Diagnosis Of Pelvic Inflammatory Disease Research Articles

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.

Pelvic Inflammatory Diseases- An Ayurvedic Perspective.

Pelvic Inflammatory Disease (PID) is responsible for a considerable disease burden and represents an important healthcare issue in worldwide. PID is the clinical syndrome associated with upper genital tract infection and inflammation caused by the spread of micro-organisms from the lower to upper genital tract. Prevention of PID and recurrent PID is also a public health priority in the present scenario. Clinical signs and symptoms are relayed by clinician to diagnose PID, mainly due to the lack of a minimally or non-invasive diagnostic test that reliably identifies women with upper genital tract inflammation. Aim and objectives: The search for an Ayurveda equivalent of PID in Ayurveda classics doesn’t yield any one disease entity that entirely matches the clinical picture of this condition. Material and Methods: Diagnosis of PID is based on centers for disease control and prevention 2015 PID guideline. Considering it as ‘Anukta Vyadhi’ (unexplained disorder), this review attempts to understand the disorder by deriving its Vikaraprakriti (nature of disease), Adhishtanantarani (structures and sites affected), and Samutthanavishesha (specific etiological factor) based on a detailed analysis of the clinical features and other findings regarding the disease available in various textbooks and articles in the light of related references in Ayurvedic classics. Discussion and conclusion: PIDs are established in terms of Nidana Panchaka (five components of understanding a disease). Pittala and Paripluta Yonivyapad can be implied as pelvic inflammatory diseases

Diagnostic accuracy of pelvic imaging for acute pelvic inflammatory disease in an emergency care setting: a systematic review and meta-analysis.

The aim of this review is to investigate the diagnostic accuracy or performance of contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) for acute pelvic inflammatory disease (PID) in an emergency care setting. We searched for studies on the diagnostic test accuracy of contrast-enhanced CT or MRI for women of reproductive age with acute abdominal pain using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform, and ClinicalTrials.gov. The reference standard was gynecological examinations by gynecologists using standard diagnostic criteria with or without laparoscopy or transcervical endometrial biopsy. Two reviewers undertook screening of records, data extraction, and assessment of the risk of bias in each included study using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate model was used for the meta-analysis. Of 2,619 screened studies, three studies investigating contrast-enhanced CT and one study investigating MRI were eligible, including a total 635 patients and with a median prevalence of acute PID of 29%. All of the included studies had a high risk of bias for a reference standard and had some applicability concerns. Contrast-enhanced CT had a pooled sensitivity of 0.79 (95% confidence interval [CI], 0.52-0.93) and specificity of 0.99 (95% CI, 0.94-1.00). Magnetic resonance imaging had a sensitivity of 0.95 (95% CI, 0.76-1.00) and specificity of 0.89 (95% CI, 0.52-1.00). Contrast-enhanced CT might serve as a practical alternative to gynecological examination in the diagnosis of acute PID in an emergency care setting, however, the evidence was uncertain. The evidence on MRI was also very uncertain.

Characteristics of Vaginal Microbiome in Women with Pelvic Inflammatory Disease in Korea.

Human vaginal microorganisms play an important role in maintaining good health throughout the human life cycle. An imbalance in the vaginal microbiota is associated with an increased risk of pelvic inflammatory disease (PID). This study aimed to characterize and compare vaginal microbial profiles of premenopausal Korean women with and without PID. 74 Korean premenopausal female vaginal samples were obtained; 33 were from healthy women (a control group) and 41 from PID patients. Vaginal fluid samples were collected from the vaginal wall and posterior cervix and then analyzed by 16S ribosomal ribonucleic acid (rRNA) gene-based amplicon sequencing. Results showed a significant difference between the vaginal microbial communities of the two groups (Jensen-Shannon, p = 0.014; Bray-Curtis, p = 0.009; Generalized UniFrac, p = 0.007; UniFrac, p = 0.008). Lactobacillus accounted for the highest percentage (61.0%) of the control group but was significantly decreased (34.9%) in PID patients; this was the most significant difference among all bacterial communities (p = 0.028, LDA effect size = 5.129). In addition, in the PID patient group, species diversity significantly increased (Simpson, p = 0.07) as the proportion of various pathogens increased evenly, resulting in a polymicrobial infection. Similarly, lactate, which constituted the highest percentage of the organic acids in the control group, was significantly decreased in the PID patient group (p = 0.04). The present study’s findings will help understand PID from the microbiome perspective and are expected to contribute to the development of more efficient PID diagnosis and treatment modalities.

What Do Diagnoses of Pelvic Inflammatory Disease in Specialist Sexual Health Services in England Tell Us About Chlamydia Control?

Pelvic inflammatory disease (PID) is an outcome measure for the evaluation of chlamydia screening programs. We explore PID diagnoses in specialist sexual health services (SSHSs) in England to inform the evaluation of the National Chlamydia Screening Programme, which was implemented nationally in 2008. We conducted descriptive analyses using data on diagnoses of PID-with and without Chlamydia trachomatis (CT) and/or Neisseria gonorrhoeae (GC)-by age and year of birth, in SSHSs between 2009 and 2019 from the GUMCAD STI Surveillance System database. Rates were calculated per 100 000 females residing in England. CT screening activity peaked in 2010. The rates of all PID diagnoses decreased between 2009 and 2019 by 39%. CT-associated PID (CT-PID) declined by 58%, and nonspecific PID declined by 37%. GC-PID increased by 34%. CT-PID decreased across all age groups with the highest observed decline, 71%, in 15- to 19-year-olds. A dose-response relationship was observed between CT-PID rates and screening, with rates lowest in those with the greatest exposure to screening. There was a marked decline in diagnoses of CT-PID, and nonspecific PID, at SSHSs after the introduction of widespread chlamydia screening, whereas GC-PID diagnoses increased. This ecological trend was broadly consistent with what we would have expected to see if widespread screening reduced the incidence of chlamydia-associated PID (and of nonspecific PID), as has been observed in randomized controlled trials of screening.

A Commentary on Current Diagnostic Challenges and Research Needs for Evaluating Reproductive Sequelae of Sexually Transmitted Infections

Advancing the understanding of pelvic inflammatory disease (PID) requires access to advanced diagnostic approaches for evaluating reproductive sequelae of sexually transmitted infections (STIs). Current limitations of clinical criteria and advanced imaging technologies for diagnosing reproductive sequelae make diagnosis and surveillance of PID a challenge. We summarize and comment on major challenges in diagnostic evaluation of reproductive sequelae: limited point-of-care clinical diagnostic options for reproductive sequelae, economic and geographical obstacles to accessing state-of-the-art diagnostics, an expanding list of STIs that may cause reproductive sequelae and the complexities in evaluating them, and the need for coordinated research efforts to systematically evaluate biomarkers with gold-standard, well-defined specimens and associated clinical data. The future use of biomarkers in readily accessible mucosal or blood-derived specimens as a noninvasive approach to determining STI etiologies may be fruitful and requires more research. Biomarkers under consideration include cytokines, STI-specific antibody responses, and mRNA transcriptional profiles of inflammatory markers.

Studies on the Prevalence and Etiology of Pelvic Inflammatory Disease Among Women Attending Primary Health Centers in Sokoto Metropolis

Pelvic Inflammatory Disease (PID) is an inflammation of the uterus, fallopian tube, and ovaries as it progresses to scar leading to infertility and other reproductive problems. This research work was conducted to determine the etiology, antibiogram and prevalence of pelvic inflammatory disease among women attending Public Health Centres in Sokoto metropolis. The main objective of the study is to isolate the pathogens and determine the antibiotics sensitivity pattern and prevalence age of the Disease among the patients diagnosed with PID. 155 PID patients that were sorted by age and month were diagnosed within the year 2020. Laboratory assay on the etiology and antibiogram were carried out. From the total (155) patients diagnosed with PID in this study, thirty-three (33) were within the age of 15-20, forty-one (41) were between the ages of 21-25 and fifty-five (55) were between the age ranges of 26-30. The least (26) were between ages of 36 and 40. The highest prevalence age (35.5%) in this study were observed to fall between the ages of 26-30 then followed by forty-one patients (26.5%) prevalence that were between the ages of 21-25. The least in occurrence were 26 patients (8.4%) that were between the age range of 36 and 40. Similarly, the results obtained from this study revealed that there were 77 (49.67%) recorded in the first quarter of the year 2020. This was then followed by 48 (30.97%) patients in the last quarter. The least occurrence of PID patients 30 (19.35%) were diagnosed in the second quarter of the same year. The pathogens consistently identified to be associated with the disease were Neisseria gonorrhea and ciprofloxacin was the most sensitive on antibiogram. The factors responsible were poor personal hygiene, environmental pollution and unsanitary conditions of the toilets. It is recommended that patients should regularly visit health facilities for routine diagnosis of PID and ciprofloxacin and Broad spectrum antibiotics were the most efficacious for use in this study in the treatment of Pelvic inflammatory Disease.

Pelvic Inflammatory Disease Trends Among Emergency Department Visits in North Carolina, 2008 to 2017.

Pelvic inflammatory disease (PID) is an infection of the upper female reproductive organs that can lead to infertility and ectopic pregnancies. It is a reportable condition in North Carolina (NC) but is likely underreported. We aimed to quantify PID diagnoses in NC emergency department (ED) visits. The NC Disease Event Tracking and Epidemiology Collection Tool tracks all ED visits in NC. We identified PID diagnoses among women of reproductive age (15-44 years) between 2008 and 2017 using International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification codes, and calculated the yearly proportion with PID diagnoses. We assessed the number of PID visits per patient each year, and the proportion of ED visits with a PID diagnosis by age, proportion of the patient's ZIP code living below the poverty line, insurance coverage, and NC provider region. The percent of women with PID decreased from 6189 (1.0%) in 2008 to 4337 (0.58%) in 2016 before increasing slightly to 4371 (0.61%) in 2017. We identified 54,502 (0.45%) ED visits among 51,847 (0.76%) women with ≥1 PID diagnosis code. Most (95.5%) women with PID had one ED visit during the calendar year. Each year, the proportion with PID was highest among women aged 20 to 24 years, covered under public insurance, from the most impoverished areas, and whose provider was in the Coastal region of NC. The percent with PID among women visiting EDs decreased between 2008 and 2017 in NC. Although this decline was observed across all demographics, disparities associated with PID continued to persist over time.

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.

Despite coronavirus, general practice is still the best job in the world.

<h3>Background</h3> Intrauterine contraception is a first-line option for young women, yet relatively few prospective studies have been performed in nulliparous women using currently available devices, and many providers are still reluctant to provide this option. <h3>Methods</h3> Between January 2012 and June 2014, 109 nulliparous women, aged 18–30 years, who had an intrauterine device (IUD) placed at a student health clinic [88 levonorgestrel-intrauterine system (LNG-IUS) users and 21 Cu T 380A (IUD) users] were surveyed at 1, 6, 12 and 18 months after insertion. <h3>Results</h3> Overall satisfaction was high; at follow-up survey 83% of 100 women (mean use 13.4 months) were ‘happy’ or ‘very happy’ with their IUD, and there were no differences in satisfaction between the two IUD types. Some 75% of participants stated that the insertion procedure went ‘very well’, despite 78% rating insertion pain as moderate to severe, and 46% experiencing vasovagal symptoms. The 12-month continuation rate was 89%, with discontinuations for expulsion (3%), side effects (6%), lack of anticipated benefit (1%) and pregnancy (1%). Users of the Cu T 380A were more likely to have heavy menses (74% vs 2%; <i>p</i>&lt;0.0001) or moderate to severe cramping (68% vs 20%; <i>p</i>=0.0002) compared with LNG-IUS users. There were no uterine perforations or diagnoses of pelvic inflammatory disease. The rate of failed insertions during the study period was 6.2%. <h3>Conclusions</h3> Despite significant symptoms with insertion, intrauterine contraception is safe, effective and ultimately well tolerated in nulliparous women and should be provided to this population in both university and community health settings.

Diagnosis of pelvic inflammatory disease and barriers to conducting pelvic examinations in Australian general practice: findings from an online survey.

An online survey investigating Australian GPs' chlamydia management, including PID diagnosis, was conducted in 2019. From 323 respondents, 85.8% (n = 277) answered multiple-choice questions about PID and 74.6% (n = 241) answered a free-text question about barriers to conducting pelvic examinations. Using multivariable logistic regression, we identified factors associated with conducting pelvic examinations. Barriers to performing pelvic examinations were explored using thematic analysis. Most GPs indicated that they routinely ask female patients with a sexually transmissible infection about PID symptoms, including pelvic pain (86.2%), abnormal vaginal discharge (95.3%), abnormal vaginal bleeding (89.5%), and dyspareunia (79.6%). Over half reported routinely conducting speculum (69.0%) and bimanual pelvic (55.3%) examinations for women reporting pelvic pain. Female GPs were more likely to perform speculum [adjusted odds ratio (AOR) 4.6; 95%CI: 2.6-8.2] and bimanual pelvic examinations (AOR 3.7; 95%CI: 2.1-6.5). GPs with additional sexual health training were more likely to routinely perform speculum (AOR 2.2; 95%CI: 1.1-4.2) and bimanual pelvic examinations (AOR 2.1; 95%CI: 1.2-3.7). Barriers to pelvic examinations were patient unwillingness and/or refusal, GP gender, patient health-related factors, time pressures, and GP reluctance. Although GPs typically ask about PID symptoms when managing patients with chlamydia, they are not consistently able or willing to perform pelvic examinations to support a diagnosis, potentially reducing capacity to diagnose PID.

Analysis regarding etiological aspect and clinical features of pelvic inflammatory disease (PID)

Inflammatory disease of pelvic organ (PID) and its association with sub fertility and chronic pelvic pain is an important issue in recent days gynaecological practice. PID is a complex, insufficiently studied problem associated with serious medical, social and economic losses worldwide. Because of widespread sufferings, high treatment cost associated with PID and its sequel investment in prevention offers clear benefit than treatment. The study aims to analyse the etiological and clinical features of PID which may have an important impact in prevention as well as improved diagnosis and early management of PID and its sequele. It is a cross sectional study carried out in the outpatient Department of Obstetrics and Gynaecology, Chittagong Medical College Hospital, Chattogram, Bangladesh from October 2013 to April 2014. In this study 54% patient belonged to the age group 26-35 years, 96% married and 86% was housewife. More than 60% patient had home delivery by untrained birth attendant with puerperal sepsis in 54% patient, 54% patient had history of MR and 11% inserted IUCD, 37% patient had no history of contraception.

Pelvik inflamatuar hastalık ve kontrasepsiyon : Üçüncü basamak merkezde kesitsel bir çalişma

Aim: The purpose of our study in the light of this information; to investigate the relationship between the contraceptive methods used in the patient population treated for pelvic inflammatory disease (PID) in a tertiary center with clinical and laboratory features and clinical outcome of PID.&#x0D; Material and Method: This is a cross-sectional study using the anamnesis, examination findings, microbiological and pathological evaluation results of vaginal and cytological samples recorded in the hospital database of 974 patients treated with a diagnosis of PID in a tertiary center between 2017 and 2019.&#x0D; Results: Copper-Intrauterine Device (Cu-IUD) was the most commonly used contraceptive method in women with a history of PID. When the cervicovaginal culture results are evaluated; E.coli positivity was more frequent in patients using CU-IUD and Levonorgesterone IUD (LNG-IUD) (

Perioperative Complications of Laparoscopic Versus Open Surgery for Pelvic Inflammatory Disease

Study Objective To compare complications in patients undergoing laparoscopic versus open surgery for acute pelvic inflammatory disease (PID). Design We performed a retrospective cohort study of patients who underwent surgery for PID using the National Surgical Quality Improvement Program database from 2010-2015. Propensity-score matching was used to balance baseline characteristics and compare complications in patients who underwent laparoscopic versus open surgery. Setting Surgical management of acute PID. Patients or Participants Patients with preoperative diagnosis of PID were identified using ICD-9 codes. We excluded patients with a diagnosis of chronic PID, with gynecologic malignancy, and those whom the surgical route was unknown. Interventions Surgery for acute PID. Measurements and Main Results The study population was comprised of 367 patients. The mean age was 43.0±11.1 years, BMI was 29.4 (IQR 24.3-36.7), and ASA class was 2 (IQR 2-3). Preoperative sepsis was noted in 32.4%, and septic shock was present in 1.4%. Hysterectomy was performed in 67.6%, oophorectomy in 12.0%, and salpingectomy in 4.6%. Complications were experienced by 115 patients (31.3%), 14 (3.8%) of which were potentially life-threatening. Multivariate logistic regression identified the following to be independently associated with complications: laparoscopy (aOR 0.55, p=0.04), hysterectomy (aOR 1.87, p=0.05), appendectomy (aOR 2.6, p=0.03), preoperative hematocrit < 30g/dl (aOR 2.68, p<0.01), preoperative INR > 1.2 (aOR 2.44, p<0.01), and operative time (aOR 1.004, p=0.02). Propensity-scores were calculated and utilized to generate a matched cohort of laparoscopic versus open surgery; groups were similar with p<0.05 for all covariates. After balancing potentially confounding variables, the composite complication rate remained lower in patients who underwent laparoscopy (20.5%) versus open surgery (35.2%), p=0.04. Conclusion Laparoscopy was associated with lower complication rates than open surgery in this well-matched cohort of patients who underwent surgery for acute PID. To compare complications in patients undergoing laparoscopic versus open surgery for acute pelvic inflammatory disease (PID). We performed a retrospective cohort study of patients who underwent surgery for PID using the National Surgical Quality Improvement Program database from 2010-2015. Propensity-score matching was used to balance baseline characteristics and compare complications in patients who underwent laparoscopic versus open surgery. Surgical management of acute PID. Patients with preoperative diagnosis of PID were identified using ICD-9 codes. We excluded patients with a diagnosis of chronic PID, with gynecologic malignancy, and those whom the surgical route was unknown. Surgery for acute PID. The study population was comprised of 367 patients. The mean age was 43.0±11.1 years, BMI was 29.4 (IQR 24.3-36.7), and ASA class was 2 (IQR 2-3). Preoperative sepsis was noted in 32.4%, and septic shock was present in 1.4%. Hysterectomy was performed in 67.6%, oophorectomy in 12.0%, and salpingectomy in 4.6%. Complications were experienced by 115 patients (31.3%), 14 (3.8%) of which were potentially life-threatening. Multivariate logistic regression identified the following to be independently associated with complications: laparoscopy (aOR 0.55, p=0.04), hysterectomy (aOR 1.87, p=0.05), appendectomy (aOR 2.6, p=0.03), preoperative hematocrit < 30g/dl (aOR 2.68, p<0.01), preoperative INR > 1.2 (aOR 2.44, p<0.01), and operative time (aOR 1.004, p=0.02). Propensity-scores were calculated and utilized to generate a matched cohort of laparoscopic versus open surgery; groups were similar with p<0.05 for all covariates. After balancing potentially confounding variables, the composite complication rate remained lower in patients who underwent laparoscopy (20.5%) versus open surgery (35.2%), p=0.04. Laparoscopy was associated with lower complication rates than open surgery in this well-matched cohort of patients who underwent surgery for acute PID.

Perioperative Complications of Laparoscopic versus Open Surgery for Pelvic Inflammatory Disease

To compare complications in patients undergoing laparoscopic vs open surgery for acute pelvic inflammatory disease (PID). We performed a retrospective cohort study of patients who underwent surgery for PID, using the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2015. Propensity score matching was used to balance baseline characteristics and compare complications in patients who underwent laparoscopic vs open surgery. Surgical management of acute PID. Patients with a preoperative diagnosis of PID were identified using International Classification of Diseases, Ninth Revision, codes. We excluded patients with chronic PID, gynecologic malignancy, and those for whom the surgical route was unknown. Surgery for acute PID. The study included 367 patients. The mean age was 43.0 ± 11.1 years, body mass index was 30.9 ± 11.2 kg/m2, and American Society of Anesthesiology class was 2 (interquartile range 2-3). Preoperative signs of sepsis were noted in 33.8% of the patients, and septic shock was present in 1.4%. Hysterectomy was performed in 67.6%, oophorectomy in 12.0%, and salpingectomy in 4.6%. Complications were experienced by 114 patients (31.1%), 11 (3.0%) of which were potentially life-threatening. Multivariate logistic regression identified the following to be independently associated with complications: laparoscopy (adjusted odds ratio [aOR] 0.48; 95% confidence interval [CI], 0.3-0.8; p <.01), operative time (aOR 1.01; 95% CI, 1.00-1.01; p <.01), appendectomy (aOR 2.36; 95% CI, 1.0-5.4; p = .04), elevated international normalized ratio (aOR 2.30; 95% CI, 1.3-4.2; p <.01), and low hematocrit level (aOR 2.53; 95% CI, 1.4-4.5; p <.01). Propensity scores were calculated and used to generate a matched cohort of patients who underwent laparoscopic vs open surgery; the groups were similar, with p <.05 for all covariates. After balancing confounding variables, a laparoscopic approach to surgery remained significantly associated with a lower risk of complications (coefficient -0.07; 95% CI, -0.11 to -0.02; p = .008). Laparoscopy was associated with lower complication rates than open surgery in this well-matched cohort of patients who underwent surgery for acute PID.

A Need for Standardization of the Diagnosis and Treatment of Pelvic Inflammatory Disease: Pilot Study in an Outpatient Clinic in Quito, Ecuador.

Background Pelvic inflammatory disease (PID) diagnosis is often challenging as well as its treatment. This study sought to characterize the diagnostic and therapeutic trend among physicians at the outpatient level, in Quito, Ecuador, where currently no nationwide screening or specific clinical guideline has been implemented on PID or its main microbiological agents. Methods A retrospective analysis of medical records with pelvic inflammatory disease diagnosis in an outpatient clinic was performed. Electronic medical records from 2013 to 2018 with any pelvic inflammatory disease-related diagnoses were retrieved. Information with regard to age, sexually related risk factors, symptoms and physical exam findings, ancillary tests, method of diagnosis, and antibiotic regimens was extracted. Results A total of 186 records were included. The most frequent clinical manifestations were vaginal discharge (47%) and pelvic pain (39%). In the physical examination, leucorrhea was the most frequent finding (47%), followed by lower abdominal tenderness (35%) and cervical motion tenderness in 51 patients (27%). A clinical diagnosis was established in 60% of patients, while 37% had a transvaginal sonography-guided diagnosis. Antibiotic treatment was prescribed with standard regimens in 3% of cases, while other regimens were used in 93% of patients. Additionally, an average of 1.9 drugs were prescribed per patient, with a range from 1 to 5, all in different combinations and dosages. Conclusions No standardized methods of diagnosis or treatment were identifiable. These findings highlight the need for standardization of the diagnosis and treatment of PID attributed to chlamydial and gonococcal infections.

Diagnostik und Therapie der Adnexitis (Pelvic Inflammatory Disease)

Management of Pelvic Inflammatory Disease Abstract. Pelvic inflammatory disease (PID) is a common medical problem, but the diagnosis of PID can be challenging because the clinical manifestations may mimic those of other pelvic and abdominal processes. As PID might cause late complications such as infertility or chronic pelvic pain, it is of prime importance that the diagnosis of PID is made promptly to assure the early onset of an adequate antibiotic therapy. Where uncomplicated PID usually has a favorable course, complicated forms with tubo-ovarian abscess generally require surgical exploration.

Pelvic inflammatory disease among users and non-users of an intrauterine device

The correlation between pelvic inflammatory disease (PID) and a present intrauterine device (IUD) has been debated. We aimed to evaluate the differences between IUD users and non-users among women hospitalised with a diagnosis of PID. Our hypothesis was that the role of a present IUD among PID patients is minimal, if any. We performed a retrospective cohort study during 2010–2018 in a tertiary university hospital. Overall, 474 hospitalised patients were diagnosed with PID. Of these, 121 patients were IUD users. The patients without an IUD were younger and had lower gravidity and parity. Among the patients without an IUD, higher rates of prior history of PID and fever at presentation were noticed. In 23.9% (29/121) of women, the IUD was inserted less than four weeks prior to the PID diagnosis. The patients with an IUD insertion-associated PID, had lower rates of tubo-ovarian abscess (2 (6.9%) versus 24 (26.0%), OR [95% CI] 0.18 (0.04–0.84), p = .02) at presentation, as well as a shorter length of stay (LOS) (median 4 versus 5 days, p = .05). In a patient in whom the IUD was retained, hospitalisation period was shorter (median LOS 4 days versus 5 days, p = .007). PID inpatients who carry an IUD represent a specific subset of patients with a milder disease. Impact statement What is already known on this subject? The correlation between pelvic inflammatory disease (PID) and a present intrauterine device (IUD) is debateable. What the results of this study add? PID inpatients who carry an IUD represent a specific subset of patients with milder disease. What the implications are of these findings for clinical practice and/or further research? Our results show that in IUD users with PID, the practice of IUD removal as part of their PID treatment is of little benefit.

Association between pelvic inflammatory disease, infertility, ectopic pregnancy and the development of ovarian serous borderline tumor, mucinous borderline tumor and low-grade serous carcinoma

ObjectiveRisk factors for ovarian borderline tumors and low-grade serous carcinoma (LGSC) are poorly understood. The aim of this study was to examine the association between infertility, pelvic inflammatory disease (PID), endometriosis, ectopic pregnancy, hysterectomy, tubal ligation and parity and the risk of serous borderline tumor (SBT), mucinous borderline tumor (MBT) and LGSC. MethodsThis was a population-based cohort study using linked administrative and hospital data. Participants were 441,382 women born between 1945 and 1975 who had been admitted to hospital in Western Australia between 1 January 1980 and 30 June 2014. We used Cox regression to estimate hazard ratios (HRs). ResultsWe observed an increased rate of SBT associated with infertility, PID and ectopic pregnancy (HRs and 95% CIs were, respectively, 1.98 (1.20–3.26); 1.95 (1.22–3.10) and 2.44 (1.20–4.96)). We did not detect an association between any of the factors under study and the rate of MBT. A diagnosis of PID was associated with an increased rate of LGSC (HR 2.90, 95% CI 1.21–6.94). ConclusionsThe association with PID supports the hypothesis that inflammatory processes within the upper gynaecological tract and/or peritoneum may predispose to the development of SBT and LGSC.

Bacterial colonization of Intrauterine Device samples from patients without a history of Pelvic Inflammatory Disease

Aim: In this research, we aim to evaluate microbiological colonization of intrauterine devices (IUDs) in patients without the diagnosis of Pelvic Inflammatory Disease (PID) whether it has relationship with the duration of IUD usage. Material and Methods: Our study included patients at the Obstetrics and Gynecology Polyclinic of second degree state hospital between January 1, 2015 and January 1, 2016, who requested the removal of an IUD. A total of 176 patients were recruited for our study. Age, parity, and duration of IUD use were recorded for all patients, who sought treatment at the outpatient clinic. None of the patients had a clinical or laboratory finding of PID. IUD samples, which were collected in the sterile containers, were sent to the microbiology laboratory.Results: The mean age of the patients recruited in our study was 34.5 years. 36 IUD cultures (20.4%) were positive. There were no statistically significant differences between the groups of patients with microorganisms cultured and those with none of the microorganisms cultured; in terms of age, parity, and duration of IUD use.Conclusion: In this study, aerobic bacterial growth occurred in 36 patients, 20.4% of the cultures of the IUDs. In addition, our study adds data to the literature, with the statistical analysis of the groups comparing age, parity, and the duration of IUD use with positive and negative cultures of microorganisms in the IUD samples, as was not done in previous studies.