 10) while five subjects had multiple organs transplanted. Twenty-five (86.2%) subjects took immunosuppressive medications at the time of IUD insertion. Twenty-four (82.8%) patients had their IUD placed after transplantation. The average time of IUD use was 2.5 years. . In our study of IUD use in patients with solid organ transplantation, no patients developed PID. IUDs are a safe contraceptive option for immunosuppressed transplant patients.

Risk factors for infertility and barriers to treatment in Tanzania: a survey and medical records study.

The burden of infertility is serious for women in high-fertility countries. We sought to identify demographic, behavioral/environmental, and reproductive risk factors for various infertility factors (i.e., ovarian, tubal, uterine/cervical, male/other) among women seeking infertility treatment in central Tanzania; to determine the association between pelvic inflammatory disease (PID) and tubal factor infertility (TFI); and to identify barriers to infertility treatment by women's home regional zone. We conducted a cross-sectional survey of women seeking infertility treatment in Dodoma, Tanzania from January-March 2020. We surveyed 168 participants aged 18-49 years and reviewed their medical records to confirm infertility status and potential risk factors. We estimated prevalence ratios for factors associated with infertility using logistic regression. Treatment barriers were compared by women's regional zone to see if barriers varied geographically. The median age of participants was 32 years (range: 18-48). Infertility factors did not vary greatly by patient demographics, behavioral/environmental, or reproductive risk factors. Approximately 31.48% of women had PID diagnoses. Those with PID had 1.94 (95% CI: 1.30, 2.90) times the prevalence of TFI diagnosis as those with other infertility factors, after adjusting for age, pesticide use, alcohol use, age at sexual debut, prior obstetric events, and family history of infertility. Logistical barriers to treatment, such as time and cost, were more frequently reported than emotional, stigma, or other barriers, regardless of regional zone. PID was strongly associated with TFI after adjustment for confounders. Infertility treatment access due to cost remains a challenge in Tanzania.

Association between heavy metal exposures and the prevalence of pelvic inflammatory disease: a cross-sectional study from the National Health and Nutrition Examination Survey 2013-2018.

Pelvic inflammatory disease (PID) is a common medical condition in women. However, the correlation between exposure to heavy metals, including cadmium (Cd), lead (Pb), manganese (Mn), mercury (Hg), and selenium (Se), and PID, is unclear. Using a large sample size from the National Health and Nutrition Examination Survey, these relationships were studied and verified. PID diagnosis was acquired through a self-reported questionnaire (2013-2018). Heavy metal exposure (Cd, Pb, Mn, Hg, and Se) was measured using mass spectrometry of blood samples. Covariate data were obtained through questionnaires and physical tests. Individuals with complete covariate data were included in the study. The relationship between heavy metal exposure (Cd, Pb, Mn, Hg, and Se) and PID was demonstrated using logistic regression analysis, weighted quantile sum (WQS) regression analysis, and restricted cubic splines (RCS). Overall, 2743 participants were included. Of these, 183 were diagnosed with PID. Through weighted univariate and multivariate regression analyses, the heavy metals of Cd and Pb were positively correlated with the prevalence of PID. However, no significant relationship was observed in the heavy metals of Mn, Hg, and Se. The joint effect of heavy metals further confirmed the important role of Cd and Pb in WQS analysis. After visualizing the RCS, significant curved and linear relationships were observed for Cd and Pb, respectively. Most subgroup analyses confirmed these results. In conclusion, exposure to Cd was nonlinearly correlated with the risk of PID, whereas exposure to Pb showed a linear relationship. Our findings increase the awareness of the environmental effects of exposure to heavy metals in PID. However, further studies are needed to elucidate the causality and underlying mechanisms between heavy metal exposure and the prevalence of PID.

Gynecologists and pelvic inflammatory disease: do we actually know what to do?: A cross-sectional study in Jordan.

Pelvic inflammatory disease (PID) is an upper genital tract infection caused by a variety of aerobic and anaerobic microorganisms ascending from the cervix or vagina. Though PID is mainly a sexually transmitted disease; 15% are non-sexually transmitted.[1] In our study, we aim to assess gynecologists' understanding and awareness of PID; as it presents an important health issue affecting the Jordanian community and similar communities with the same cultural and religious backgrounds. A cross-sectional study was conducted using an online questionnaire that received responses from 172 gynecologists in Jordan. The questionnaire aimed at testing gynecologists' knowledge of different aspects of PID starting with diagnosis and ending with management. 68.6% of gynecologists acknowledged that PID is a problem in Jordan. However, obvious confusion was observed in the scopes of clinical presentation, choosing the most reliable PID investigations, and treatment. PID is not being addressed properly in a sexually conservative community that has low rates of sexually transmitted diseases like Jordan, which is misleading and dangerous. In addition, we think there is a lack of certain standards on how to define PID and acknowledge its effect on the community as well as the disappointing level of knowledge about different aspects of PID gynecologists show, starting with its prevalence and ending with treatment policy. Clearer guidelines for the diagnosis, management, and prevention of PID should be adopted. These findings should be acknowledged by all doctors from neighboring countries as well as those within similar communities to Jordan.

Development of a novel wrist pulse system for early diagnosis of pathogenic bacterial infections using optimized feature selection with machine learning approaches

Pelvic inflammatory disease (PID) and urinary tract infections (UTI) are two Pathogenic bacterial infections. PID affects the female reproductive system, whereas UTI affects the urine system. Females are more vulnerable to both forms of illnesses and challenging to detect simultaneously due to similar symptoms. Many Clinical procedures have previously been used to diagnose the diseases, but they are painful, costly, prone to radiation, and invasive. Therefore, this paper proposed the Ayurvedic and Traditional Chinese Medicine [TCM] based wrist pulse measurement to diagnose these bacterial infections non-invasively. An Artery tonometry-based test prototype was designed to measure the pulse signals at three doshas (Vata, Pitta, Kapha) locations on the radial artery under variable static force. The data is recorded at an intermediate force level to get maximum accuracy. Signals feature viz., time domain feature, autoregressive (AR) model features, approximation entropy, sample entropy, and multiscale entropy have been calculated. Further, the efficiency of the machine learning model is enhanced through optimization-based feature selection techniques. Three different optimization-based feature selection, viz., whale optimization (WOA), ant colony optimization (ACO), and proposed binary Greywolf optimization (BGWO), has been proposed to acquire the optimized features subsets for accurate classification of disease subjects. These subsets have been used by popular machine learning techniques to classify the PID and UTI. The results of the experiment demonstrate that as the static force changed, the wrist pulse signal first increased to an intermediate force level and then decreased. Second, the classification accuracy of the machine learning model with feature selection is more than conventional feature classification. Third, the wrist pulse analysis (WPA) shows the maximum accuracy in comparison to conventional clinical PID diagnosis, where Vata dosha has the highest classification accuracy (94.1%) when using BGWO-SVM, followed by Pitta dosha (88.2%) when using BGWO-BNN. Similarly, specificity has been used for UTI classification, where Vata dosha has the highest specificity of 100% with BGWO-SVM, followed by pitta dosha with 83.3% BGWO-BNN. Finally, three dosha classification findings demonstrate that Vata and Pitta doshas have been more significantly impacted, as they have the highest classification accuracy compared to conventional clinical diagnosis, which produces similar results consistent with ayurvedic literature. Therefore, WPA can provide a unique diagnostic method for early PID/UTI identification.

Association of Neighborhood Economic Status and Race With Developing Pelvic Inflammatory Disease After Sexually Transmitted Infections.

To explore the association of neighborhood-level socioeconomic status (SES) and race with developing pelvic inflammatory disease (PID) after sexually transmitted infection (STI) among female adolescents and young adults in Maryland. We used Maryland statewide hospital claims data (outpatient and inpatient visits) for this retrospective cohort study. Female adolescents and young adults aged 15-24 years who had at least one STI from July 1, 2013, to March 31, 2015, were included. A participant entered the cohort on the date of the first STI diagnosis and was followed up until PID occurrence or 3 years after the first STI. Median household income of the participant's residential ZIP code tabulation area was used as the neighborhood-level SES. Discrete-time hazard models were used to estimate the hazard of PID. Of the 2,873 participants, 88.5% were of Black race, and 67.2% were aged 20-24 years. The hazard of PID after an STI among Black women was 1.40 times that of White women (95% CI 1.06-1.85). After adjustment for age, insurance type, and number of STI events, the hazard ratio (HR) did not change. However, adding neighborhood-level SES to the model attenuated the disparity in PID after STI between Black and White women (HR 1.25, 95% CI 0.94-1.67). Racial disparities in PID diagnosis are mitigated by neighborhood-level SES.

Diagnostically significant changes in subsets CD11b<sup>+</sup>CD64<sup>-</sup>CD32<sup>+</sup>CD16<sup>+</sup>, CD11b<sup>+</sup>CD64<sup>+</sup>CD32<sup>+</sup>CD16<sup>+</sup> neutrophilic granulocytes of immunocompromised women with chronic infectious and inflammatory diseases of the genital tract of various etiologies

Chronic pelvic inflammatory disease (PID) in women remains a problem due to the importance of medical consequences. The study of the receptor apparatus of neutrophilic granulocytes (NG) involved in anti-infective protection in diseases of various etiologies seems to be relevant. Aim: to clarify the features of variants of quantitative and phenotypic changes in subsets of NG CD11b+CD64-CD32+CD16+, CD11b+CD64+CD32+CD16+ of immunocompromised women during exacerbation of chronic PID of various etiologies. We were tested women 20-40 years: Study Group 1 (SG1, n = 20) – chronic PID during the exacerbation with mono- or mixed latent/recurrent various viral infections (chronic herpes-virus infections, papillomavirus infection, recurrent ARVI); Study Group 2 (SG2, n = 30) – chronic PID of bacterial etiologies; Comparison Group (CG)– 20 healthy women. The number of subsets CD11b+CD64-CD32+CD16+NG (major) and CD11b+CD64+CD32+CD16+NG (minor), receptor expression density (MFI) was determined (FC500, USA). It was found that in PID during the period of exacerbation, diagnostically significant differences in the subset composition of NG were revealed. We got a decrease in the CD11b+СD64-СD32+СD16+NG subset and in 7,6 times increase in the CD11b+CD64+CD32+CD16+NG subset in SG2 with chronic PID of bacterial etiology, in contrast to chronic PID occurring in combination with recurrent/persistent viral infection SG1. Negative transformation of NG subsets is associated with a predominant decrease in the level of expression of the activation CD16. The absence of an adequate response to the infectious and inflammatory process was revealed – the absence of an increase in the expression of the activation CD11b in the major subset in SG1, as well as in the minor subset in groups SG1 and SG2. In the major subset of NG in groups SG2 a decrease in the expression of the activation marker CD11b. In the various viral infections and PID (SG1), in the negatively altered minor subset of NG we got a decrease of expression of CD16, an increase of expression of CD64 and CD32. Determination of subsets of CD11b+СD64-СD32+СD16+, CD11b+CD64+CD32+CD16+NG and their phenotype can be used as diagnostic markers for the differential diagnosis of PID of viral and bacterial etiology, and for the development of new methods of targeted immunomodulatory therapy.

Management of Pelvic Inflammatory Disease in Clinical Practice.

Pelvic inflammatory disease (PID) is a common reproductive health disorder among women of reproductive age. The treatment of PID has slowly evolved, reflecting changing antibiotic susceptibility and advancements in therapeutics and research; however, it has been largely unchanged over the last several decades. The most recent treatment recommendations consider the severity of infection, clinical presentation, and the polymicrobial nature of the disease. In addition, the role of novel organisms like Mycoplasma genitalium in PID is of emerging significance. PID treatment guidance offers oral and parenteral treatment options based on the patient's clinical status; however, deviations from the published guidelines are a general concern. Point of care (POC) testing for precision care, provision of adherence support, optimizing self-management and prevention strategies, and other alternative or synergistic approaches that maximize treatment outcomes will be instrumental for addressing the current challenges in PID diagnosis and management.

CONSERVATIVE TREATMENT AND FOLLOW-UP FOR ACUTE APPANDICITIS: IS EMERGENT SURGERY NECESSARY ?

Introduction: Emergent operation is the accepted standart therapy of acute appendicitis. But conservative medical therapy is an emerging solution for acute appendicitis. We aimed to publish the conservative treatment experience of Inonu University Medical School, Department of General Surgery. Material and Method: Between January 2020 and January 2022, patients who had a clinical suspicous acute appendicitis with an Abdominal Ultrasonography or a computer tomography reporting a term ’appendicitis’ that referred to Emergency or General Surgery Department and also had a medical therapy with a non-operative approach were detected in the hospital data system. Patient demographics and clinical data analysed retrospectively. Results: Fifteen patients were detected within the 2 years period that had been received medical therapy for acute appendicitis. Median age was 32.0 (min:19 - max:70), median appendix diameter was 7.2 mm (min:5.5 - max:11.0). One patient was died due to Non-Hodgkin Lymphoma after 16 days of diagnosis of acute appendicitis. None of the patients required an operation during surveillance. Most frequent reasons for conservative treatment were not eliminating the diagnosis of pelvic inflammatory disease, inflammatory intestinal disease and urinary tract infections. Discussion and Conclusion: While some comorbidities can go along with acute appendicitis such as cardiac and systemic haematologic diseases, some of them mimic acute appendicitis such as pelvic inflamatory disease or inflamatory bowel diseases. Especially elder patients, who have a suspicous case, with a low CRP and Neutrophilia counts with an uncomplicated appendicitis, may benefit from antibiotherapy. More patients, that had an appendectomy history need to be evaluated on this aspect.

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.

An enigmatic tale of the missed and migrated tail

We, report a case of missing and migrated intrauterine device presenting as vague abdominal pain. The patient had symptoms of vaginal discharge and menstrual disturbances as polymenorrhagia and leukorrhea. She was evaluated for a suspected malignancy of the ovaries. During evaluation on pelvic CT scan, the missing and migrated Intrauterine Contraceptive Device (IUCD) was located in the small bowel and tumor markers were normal. We treated her with antibiotics for presumptive diagnosis of pelvic inflammatory disease and then posted her for the evaluation of the missing IUCD and the tubo-ovarian masses by endoscopy. The missed IUCD was seen embedded in the terminal ileum with intraperitoneal adhesions and the tubo-ovarian masses. The IUCD was removed endoscopically enterotomy of ileum which was sutured. The patient recovered well and was discharged on the 6th post-operative day.

Is there a place for a molecular diagnostic test for pelvic inflammatory disease in primary care? An exploratory qualitative study.

IntroductionThere is currently no test for pelvic inflammatory disease (PID) that is non-invasive and sufficiently sensitive and specific. Clinicians must therefore diagnose PID clinically, ruling out medical emergencies and conducting pelvic examinations where possible. While guidelines state that clinicians should be prepared to over-diagnose PID, it remains an under-diagnosed condition, with severe reproductive health impacts when left untreated. This research is the first to consider the perspectives of end-users on the development of a diagnostic test for PID.MethodsSemi-structured live video feed online (Zoom) interviews were conducted with 11 clinicians and nine women (aged 18–30 years) in Australia to understand how a diagnostic test might be used, and what characteristics a test would need for it to be acceptable to clinicians and young women. Participants were recruited via researcher and university student networks. Reflexive thematic analysis was used to identify key themes relating to the acceptability and characteristics of a diagnostic test for PID.ResultsSeven general practitioners, four clinicians working in sexual health clinics, and nine young women (aged 21–27 years) were interviewed. Clinicians were aged between 31–58 years and were predominantly female. Clinicians recognised that the development of an accurate test to diagnose PID would be valuable to themselves and other clinicians, particularly those who lack experience diagnosing PID, and those working in certain settings, including emergency departments. They discussed how they might use a test to enhance their clinical assessment but highlighted that it would not replace clinical judgement. Clinicians also considered how a test would impact the patient experience and time to treatment, emphasising that it should be minimally invasive and have a quick turnaround time. Young women said a test would be acceptable if endorsed by a trustworthy clinician.ConclusionsPID remains a challenging diagnosis. Development of a minimally invasive and sufficiently accurate diagnostic test would be acceptable to young women and benefit some clinicians, although no test would completely replace an experienced clinician’s judgement in making a PID diagnosis.

Performance of a rapid molecular test to detect Chlamydia trachomatis and Neisseria gonorrhoeae in women with pelvic inflammatory disease

ObjectiveThe aim of this study was to investigate the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in women with pelvic inflammatory disease (PID) and the usefulness and cost-effectiveness of a rapid molecular test for the diagnosis and clinical management of PID. MethodsThis observational study included 75 patients with mild-to-moderate PID (n=33), severe PID (n=29) and non-specific lower abdominal pain (NSAP) (n=13). CT/NG infections were analyzed using a standard and a rapid test. A cost analysis was carried out. ResultsSamples of 19 patients (25.3%) were CT/NG positive. Concordance between rapid and standard tests was 100%. No significant differences were observed in the incidence of CT/NG in mild-to-moderate compared to severe PID. Costs differed according only to disease severity. ConclusionsRapid molecular tests could help with the diagnosis of PID in sexually active women in clinical settings in which a standard technique is not available.

Cervical Power Doppler Angiography with Micro Vessel Blood Flow Indices in the Auxiliary Diagnosis of Acute Cervicitis.

We have conducted cervical imaging of uterine and micro-vessel flow velocity waveforms in acute pelvic inflammatory disease (PID) by transvaginal power Doppler ultrasound (TVPDU) in order to explore the associations of sonographic parameters with simple and complex cervicitis. Thirty-eight patients with acute PID (26 with acute simple cervicitis and 12 with complex cervicitis) were enrolled for an assessment of vascular grading of cervix and micro-vessel flow velocity using TVPDU before treatment. Seven parameters, including vascular grading (VG), lowest pulsatility index (PI), resistance index (RI), peak systolic velocity (PS), end diastolic velocity (ED), time average maximum velocity (TAMV), and vascular index (VI = PS/ED), were measured and recorded. Forty-one healthy patients were assessed as the control group. Vascular grading (VG) was significantly higher in the study group than the control group (p < 0.0001). The PI, RI, and VI were significantly lower in the study group than control group (p < 0.0001). No significant associations were observed between seven sonographic parameters and acute simple or/and complex cervicitis. For acute simple cervicitis, a PI cutoff of 1.1 had a sensitivity of 85.4% and a specificity of 92.1% (area under ROC curve [AUC], 93.2%). A RI of 0.6 had a sensitivity of 85.4% and a specificity of 78.9% (AUC, 86.1%). A VI of 2.6 had a sensitivity of 85.4% and a specificity of 78.9% (AUC, 84.9%). Power Doppler angiography of micro-vessel flow velocity waveforms in the cervix could represent a practical method to assist the diagnosis of pelvic inflammatory disease presented as acute cervicitis detected on transvaginal ultrasound before medical or surgical treatment. Cervical PI may be a useful index to detect micro-vessel flow velocity waveforms in acute cervicitis and differentiate acute simple cervicitis from complex cervicitis.

Patients with Pelvic Inflammatory Disease vs. Tuboovarian Abscess: Comparison of Follow-Up and Treatment Processes

Pelvic inflammatory disease (PID) is an infection of the upper vaginal tract in women that can be subclinical or severe, affecting any or all of the uterus, fallopian tubes, and ovaries. Tuboovarian abscess (TOA) is a common consequence of PID. The purpose of this study is to compare the demographic features, symptoms, clinical findings, and treatment techniques of patients hospitalized with the diagnosis of PID and TOA, to assess their response to treatment protocols and therapy, and to evaluate the development of recurrence.

Serum antibodies to surface proteins of Chlamydia trachomatis as candidate biomarkers of disease: results from the Baltimore Chlamydia Adolescent/Young Adult Reproductive Management (CHARM) cohort.

We previously observed that the nine-member family of autotransported polymorphic membrane proteins (Pmps) of Chlamydia trachomatis is variably expressed in cell culture. Additionally, C. trachomatis-infected patients display variable Pmp-specific serum antibody profiles indirectly suggesting expression of unique Pmp profiles is an adaptive response to host-specific stimuli during infection. Here, we propose that the host response to Pmps and other outer surface proteins may correlate with disease severity. This study tests this hypothesis using an ELISA that measures serum IgG antibodies specific for the nine C. trachomatis Pmp subtypes and four immunodominant antigens (MOMP, OmcB, Hsp60, ClpP) in 265 participants of the Chlamydia Adolescent/Young Adult Reproductive Management (CHARM) cohort. More C. trachomatis-infected females displayed high Pmp-specific antibody levels (cut-off Indexes) than males (35.9%-40.7% of females vs. 24.2%-30.0% of males), with statistical significance for PmpC, F and H (P < 0.05). Differences in Pmp-specific antibody profiles were not observed between C. trachomatis-infected females with a clinical diagnosis of pelvic inflammatory disease (PID) and those without. However, a statistically significant association between high levels of OmcB-specific antibody and a PID diagnosis (P< 0.05) was observed. Using antibody levels as an indirect measure of antigen expression, our results suggest that gender- and/or site-specific (cervix in females vs. urethra in males) stimuli may control pmp expression in infected patients. They also support the possible existence of immune biomarkers of chlamydial infection associated with disease and underline the need for high resolution screening in human serum.