Diagnosis Of Pelvic Inflammatory Disease Research Articles

A Community Based Study on Pelvic Inflammatory Disease in Postmenopausal Females: Microbiological Spectrum and Socio-Demographic Correlates.

Pelvic Inflammatory Disease (PID) is a common and serious complication of sexually transmitted diseases in young women but is rarely diagnosed in the postmenopausal women. Very few studies have been done regarding post-menopausal PID. To determine the burden of PID, associated micro-organisms, pathophysiology and risk factors among post-menopausal women of the community. A cross-sectional study was conducted among 530 post-menopausal women in the registered field practice areas of the JN Medical College and Hospital, Aligarh, Uttar Pradesh, India. A pre designed and pre tested proforma was used to obtain data regarding socio-demographic details and factors associated with PID. Clinical and laboratory examinations were done to confirm the diagnosis of PID. Data was analyzed using SPSS 23.0. Association between categorical variables was tested with chi-square test and logistic regression analysis was used to find independent risk factors. The value of p<0.05 was considered as significant. About 11.55% of the study subjects were diagnosed with PID (12.5% in rural areas and 10.6% in urban areas). Bacterial vaginosis followed by Trichomonas vaginalis were most common. Among the important risk factors, significant association was found with occupation of the women, increasing parity, multiple sexual contacts, and associated pelvic organ prolapse. Association with smoking, chronic illnesses, diabetes mellitus and hypertension, and associated urinary tract infection were not found to be significant. The study shows the hidden burden of the disease in the community and the associated risk factors, which can be prevented by life style and cultural changes if incorporated earlier in the lives.

Pelvic Inflammatory Disease: Multimodality Imaging Approach with Clinical-Pathologic Correlation.

Pelvic inflammatory disease (PID) is a common medical problem, with almost 1 million cases diagnosed annually. Historically, PID has been a clinical diagnosis supplemented with the findings from ultrasonography (US) or magnetic resonance (MR) imaging. However, the diagnosis of PID can be challenging because the clinical manifestations may mimic those of other pelvic and abdominal processes. Given the nonspecific clinical manifestations, computed tomography (CT) is commonly the first imaging examination performed. General CT findings of early- and late-stage PID include thickening of the uterosacral ligaments, pelvic fat stranding with obscuration of fascial planes, reactive lymphadenopathy, and pelvic free fluid. Recognition of these findings, as well as those seen with cervicitis, endometritis, acute salpingitis, oophoritis, pyosalpinx, hydrosalpinx, tubo-ovarian abscess, and pyometra, is crucial in allowing prompt and accurate diagnosis. Late complications of PID include tubal damage resulting in infertility and ectopic pregnancy, peritonitis caused by uterine and/or tubo-ovarian abscess rupture, development of peritoneal adhesions resulting in bowel obstruction and/or hydroureteronephrosis, right upper abdominal inflammation (Fitz-Hugh-Curtis syndrome), and septic thrombophlebitis. Recognition of these late manifestations at CT can also aid in proper patient management. At CT, careful assessment of common PID mimics, such as endometriosis, adnexal torsion, ruptured hemorrhagic ovarian cyst, adnexal neoplasms, appendicitis, and diverticulitis, is important to avoid misinterpretation, delay in management, and unnecessary surgery. Correlation with the findings from complementary imaging examinations, such as US and MR imaging, is useful for establishing a definitive diagnosis. (©)RSNA, 2016.

How Good are We at Recognizing and Treating Pelvic Inflammatory Disease?

The aim of this discursive article is to highlight the challenges for clinicians when diagnosing and treating women with pelvic inflammatory disease, especially when the woman has an intrauterine device in-situ. The article will highlight key areas of the decision making process involved in this specific example and will include discussions on evidence based practice, clinician experience, knowledge base and patient preference. Current clinical guidelines are conflicting on whether an intra-uterine contraceptive device should be removed or not when pelvic inflammatory disease is suspected. Research on clinicians found that they appear to have a relatively low level of knowledge with regards to both pelvic inflammatory disease diagnosis, and general intra-uterine contraceptive device use. The importance of patient preference is another factor to consider, with particular focus on potential issues with clinician delivered patient education. Recommendations for future practice, policy and research also will be discussed.

Risk of reproductive complications following chlamydia testing: a population-based retrospective cohort study in Denmark

Uncertainty in the risk of reproductive complications (pelvic inflammatory disease, ectopic pregnancy, and tubal factor infertility) following chlamydia infection and repeat infection hampers the design of evidence-based chlamydia control programmes. We estimate the association between diagnosed chlamydia and episodes of hospital health care (inpatient, outpatient, and emergency department) for a reproductive complication. We constructed and analysed a retrospective population-based cohort of women aged 15-44 years from administrative records in Denmark (1995-2012). We used a subset of the national Danish Chlamydia Study. The master dataset contains all residents of Denmark (including Greenland) who had a positive chlamydia test recorded by a public health microbiology laboratory from Jan 1, 1992, to Nov 2, 2011. Individuals were randomly matched (by age and sex) to four individuals drawn from the population register (Danish Civil Registration System) who did not have a positive chlamydia test during this interval. The outcomes in the study were hospital episodes of health-care (inpatient, outpatient, and emergency department) with a diagnosis of pelvic inflammatory disease, ectopic pregnancy, or tubal factor infertility. The 516 720 women (103 344 positive, 182 879 negative, 230 497 never-tested) had a mean follow-up of 7·96 years. Compared with women with only negative tests, the risk of each complication was 30% higher in women with one or more positive tests (pelvic inflammatory disease, adjusted hazard ratio [AHR] 1·50 [95% CI 1·43-1·57]; ectopic pregnancy, AHR 1·31 [1·25-1·38]; tubal factor infertility, AHR 1·37 [1·24-1·52]) and 60% lower in women who were never-tested (pelvic inflammatory disease, AHR 0·33 [0·31-0·35]; ectopic pregnancy, AHR 0·42 [0·39-0·44]; tubal factor infertility AHR 0·29 [0·25-0·33]). A positive test had a minor absolute impact on health as the difference in the lifetime incidence of complications was small between women who tested positive and those who tested negative (pelvic inflammatory disease, 0·6%; ectopic pregnancy, 0·2%; tubal factor infertility, 0·1%). Repeat infections increased the risk of pelvic inflammatory disease by a further 20% (AHR 1·20, 95% CI 1·11-1·31). A single diagnosed chlamydia infection increased the risk of all complications and a repeat diagnosed infection further increased the risk of pelvic inflammatory disease. Therefore, control programmes must prevent first and repeat infections to improve women's reproductive health. Unrestricted partial funding from Frederiksberg Kommune, Frederiksberg, Denmark. BD held an Medical Research Council Population Health Scientist Fellowship (G0902120). KT held an National Institute for Health Research Post-Doctoral Fellowship 2009-02-055.

A prospective assessment of pelvic infection risk following same-day sexually transmitted infection testing and levonorgestrel intrauterine system placement

Misperceptions persist that intrauterine device placement is related to pelvic infections and Chlamydia and gonorrhea testing results are needed prior to placement. We sought to evaluate the relationship of Chlamydia and gonorrhea screening to pelvic infection for up to 2 years following placement of the levonorgestrel 52-mg intrauterine system. A total of 1751 nulliparous and multiparous females 16 to 45 years old enrolled in a multicenter trial designed to evaluate the efficacy and safety of a new levonorgestrel intrauterine system for up to 7years. Participants had Chlamydia screening at study entry and yearly if they were age ≤25 years. Women also had baseline gonorrhea screening if testing had not been performed since starting their current sexual relationship. Those who changed sexual partners during the trial had repeated Chlamydia and gonorrhea testing. Intrauterine system insertion could occur on the same day as screening. Participants did not receive prophylactic antibiotics for intrauterine system placement. Investigators performed pelvic examinations after 12 and 24 months and when clinically indicated during visits at 3, 6, and 18 months after placement and unscheduled visits. Pelvic infection included any clinical diagnosis of pelvic inflammatory disease or endometritis. Most participants (n= 1364, 79.6%) did not have sexually transmitted infection test results available prior to intrauterine system placement. In all, 29 (1.7%) participants had positive baseline testing for a sexually transmitted infection (Chlamydia, n= 25; gonorrhea, n= 3; both, n= 1); 6 of these participants had known results (all with Chlamydia infection) prior to intrauterine system placement and received treatment before enrollment. The 23 participants whose results were not known at the time of intrauterine system placement received treatment without intrauterine system removal and none developed pelvic infection. The incidence of positive Chlamydia testing was similar among those with and without known test results at the time of intrauterine system placement (1.9% vs 1.5%, respectively, P= .6). Nine (0.5%) participants had a diagnosis of pelvic infection over 2 years after placement, all of whom had negative Chlamydia screening on the day of or within 1 month after intrauterine system placement. Infections were diagnosed in 3 participants within 7 days, 1 at 39 days, and 5 at ≥6 months. Seven participants received outpatient antibiotic treatment and 2 (diagnoses between 6-12 months after placement) received inpatient treatment. Two (0.1%) participants had intrauterine system removal related to infection (at 6 days and at 7 months after placement), both of whom only required outpatient treatment. Conducting Chlamydia and gonorrhea testing on the same day as intrauterine system placement is associated with a low risk of pelvic infection (0.2%). Over the first 2 years of intrauterine system use, infections are infrequent and not temporally related to intrauterine system placement. Pelvic infection can be successfully treated in most women with outpatient antibiotics and typically does not require intrauterine system removal. Women without clinical evidence of active infection can have intrauterine system placement and sexually transmitted infection screening, if indicated, on the same day.

Intra-abdominal Infection

The basic principles of rapid diagnosis, timely physiologic support, and definitive intervention for intra-abdominal infections have remained unchanged over the past century; however, specific management of these conditions has been transformed as a result of numerous advances in technology. This review covers clinical evaluation, investigative studies, options for intervention, early source control and duration of antimicrobial therapy, infections of the upper abdomen, infections of the lower abdomen, other abdominal infections, and special cases. Figures show an algorithm outlining the approach to a suspected upper abdominal infection, abnormal abdominal ultrasounds showing calculi in the gallbladder and confirming the diagnosis of acute acalculous cholecystitis, endoscopic retrograde cholangiopancreatographies showing a distal common bile duct stone in acute pancreatitis, extrinsic compression of the common hepatic duct by a stone in the Hartmann pouch, and endoscopic sphincterotomy for acute biliary decompression in acute obstructive cholangitis, air outlining the gallbladder and bile ducts in emphysematous cholecystitis, abdominal and pelvic CT scans showing pancreatic findings graded by Ranson into five categories, a splenic abscess, an inflamed and thickened appendix with surrounding fat stranding, appendiceal perforation and abscess formation, diverticulitis with a small amount of extraluminal air, left lower quadrant fluid collection consistent with peridiverticular abscess, diffuse inflammation and right upper quadrant extraluminal air, and thickening of the colonic wall with both intramural and extramural air, an algorithm outlining the approach to the patient with a suspected lower abdominal infection, upright chest x-ray and abdominal CT scans of patients with sudden-onset diffuse abdominal pain, and an omental (Graham) patch. Tables list diagnostic indicators of upper abdominal pain and fever, comparison of acute cholecystitis and emphysematous cholecystitis, Hinchey system for classification of perforated diverticulitis, Centers for Disease Control and Prevention (CDC) guidelines for diagnosis of pelvic inflammatory disease, and CDC guidelines for antibiotic treatment of pelvic inflammatory disease. This review contains 16 highly rendered figures, 5 tables, and 238 references

Physician Specialty Influences Care of Pelvic Inflammatory Disease.

CDC guidelines recommend Neisseria gonorrhoeae, Chlamydia trachomatis, and HIV testing, as well as specific antibiotic regimens in the diagnosis and treatment of pelvic inflammatory disease (PID), although latitude in adhering to these guidelines is common. We hypothesized that adherence to CDC guidelines for antibiotic regimens and laboratory testing, coverage for anaerobic organisms, and the use of diagnostic imaging techniques do not differ significantly between practitioners with emergency medicine (EM) versus obstetrics and gynecology (OB-GYN) training. We conducted a retrospective medical chart review on patients (N = 351) discharged with a diagnosis of PID over a 20-month period at two neighboring emergency care facilities-one with EM-trained providers and the other with OB-GYN-trained providers. Adjusted for demographic predictors and chief complaint, there was no significant difference in adherence to N. gonorrhoeae and C. trachomatis antibiotic coverage guidelines between the two facilities (adjusted odds ratio [AOR] 1.34; 95% CI 0.66-2.74), using the OB-GYN facility in the numerator of the AOR. Anaerobic coverage was significantly more common at the OB-GYN facility (AOR 9.11; 95% CI 5.36-15.48). Both sites had very low rates of adherence to CDC laboratory testing guidelines with overall rates of adherence at 4.0% (95% CI 1.9%-5.9%). Utilization of diagnostic tests differed greatly between facilities: ultrasound utilization was 66.7% (95% CI 58.2%-75.2%) at the OB-GYN facility and 39.7% (95% CI 33.4%-45.9%) at the EM facility. The diagnostic pathway for PID and adherence to guidelines differ significantly depending on physician specialty and practice environment, suggesting the need for further standardization, perhaps with cross-disciplinary training.

Intra-abdominal Infection

The basic principles of rapid diagnosis, timely physiologic support, and definitive intervention for intra-abdominal infections have remained unchanged over the past century; however, specific management of these conditions has been transformed as a result of numerous advances in technology. This review covers clinical evaluation, investigative studies, options for intervention, early source control and duration of antimicrobial therapy, infections of the upper abdomen, infections of the lower abdomen, other abdominal infections, and special cases. Figures show an algorithm outlining the approach to a suspected upper abdominal infection, abnormal abdominal ultrasounds showing calculi in the gallbladder and confirming the diagnosis of acute acalculous cholecystitis, endoscopic retrograde cholangiopancreatographies showing a distal common bile duct stone in acute pancreatitis, extrinsic compression of the common hepatic duct by a stone in the Hartmann pouch, and endoscopic sphincterotomy for acute biliary decompression in acute obstructive cholangitis, air outlining the gallbladder and bile ducts in emphysematous cholecystitis, abdominal and pelvic CT scans showing pancreatic findings graded by Ranson into five categories, a splenic abscess, an inflamed and thickened appendix with surrounding fat stranding, appendiceal perforation and abscess formation, diverticulitis with a small amount of extraluminal air, left lower quadrant fluid collection consistent with peridiverticular abscess, diffuse inflammation and right upper quadrant extraluminal air, and thickening of the colonic wall with both intramural and extramural air, an algorithm outlining the approach to the patient with a suspected lower abdominal infection, upright chest x-ray and abdominal CT scans of patients with sudden-onset diffuse abdominal pain, and an omental (Graham) patch. Tables list diagnostic indicators of upper abdominal pain and fever, comparison of acute cholecystitis and emphysematous cholecystitis, Hinchey system for classification of perforated diverticulitis, Centers for Disease Control and Prevention (CDC) guidelines for diagnosis of pelvic inflammatory disease, and CDC guidelines for antibiotic treatment of pelvic inflammatory disease. This review contains 16 highly rendered figures, 5 tables, and 238 references

Improving Adolescent Pelvic Inflammatory Disease Follow-up From the Emergency Department: Randomized Controlled Trial With Text Messages

Centers for Disease Control and Prevention guidelines recommend follow-up within 72 hours of diagnosis of pelvic inflammatory disease because patients with inadequate treatment are at increased risk of acute and chronic complications. Follow-up rates in adolescents after diagnosis range between 10% and 16%. The primary objective is to assess the effect of text message reminders to adolescent patients receiving a diagnosis of pelvic inflammatory disease on obtaining follow-up care within 72 hours of emergency department (ED) discharge. This was a single-blinded randomized controlled trial of adolescents receiving a diagnosis of pelvic inflammatory disease in the ED. Patients received standard discharge instructions or standard discharge instructions plus text message reminders. Patients in the text message group received daily, tailored text messages for 4 days, with a reminder to schedule and attend primary care provider follow-up. The primary outcome was follow-up within 72 hours of ED discharge. Ninety-five patients (48 standard; 47 text message) were randomized. Three patients were excluded, leaving 92 patients (46 standard; 46 text message) for analysis. Baseline characteristics were similar between treatment groups. Follow-up was 15.2% in the standard group and 43.5% in the text message group. Patients receiving text message reminders were more likely to follow up compared with the standard group (relative risk 2.9; 95% confidence interval [CI] 1.4 to 5.7). The absolute efficacy difference was 28.3% (95% CI 9.5% to 46.9%), yielding number needed to treat of 4 (95% CI 2.2 to 9.5). Personalized text message reminders were efficacious in improving follow-up for adolescents after ED diagnosis of pelvic inflammatory disease.

Pelvic inflammatory disease associated with Chlamydia trachomatis but not Mycoplasma genitalium in New Zealand.

Background There is a paucity of studies looking at associations between Mycoplasma genitalium and pelvic inflammatory disease (PID). The objectives of this study were to estimate the prevalence of M. genitalium in women attending a sexual health service in New Zealand and secondly to examine for an association of M. genitalium with PID. Women consecutively attending the service for a sexual health screen (Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis) were recruited to establish a baseline prevalence of M. genitalium. An extra cervical swab was taken for the detection of M. genitalium. Recruitment of additional women with a clinical diagnosis of PID continued until a sufficient sample size was obtained to examine the association of PID with M. genitalium. Women in the baseline sample without PID were used as the control group. The control group included 250 women, with M. genitalium diagnosed in 8.7% (95% CI 5.8-12.9%) and C. trachomatis in 9.9% (95% CI 6.8-14.2%). Ninety-one women were recruited with PID; M. genitalium was diagnosed in 9.9% (95% CI 5.3-17.7%) and C. trachomatis in 27.5% (95% CI 19.4-37.4%). Multivariate analysis using clinically relevant variables showed that a diagnosis of C. trachomatis (OR 2.44, 95% CI 1.24-4.81) but not M. genitalium (OR 0.91, 95% CI 0.38-2.20) was significantly associated with a PID diagnosis. M. genitalium was almost as commonly diagnosed as C. trachomatis in this population. C. trachomatis was the only infection that was significantly associated with PID.

Sonography of the Pelvic Infection

ABSTRACT The sonographic diagnosis of pelvic inflammatory disease (PID) is a challenge for the sonographer. Sonographic diagnosis is possible when tube enlarges and liquid accumulates inside the fallopian tube, a sign that can be detected with vaginal probes. As the disease progresses, more complex images are found depending on the enlarging of the adnexa and the accumulation of necrotic material. Sonography allows a sensitive diagnostic suspicion in the case of women with clinical and epidemiologic criteria for PID. How to cite this article Platero-Mihi M, Martinez-Moya M, Serrano-González L, Bajo-Arenas J, Perez-Medina T. Sonography of the Pelvic Infection. Donald School J Ultrasound Obstet Gynecol 2017;11(1):59-68.

P08.20 Pathogen negative pelvic inflammatory disease: is it pid?

Background Pelvic inflammatory disease (PID) occurs when pathogens (often sexually transmitted) ascend from the cervix to the upper genital tract. No pathogen is detected in up to two thirds of PID cases yet few studies have assessed the characteristics of pathogen-negative PID. We assessed the characteristics of pathogen-negative compared to pathogen-positive PID using data from females attending a large urban sexual health clinic in Melbourne. Methods Data were extracted from the clinic’s electronic patient database for women aged 16–49 and tested for chlamydia (CT), gonorrhoea (NG), mycoplasma genitalium (MG) and bacterial vaginosis (BV) and diagnosed with PID at first clinic visit between Jan 2006–June 2013. PID diagnosis was clinical: based on uterine, cervical motion, or adnexal tenderness in sexually active women with pelvic pain where no cause beside PID was identified. Multivariable logistic regression was conducted to identify demographic, sexual behavioural factors and whether vaginal inflammation (defined as ≥5 polymorphonuclear leukocytes (PMNL) per 1000 high powered field from high vaginal swabs) was associated with pathogen- negative PID. Results Between 2006–2013, a total of 326 new females patients were diagnosed with PID and tested for CT, NG, MG and BV; 203 (62%; 95% CI: 57%–68%) tested negative for the four infections (pathogen-negative PID). Among pathogen-positive PID cases, 49.6% (95% CI: 40.6–58.6) had CT, 6.5% (95% CI: 2.1–10.9) had NG, 12.2% (95% CI: 6.3–18.1) had MG, 56.1% (95% CI: 47.2–65.0) had BV. Multivariate analysis showed that pathogen-negative PID cases were less likely to have vaginal inflammation (OR = 0.5, 95% CI: 0.3–0.8), to report unprotected sex with non-regular sexual partners in the past three months (OR = 0.6, 95% CI: 0.4–1.0) or to present as an STI contact (OR = 0.4, 95% CI: 0.2–1.0). Conclusion These findings suggest that pathogen-negative PID is associated with a lower sexual risk and inflammation then pathogen-positive PID cases. In the clinical setting, consideration of PMNS in diagnosing PID may improve diagnostic precision. Disclosure of interest statement The authors declare that they have no commercial or other association that might pose a conflict of interest.

P08.19 Risk of pelvic inflammatory disease from chlamydia and gonorrhoea among australian sexual health clinic attendees

Background Pelvic inflammatory disease (PID) is an important cause of infertility in women and can occur when micro-organisms such as chlamydia or gonorrhoea ascend to the upper genital tract. However few studies have quantified the contribution of these pathogens to PID. We estimated the burden of PID using the population attributable risk percent (PAR%) in an Australian urban sexual health clinic population that could potentially be avoided if chlamydia or gonorrhoea infection were prevented. Methods Data were extracted from the clinic’s electronic patient database for all females aged 16–49 at first visit to an urban sexual health clinic between Jan2006-Jun2013. Chlamydia and gonorrhoea tests were based on clinical and risk assessment. PID diagnosis was based on clinical examination findings. Two analyses were undertaken; one among chlamydia-tested women and one among a subset of the chlamydia-tested group who were also tested for gonorrhoea (chlamydia/gonorrhoea tested). Univariable and multivariable logistic regression was conducted to identify factors associated with PID. The PAR% for PID from a current chlamydia or gonorrhoea infection was calculated and adjusted for demographic and behavioural factors using multivariable logistic regression. Results Among 15690 chlamydia-tested women, 1279 (8.2%, 95% CI 7.7–8.6) tested chlamydia-positive, 436 (2.8%, 95% CI 2.5–3.0) had PID diagnosed. The PAR% for chlamydia was 14.1% (95% CI 9.9–18.1). Among 8839 chlamydia/gonorrhoea-tested women, 681 (7.7%, 95% CI 7.2–8.3) had chlamydia only, 30 (0.3%, 95% CI 0.2–0.5) gonorrhoea only, 22(0.2%, 95% CI 0.2–0.4) chlamydia and gonorrhoea; 419 (4.7%, 95% CI 4.3–5.2) had PID diagnosed. The PAR% was highest for chlamydia only (12.5%, 95% CI 8.5–16.3) compared with gonorrhoea only (0.9%, 95% CI-0.1–1.8) or concurrent infections (1.0%, 95% CI 0.0–1.9). Conclusion In this low gonorrhoea prevalence population, chlamydia control would have the greatest impact on reducing PID. Disclosure of interest statement The authors declare that they have no commercial or other association that might pose a conflict of interest.

P04.07 “Summer loving”: an analysis of seasonal differences in sexual behaviour and sexually transmissible infections

Introduction Public health campaigns must be timed to target their audience at times of highest risk. To date no study has correlated seasonal differences in sexual behaviour with those in sexually transmissible infection (STI) positivity; and no seasonal study has been conducted in the southern hemisphere. Our study aimed to describe seasonal differences in sexual behaviour and correlate this with STI positivity. Methods This was a cross-sectional study of individuals attending the Melbourne Sexual Health Centre (MSHC) over a 9 year period from 2006–2014 inclusive. We conducted separate analyses for women, men who have sex with men (MSM) and men who have sex with women (MSW). Seasonal patterns of sexual behaviour (partner numbers, condom use and injecting drug use), and STI positivity were examined in all groups. STI with a high symptomatic rate and short incubation period were selected for the analysis: gonorrhoea, primary herpes simplex virus (HSV) infections, non-gonococcal urethritis (NGU) (men only), and pelvic inflammatory disease (PID) (women only). Results All groups reported a significantly higher number of partners in summer compared to winter (women P MSW reported less consistent condom use in summer (P = 0.016); a similar but non-significant trend was observed in MSM and women. The urethral gonorrhoea positivity among MSM was significantly higher in summer compared to winter (P = 0.017). Similarly, the NGU positivity among MSW was the highest in summer (P = 0.009). In women PID diagnoses climbed over summer to peak in autumn, which then dropped to a low in winter (P = 0.025). The other STIs did not show statistically significant seasonal differences. Conclusion Our study describes a peak in sexual partner number and STI positivity in summer. This seasonal difference must inform the timing of public health campaigns, as these are likely to be maximally effective in spring and summer. Disclosure of interest statement None.

Management of Pelvic Inflammatory Disease in Selected U.S. Sexually Transmitted Disease Clinics: Sexually Transmitted Disease Surveillance Network, January 2010-December 2011.

Pelvic inflammatory disease (PID) remains an important source of preventable reproductive morbidity, but no recent studies have singularly focused on US sexually transmitted disease (STD) clinics in relationship to established guidelines for diagnosis and treatment. Of the 83,076 female patients seen in 14 STD clinics participating in the STD Surveillance Network, 1080 (1.3%) were diagnosed as having PID from 2010 to 2011. A random sample of 219 (20%) women were selected, and medical records were reviewed for clinical history, examination findings, treatment, and diagnostic testing. Our primary outcomes were to evaluate how well PID diagnosis and treatment practices in STD clinic settings follow the Centers for Disease Control and Prevention (CDC) treatment guidelines and to describe age group-specific rates of laboratory-confirmed Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in patients clinically diagnosed as having PID in the last 12 months, inclusive of the PID visit. Among the 219 women, 70.3% of the cases met the CDC treatment case definition for PID, 90.4% had testing for CT and GC on the PID visit, and 68.0% were treated with a CDC-recommended outpatient regimen. In the last 12 months, 95.4% were tested for CT or GC, and positivity for either organism was 43.9% in women aged 25 years or younger with PID, compared with 19.4% of women older than 25 years with PID. Compliance with CDC guidelines was documented for many of the women with PID, though not all. Our findings underscore the need for continued efforts to optimize quality of care and adherence to current guidance for PID management given the anticipated expertise of providers in these settings.

Epidemiology and Risk Factors of Pelvic Inflammatory Disease.

Introduction: Knowledge of pelvic inflammatory disease and its epidemiology is essential to understand reproductive morbidity in women. This paper estimates the level of association between demographic factors and pelvic inflammatory disease in women in their reproductive age. Methods: A descriptive study done in Humla, Kritipur and Baudha by organizing a health camp. Women of reproductive age group and who have lower abdominal pain, pervaginal discharge, fever, and dysparunia were included in the study after taking informed verbal consent from the patient. Patients who have lower abdominal pain and pervaginal discharge were diagnosed as pelvic inflammatory disease. Results: Diagnoses of pelvic inflammatory disease were made in 30% of attendances amongst women aged between 16 to 48. Increased risk of pelvic inflammatory disease was associated with smoking (P&lt;0.0001), age groups 31 – 40 yrs (44.6%),in rural areas(45%) and people who are illiterate (P&lt;0.0001). Among 400, 383(95%) were reported ever using a modern contraceptive. Conclusion: The prevalence of pelvic inflammatory disease was 30% in reproductive age group and was significantly associated with smoking.doi: http://dx.doi.org/10.3126/mjsbh.v13i1.12992

RNA Biosignatures in Adolescent Patients in a Pediatric Emergency Department With Pelvic Inflammatory Disease.

Adolescents are at high risk for pelvic inflammatory disease (PID). Because accurate diagnosis of PID is difficult, and complications of untreated PID are significant, novel methods to improve diagnosis are essential. To determine if patients with PID have unique RNA expression patterns compared to controls. Peripheral blood was collected from adolescent females with PID in the emergency department, and from control patients in the operating room. RNA was isolated, and microarray analysis was performed. Initial analysis involved a training set of 18 patients (9 PID patients with either Neisseria gonorrhoeae or Chlamydia trachomatis infection and 9 control patients). Supervised and unsupervised cluster analyses were performed, followed by network analysis. The training set was used to classify a set of 15 additional PID patients and 2 controls. Supervised cluster analysis of the training set revealed 170 genes which were differentially expressed in PID patients versus controls. Network analysis indicated that several differentially expressed genes are involved in immune activation. Analysis of additional PID patients based on the training set findings revealed that patients with positive testing for Trichomonas vaginalis partitioned with the PID group, whereas patients with no organism identified partitioned with both groups. RNA sample collection from adolescents in the emergency department is feasible. Genes were identified which were differentially expressed in PID patients versus controls, many of which are involved in inflammation. Future studies should confirm the training set findings on a larger sample and may lead to improved accuracy of PID diagnosis.

Características epidemiológicas, clínicas y quirúrgicas de la enfermedad pélvica onflamatoria. Hospital Nacional Cayetano Heredia, 1999-2005.

Objetivo: Determinar las características epidemiológicas, clínicas y quirúrgicas de las pacientes con enfermedad pélvica inflamatoria. Diseño: Estudio descriptivo, tipo serie de casos. Lugar: Servicio de Ginecología del Hospital Nacional Cayetano Heredia de Lima, Perú. Participantes: Mujeres con diagnóstico de enfermedad pélvica inflamatoria. Intervenciones: Se obtuvo los datos demográficos, antecedentes ginecológicos, criterios clínicos y tipo de intervención quirúrgica de 199 pacientes con enfermedad pélvica inflamatoria, entre enero de 1999 y diciembre de 2005. Principales medidas de resultados: Características de presentación de la enfermedad pélvica inflamatoria. Resultados: La frecuencia de enfermedad pélvica inflamatoria fue 3,2%, encontrándose una mayor presentación durante la segunda y cuarta décadas de la vida. Las características demográficas más frecuentes fueron el estado civil conviviente (40,7%) y secundaria completa (54,8%). El promedio de edad de inicio de la actividad sexual fue 18 años, siendo 50,3% monógama. Sobre conducta sexual, las relaciones contra natura correspondieron a 34,2% y las relaciones durante la menstruación a 47,7%. El antecedente de infección de transmisión sexual se presentó en 7,0%. El método anticonceptivo más empleado fue el dispositivo intrauterino (33,6%). El hallazgo clínico más frecuente fue el dolor pélvico (92,5%). Se realizó diagnóstico por laparoscopia en 14,6% y por laparotomía en 28,6%, siendo salpingitis el diagnóstico quirúrgico más frecuente (47,7%). Conclusiones: Las características epidemiológicas de nuestra población de estudio difieren de otras poblaciones en lo que respecta al grupo etáreo, grado de instrucción, estado civil, comportamiento sexual y empleo de métodos anticonceptivos. La clínica constituyó la forma más frecuente de diagnóstico de esta patología y el diagnóstico quirúrgico más frecuente fue salpingitis.

Enfermedad pélvica inflamatoria: diagnóstico y complicaciones

El diagnóstico de la enfermedad pélvica inflamatoria (EPI) puede ser difícil por lo variable de su presentación, y abarca desde una paciente agudamente enferma hasta cuadros asintomáticos. El síntoma más común es el dolor abdominal bajo (90%), otros síntomas son dispareunia, flujo vaginal y sangrado vaginal anormal, urgencia miccional, náuseas, vómitos y tenesmo rectal, entre otros. Para el diagnóstico se necesita uno de los siguientes hallazgos: dolor a la movilización cervical, a la palpación del útero o en la palpación anexial. Algunos exámenes auxiliares mejoran el criterio diagnóstico: aumento de leucocitos en la secreción vaginal, aumento de la velocidad de eritrosedimentación y la identificación de N. gonorrhoeae o C. trachomatis a nivel cervical. Otras pruebas útiles son los estudios por imágenes: ultrasonido, tomografía computarizada y resonancia magnética. El estándar de oro es el examen laparoscópico, aunque existen comunicaciones que señalan que la biopsia de endometrio puede complementar el diagnóstico, cuando no existe evidencia de enfermedad durante el examen laparoscópico. Se recomienda tener un umbral bajo para el diagnóstico de EPI, para que las complicaciones agudas perihepatitis, periapendicitis o rotura del absceso tuboovárico- o las crónicas -dolor pélvico crónico, infertilidad y embarazo ectópico- comprometen la salud sexual y reproductiva de las pacientes.

Intrauterine device use in an urban university clinic: safety of use in a population at high risk for sexually transmitted infections

ObjectiveThe objective was to describe infection rates after intrauterine device (IUD) placement at an urban teaching hospital that did not restrict IUD eligibility based on risk factors for sexually transmitted infections (STIs). MethodsWe reviewed charts of patients undergoing IUD placement at the University of Chicago obstetrics and gynecology resident clinic from July 2007 to June 2008 (n=283). The primary outcome was diagnosis of pelvic inflammatory disease (PID) within 12 months. ResultsAlmost half (49.5%) of patients reported a history of any STI. Two patients (0.7%) were diagnosed with PID. ConclusionPostplacement infection in this unrestricted population was infrequent and comparable to reported rates in previous studies.