Incidence Of Pelvic Inflammatory Disease Research Articles

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

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

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 of cardiometabolic outcomes among women with a history of pelvic inflammatory disease: a retrospective matched cohort study from the UK

IntroductionTo describe the incidence and prevalence of pelvic inflammatory disease (PID) and to estimate the risk of cardiometabolic outcomes among women with PID compared to women without PID.MethodsA UK retrospective matched cohort study using data from The Health Improvement Network. To assess cardiometabolic risk, women (aged ≥ 16 years) with PID were compared to matched controls without PID. Annual prevalence and incidence of PID (1998–2017) were estimated among women aged 16–50 years using annual cross-sectional and cohort analyses, respectively. Adjusted hazard ratios (aHR) and 95% CI for cardiometabolic outcomes were estimated using Cox proportional hazards models. The primary outcome was composite cardiovascular disease (CVD) and its subtypes, including ischaemic heart disease (IHD), heart failure (HF) and cerebrovascular disease. Secondary outcomes were hypertension, and type 2 diabetes mellitus (T2DM).ResultsAmong the 715 recorded composite CVD events, the crude incidence rate per 1000 person-years was 1.5 among women with history of PID compared to 1.3 in matched controls. Compared to women without PID (N = 73,769), the aHRs for cardiometabolic outcomes among women with PID (N = 19,804) were: composite CVD 1.10 (95% CI 0.93–1.30); IHD 1.19 (95% CI 0.93–1.53); cerebrovascular disease 1.13 (95% CI 0.90–1.43); HF 0.92 (95% CI 0.62–1.35) hypertension 1.10 (95% CI 1.01–1.20); and T2DM 1.25 (95% CI 1.09–1.43). The prevalence (per 10,000 population) of PID was 396.5 in 1998 and 237 in 2017. The incidence (per 10,000 person-years) of PID was 32.4 in 1998 and 7.9 in 2017.ConclusionThere was no excess risk of composite CVD or its subtypes among women with history of PID compared to matched controls. Findings from our study suggest that history of PID was associated with an increased risk of hypertension and type 2 diabetes mellitus, two major risk factors for CVD. Additional studies are required to support these findings.

8788 Effect of Endometriosis on Postoperative Outcomes after Hysterectomy Performed for Benign Gynecologic Disease

<h3>Study Objective</h3> Endometriosis affects 10% of reproductive aged women. Its impact on complications after gynecologic surgery is, however, not well known. This study aimed to investigate the effect of endometriosis on perioperative outcomes of patients undergoing hysterectomy for benign disease. <h3>Design</h3> The 2014-2019 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases were used to select patients undergoing elective hysterectomy performed for benign indications. Propensity scores derived from logistic regression and inverse probability treatment weighting analysis were used to assemble weighted samples of patients with and without endometriosis. Primary outcomes included 30-day mortality, postoperative complications, and reoperations. Binary logistic regression was used to compare differences in the primary outcomes between patients with and without endometriosis. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> A total of 127,556 hysterectomy cases were identified. Of those, 19,618 (15.4%) had a diagnosis of endometriosis. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Patients with endometriosis were younger, had higher incidence of pelvic inflammatory disease and prior abdominal operations but lower prevalence of chronic comorbidities. The incidence of postoperative complications was higher in patients with endometriosis (9.3% vs. 8.4%; Odds ratio (OR) [95% CI], 1.12 [1.05-1.20]; <i>P</i>=0.001). However, the incidence of 30-day mortality (0.04% vs.0.03%; OR [95% CI],1.16 [0.38-3.52]; P=0.789) and reoperations (1.50% vs. 1.36%; OR [95% CI, 1.11 [0.92-1.33]; P=0.287) were not different in patients with and without endometriosis. <h3>Conclusion</h3> Therate of postoperative complications is higher in hysterectomies involving endometriosis compared to hysterectomies without endometriosis. Likely this is due to the anatomic distortion incurring increased surgical complexity. Patients and surgeons should be aware of this increased risk when planning surgery for suspected endometriosis.

Effect of Endometriosis on Postoperative Outcomes After Hysterectomy Performed for Benign Gynecologic Disease [A115

INTRODUCTION: Endometriosis affects 10% of reproductive-aged women. Its impact on complications after gynecologic surgery is, however, not well known. This study aimed to investigate the effect of endometriosis on perioperative outcomes of patients undergoing hysterectomy for benign disease. METHODS: Institutional Review Board (IRB) approval was obtained. The 2014-2019 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases were used to select patients undergoing elective hysterectomy performed for benign indications. Propensity scores derived from logistic regression and inverse probability treatment weighting analysis were used to assemble weighted samples of patients with and without endometriosis. Primary outcomes included 30-day mortality, postoperative complications, and reoperations. Binary logistic regression was used to compare differences in the primary outcomes between patients with and without endometriosis. RESULTS: A total of 127,556 hysterectomy cases were identified. Of those, 19,618 (15.4%) had a diagnosis of endometriosis. Patients with endometriosis were younger, had higher incidence of pelvic inflammatory disease and prior abdominal operations but lower prevalence of chronic comorbidities. The incidence of postoperative complications was higher in patients with endometriosis (9.3% vs. 8.4%; OR[95% CI], 1.12 [1.05-1.20]; P=.001). However, the incidence of 30-day mortality (0.04% vs. 0.03%; OR [95% CI],1.16 [0.38-3.52]; P=.789) and reoperations (1.50% vs. 1.36%; OR [95% CI, 1.11 [0.92-1.33]; P=.287) were not different in patients with and without endometriosis. CONCLUSION: The rate of postoperative complications was higher in hysterectomies involving endometriosis compared to hysterectomies without endometriosis. Likely this is due to the anatomic distortion incurring increased surgical complexity. Patients and surgeons should be aware of this increased risk when planning surgery for suspected endometriosis.

Structure of Gynecological Diseases and Comorbidity in Women with HIV Infection and Reproductive Disorders

Background: The increase in the number of HIV-infected women of fertile age, as well as their reproductive plans to have healthy children, was the reason for studying the features of reproductive health disorders and comorbid conditions in women with HIV infection. Methods and Results: Women meeting the inclusion criteria were divided into two groups: Group 1 included 27 HIV-infected women (average age of 30.8±2.9 years) with reproductive disorders; Group 2 included 23 HIV-infected women (average age of 31.4±7.1 years) without reproductive disorders. In study groups, the main route of HIV transmission was sexual contact. When assigning women to a particular category (fertile or infertile), the WHO classification of fertility was used: fertile, presumably fertile, primarily infertile, secondarily infertile, women with unknown fertility. There was a statistically significant difference in the incidence of medical abortion in the HIV-infected women with secondary infertility [14(60.9%)], compared to Group 2 [8(29.6%)] (P=0.026). There were no statistically significant differences in the incidence of chronic co-morbidities (ENT disorders, gastritis/duodenitis, pancreatitis, cystitis, viral hepatitis (B, C), papillomavirus infection) in Groups 1 and 2 (P&gt;0.05). The incidence of pelvic inflammatory diseases was 2 times higher in Group 1 than in Group 2. No statistically significant differences in the incidence of uterine myoma, chronic cervicitis, chronic endometritis, vulvovaginal candidiasis,, and cervical dysplasia were found. A significant prevalence of chronic salpingo-oophoritis, secondary dysmenorrhea, secondary amenorrhea, opsomenorrhea, and secondary oligomenorrhea was detected significantly more frequently in Group 1 than in Group 2. The syndrome of hyperprolactinemia was also 2.6 times more frequent in Group 1 than in Group 2. Reproductive disorders in HIV-infected women were associated with a high incidence of STI combinations (trichomoniasis, gonorrhea, syphilis, chlamydia). Conclusion: Early detection of menstrual dysfunctions, prevention of abortion and sexually transmitted diseases, and timely treatment of infertility, are essential for women living with HIV.

Heterotropic pregnancy: a common masquerade than ever thought?

Heterotopic pregnancy, coexistence of living or dead intrauterine pregnancy, single or multiple, with extra-uterine pregnancy located in the oviduct, ovary, uterine cornua, cervix or rarely peritoneal cavity. Heterotropic pregnancy is relatively uncommon in spontaneous conception with 1 in 30,000 cases reported, the incidence of heterotopic pregnancy increases to 1 in 3900 when conception is enhanced with various assisted reproduction techniques (ART). It is an ectopic pregnancy coexisting with intrauterine pregnancy. But is the incidence of heterotropic pregnancy rising? A case was reported from our centre in 2018 by Ejikeme et al, and we have recorded another two cases in the period of one year. Ectopic pregnancy has been described as a great masquerader, which makes diagnosis and management of heterotropic pregnancy a dilemma to attending physician. We present a case of an unbooked 26 years old G4P3+0 who has no family history of multiple gestation and presented at gestational age of 8 weeks and 5 days with 2 days history of abdominal pain and vaginal bleeding and 2 hours history of loss of consciousness. She later had exploratory laparotomy with left salpingectomy and manual vacuum aspiration of Retained Products of Conception with good outcome. In conclusion, spontaneous heterotropic pregnancy is a rare occurrence, however with advent of artificial reproductive technology and increase incidence of pelvic inflammatory disease, the incidence could be higher than earlier suspected.

Clinical and anamnestic data and morphofunctional characteristics of the endometrium in women with uterine developmental anomalies

BACKGROUND: Uterine developmental anomalies have a negative impact on the implementation of female reproductive function, leading to a high risk of reproductive failures, premature birth, placental insufficiency, intrauterine growth retardation syndrome, labor anomalies and postpartum bleeding. The presence of both structural anomalies themselves and the high frequency of reproductive failures leads to repeated intrauterine interventions, which are considered as a premorbid background for the endometrial pathology development. Despite the combined causes of reproductive failure, morphological studies of the endometrium in women with various uterine anomalies are scarce.&#x0D; AIM: The aim of this study was to evaluate the clinical and anamnestic data and morphological characteristics of the endometrium in women with uterine anomalies and reproductive failures in the anamnesis.&#x0D; MATERIALS AND METHODS: We examined 123 women with uterine developmental anomalies (49 patients with an arcuate uterus, 38 patients with a uterine septum, 16 patients with a bicornuate uterus, 10 patients with an unicornuate uterus, 10 patients with dimetria). Standard clinical and laboratory work-up, hysteroscopy with endometrial biopsy and laparoscopy were performed in all patients. Histological and immunohistochemical examination of the endometrium was carried out according to the standard technique with assessment of the relevant receptor profile (estrogen and progesterone receptors) and pro-inflammatory markers (CD8+, CD20+, CD4+, and CD138+).&#x0D; RESULTS: Clinical and anamnestic data evaluation in patients with uterine anomalies revealed menstrual abnormalities, commonly, dysmenorrhea. Regardless of the type of uterine anomaly, a high incidence of pelvic inflammatory disease, endometriosis and a high frequency of reproductive failures were found. The morphological structure of the endometrium with uterine anomalies was characterized by a higher frequency of endometrial hyperplasia, impaired secretory transformation and the presence of chronic endometritis.&#x0D; CONCLUSIONS: Patients with a variety of uterine developmental anomalies are characterized by menstrual irregularities, a high incidence of gynecological pathology and reproductive failures. There is no association between pathognomonic signs of endometrial morphofunctional abnormalities and the type of uterine anomaly; however, they are similar to those seen in recurrent miscarriages and infertility of various origins.

183. chlamydia Trachomatis Seroprevalence with a pgp3 Serologic Assay and Association with Pelvic Inflammatory Disease Among Women, United States, 2013–2016

Background Chlamydia trachomatis (CT) causes pelvic inflammatory disease (PID) and other sequelae; however, these associations are not fully characterized. CT serologic assays including Pgp3 ELISA may detect prior CT infection and may better elucidate these associations. We used a serologic Pgp3 multiplex bead array assay (Pgp3MBA) to measure CT seroprevalence in reproductive-age US women and assess the association with PID.MethodsWe performed CT Pgp3MBA on sera collected from women 18–39 years old during the 2013–2016 cycles of the National Health and Nutrition Examination Survey (NHANES) who had available urine CT nucleic acid amplification test results. Weighted Pgp3MBA CT seroprevalence and 95% confidence intervals (95% CI) were calculated. We also determined weighted prevalence ratios (PRs) and 95% CIs of self-reported lifetime PID among women with and without detectable Pgp3MBA and other characteristics to estimate these US national statistics.ResultsAmong 2,339 women, 1,725 (73.7%) had available sera. Of these women, 1,425 (or 93.4% of those with data) were sexually experienced and had a CT seroprevalence of 35.9% (95% CI 33.4–38.4). When weighted for US women, CT seroprevalence was 30.5% (95% CI 26.6–34.4%), ranging from 16.9% (95% CI 11.0–22.8%) among non-Hispanic Asian women to 70.2% (95% CI 62.4–78.0%) among non-Hispanic black women.PID was reported by 4.2% (95% CI 3.1–5.2) of 1,413 sexually-experienced women with PID data or an estimated 3.8% (95% CI 2.6–5.0) of US women. Among US women, estimated PID varied by Pgp3MBA status; 7.3% (95% CI 4.3–10.2) of Pgp3MBA-positive women were estimated to report PID versus 2.3% (95% CI 1.3–3.4) of Pgp3MBA-negative women (PR 3.1; 95% CI 1.7–5.9). PID prevalence did not vary by age, nor self-reported recent sexually transmitted disease among US women, but was higher among non-Hispanic black women compared to non-Hispanic white women (PR 2.2; 95% CI 1.4–3.5).ConclusionNearly one-third of US women have had CT by Pgp3MBA, with differences by race/ethnicity. Women with prior CT had three times the reported PID prevalence of women without CT. Further serologic research may refine the population-level impact of CT prevention activities, such as recommended annual CT screening, on PID incidence, particularly among non-Hispanic black women.Disclosures All Authors: No reported disclosures

Association of pelvic inflammatory disease (PID) with ectopic pregnancy and preterm labor in Taiwan: A nationwide population-based retrospective cohort study.

BackgroundPelvic inflammatory disease (PID) is an infectious disease that causes tubal occlusion and other pelvic and abdominal adhesions. The incidence of pelvic inflammatory disease (PID) has increased due to the sexually active status of the young population. This leads to a more serious problem and a larger effect than previously observed. However, there have been few studies on this topic in Asian populations.AimWe aimed to evaluate the risk of preterm labor and/or ectopic pregnancy in Taiwanese women following PID.DesignUsing the Taiwan National Health Insurance Database, we designed a retrospective cohort study that included 12- to 55-year-old pregnant women between 2000 and 2010. We selected a 1:3 age-matched control group of non-PID women. The endpoint was any episode of preterm labor or ectopic pregnancy; otherwise, the patients were tracked until 31 December 2010.MethodsThe risk factors for preterm labor or ectopic pregnancy were explored. For cases included from the index date until the end of 2010, we analyzed the risk of incident preterm labor or ectopic pregnancy. With the use of a multivariate Cox proportional hazard regression analysis, we calculated the hazard ratio (HR) with a 95% CI and compared it with that of the control group.ResultsThis study examined 30,450 patients with PID and 91,350 controls. During the follow-up period, patients in the PID group were more likely to develop preterm labor or ectopic pregnancy than patients in the control group. The cumulative incidence rates for developing preterm labor were 1.84% (561/30,450 individuals) in patients with PID and 1.63% (1492/91,350 individuals) in patients without PID. On the other hand, the cumulative incidence rate for developing ectopic pregnancy in patients with PID was 0.05% (14/30,450 individuals) but was only 0.04% (33/91,350 individuals) in patients without PID. Compared with those without PID, the patients with PID had a 1.864 times (P<0.001) higher risk of developing preterm labor and a 2.121 times (P = 0.003) higher risk of developing ectopic pregnancy.ConclusionOur study provided evidence of an increased risk of preterm labor or ectopic pregnancy in PID patients.

PELVIC INFLAMMATORY DISEASE (PID): A CROSS SECTIONAL PROSPECTIVE STUDY AT A TERTIARY CARE CENTRE

Introduction : Pelvic inflammatory disease (PID) is an infection of the upper part of the female reproductive system namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Objective: to find out the clinical profile of PID in a tertiary care centre. Methods: This was a cross sectional, descriptive study conducted at the Department of Obstetrics and Gynaecology, during period from January to December2016. Total 200 patients complaining of lower abdominal pain, vaginal discharge &amp; having adnexal as well as cervical motion tenderness on bimanual examination between the age group of 18 -45 years were randomly selected for study. Parameters like age, parity, socio-economic status, age of marriage, sexual behavior, Presenting complaints and use of contraceptive were recorded. Results: Most common age group was 20-24 years (29.5%). Maximum number of cases was seen in parity between 2-5 (58%). PID was commonest amongst illiterate women (36%). Maximum number of cases was seen in women from lower socioeconomic class (74%). Out of 200 cases, 79% patients were married, 14% were remarried. Presenting complaints were pain in abdomen (93.5%), per vaginal discharge (66%), fever (51%). Abdominal tenderness was seen in 95% of cases. Palpable mass was present in 11% of cases. Forniceal &amp; cervical motion tenderness were the commonest Per Vaginal examination findings seen in 89% &amp; 84% cases respectively. Conclusion: Incidence of PID was higher in age group between 20-29 years, multipara, women from lower socioeconomic class &amp; illiterate women. Pain in lower abdomen, per vaginal discharge &amp; fever were the commonest complaints. Most of the patients on examination had forniceal &amp; cervical motion tenderness.

Risk of pelvic inflammatory disease after intrauterine insemination: a systematic review.

The aim of this study was to ascertain the incidence of pelvic inflammatory disease (PID) after intrauterine insemination (IUI). A systematic review was conducted using three different approaches: a search of IUI registries; a search of published meta-analyses; and a search of prospective randomized trials. Search terms were 'IUI', 'complications', 'infection' and 'PID'. Two IUI registers were identified that met the inclusion criteria, totalling 365,874 cycles, with 57 PID cases being reported. The post-IUI PID rate was 0.16/1000 (95% CI 0.2 to 0.3/1000). The frequency was higher in husband sperm cycles (0.21/1000) (28/135,839) than in donor sperm cycles (0.03/1000) (1/33,712) (P < 0.05; OR 6.95). Nineteen meta-analyses were retrieved, which included 156 trials, totalling 43,048 cycles, with no PID case being reported. Seventeen prospective clinical trials published between 2013 and 2014 were identified, totalling 4968 cycles; no PID case was reported. The reported rate of post-IUI clinical PID is low (0.16/1000), about 40% higher than reported in the general population of women during their reproductive life. No antibiotic prophylaxis should be recommended unless there is an associated risk factor.

Should we screen for the sexually-transmitted infection Mycoplasma genitalium? Evidence synthesis using a transmission-dynamic model

There is increasing concern about Mycoplasma genitalium as a cause of urethritis, cervicitis, pelvic inflammatory disease (PID), infertility and ectopic pregnancy. Commercial nucleic acid amplification tests (NAATs) are becoming available, and their use in screening for M. genitalium has been advocated, but M. genitalium’s natural history is poorly-understood, making screening’s effectiveness unclear. We used a transmission-dynamic compartmental model to synthesise evidence from surveillance data and epidemiological and behavioural studies to better understand M. genitalium’s natural history, and then examined the effects of implementing NAAT testing. Introducing NAAT testing initially increases diagnoses, by finding a larger proportion of infections; subsequently the diagnosis rate falls, due to reduced incidence. Testing only symptomatic patients finds relatively little infection in women, as a large proportion is asymptomatic. Testing both symptomatic and asymptomatic patients has a much larger impact and reduces cumulative PID incidence in women due to M. genitalium by 31.1% (95% range:13.0%-52.0%) over 20 years. However, there is important uncertainty in M. genitalium’s natural history parameters, leading to uncertainty in the absolute reduction in PID and sequelae. Empirical work is required to improve understanding of key aspects of M. genitalium’s natural history before it will be possible to determine the effectiveness of screening.

Early screening for Chlamydia trachomatis in young women for primary prevention of pelvic inflammatory disease (i-Predict): study protocol for a randomised controlled trial

BackgroundGenital infection with Chlamydia trachomatis (Ct) is the most common bacterial sexually transmitted infection, especially among young women. Mostly asymptomatic, it can lead, if untreated, to pelvic inflammatory disease (PID), tubal factor infertility and ectopic pregnancy. Recent data suggest that Ct infections are not controlled in France and in Europe. The effectiveness of a systematic strategy for Ct screening in under-25 women remains controversial. The main objective of the i-Predict trial (Prevention of Diseases Induced by Chlamydia trachomatis) is to determine whether early screening and treatment of 18- to-24-year-old women for genital Ct infection reduces the incidence of PID over 24 months.Methods/designThis is a randomised prevention trial including 4000 eighteen- to twenty-four-year-old sexually active female students enrolled at five universities. The participants will provide a self-collected vaginal swab sample and fill in an electronic questionnaire at baseline and at 6, 12 and 18 months after recruitment. Vaginal swabs in the intervention arm will be analysed immediately for Ct positivity, and participants will be referred for treatment if they have a positive test result. Vaginal swabs from the control arm will be analysed at the end of the study. All visits to general practitioners, gynaecologists or gynaecology emergency departments for pelvic pain or other gynaecological symptoms will be recorded to evaluate the incidence of PID, and all participants will attend a final visit in a hospital gynaecology department. The primary endpoint measure will be the incidence of PID over 24 months. The outcome status (confirmed, probable or no PID) will be assessed by two independent experts blinded to group assignment and Ct status.DiscussionThis trial is expected to largely contribute to the development of recommendations for Ct screening in young women in France to prevent PID and related complications. It is part of a comprehensive approach to gathering data to facilitate decision-making regarding optimal strategies for Ct infection control. The control group of this randomised trial, following current recommendations, will allow better documentation of the natural history of Ct infection, a prerequisite to evaluating the impact of Ct screening. Characterisation of host immunogenetics will also allow identification of women at risk for complications.Trial registrationClinicalTrials.gov, NCT02904811. Registered on September 14, 2016.World Health Organisation International Clinical Trials Registry, NCT02904811.AOM, 15-0063 and P150950. Registered on September 26, 2016. A completed Standard Protocol Items : Recommendations for International Trials (SPIRIT) Checklist is available in additional file 1.

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

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

Comparison of the population excess fraction of Chlamydia trachomatis infection on pelvic inflammatory disease at 12-months in the presence and absence of chlamydia testing and treatment: Systematic review and retrospective cohort analysis.

BackgroundThe impact of Chlamydia trachomatis (chlamydia) control on the incidence of pelvic inflammatory disease (PID) is theoretically limited by the proportion of PID caused by chlamydia. We estimate the population excess fraction (PEF) of treated chlamydia infection on PID at 12-months in settings with widespread chlamydia control (testing and treatment) and compare this to the estimated PEF of untreated chlamydia.MethodsWe used two large retrospective population-based cohorts of women of reproductive age from settings with widespread chlamydia control to calculate the PEF of treated chlamydia on PID at 12-months. We undertook a systematic review to identify further studies that reported the risk of PID in women who were tested for chlamydia (infected and uninfected). We used the same method to calculate the PEF in eligible studies then compared all estimates of PEF.ResultsThe systematic review identified a single study, a randomised controlled trial of chlamydia screening (POPI-RCT). In the presence of testing and treatment <10% of PID at 12-months was attributable to treated (baseline) chlamydia infections (Manitoba: 8.86%(95%CI 7.15–10.75); Denmark: 3.84%(3.26–4.45); screened-arm POPI-RCT: 0.99%(0.00–29.06)). In the absence of active chlamydia treatment 26.44%(11.57–46.32) of PID at 12-months was attributable to untreated (baseline) chlamydia infections (deferred-arm POPI-RCT). The PEFs suggest that eradicating baseline chlamydia infections could prevent 484 cases of PID at 12-months per 100,000 women in the untreated setting and 13–184 cases of PID per 100,000 tested women in the presence of testing and treatment.ConclusionTesting and treating chlamydia reduced the PEF of chlamydia on PID by 65% compared to the untreated setting. But in the presence of testing and treatment over 90% of PID could not be attributed to a baseline chlamydia infection. More information is needed about the aetiology of PID to develop effective strategies for improving the reproductive health of women.

Prevalence of Pelvic Inflammatory Disease in Sexually Experienced Women of Reproductive Age - United States, 2013-2014.

Pelvic inflammatory disease (PID) is a clinical syndrome of the female reproductive tract characterized by inflammation of the endometrium, fallopian tubes, or peritoneum (1). PID occurs when microorganisms ascend from the vagina or cervix to the fallopian tubes and other upper genital tract structures (1). PID can result from untreated bacterial infections, including chlamydia and gonorrhea, and can lead to infertility, ectopic pregnancy, and chronic pelvic pain (1). Because there is no single diagnostic test for PID, clinicians rely on nonspecific signs and symptoms for diagnosis. The purpose of these analyses was to assess the burden of self-reported PID in a nationally representative sample using data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 cycle. Starting in 2013, NHANES female participants aged 18-44 years were asked about a lifetime history of PID diagnosis. Based on these data, the estimated prevalence of self-reported lifetime PID was 4.4% in sexually experienced women of reproductive age (18-44 years). The prevalence of self-reported lifetime PID was highest in women at increased risk, such as women reporting a previous sexually transmitted infection (STI) diagnosis. Stratified by race/ethnicity and having a previous STI diagnosis, non-Hispanic black (black) and non-Hispanic white (white) women reporting a previous STI diagnosis had nearly equal self-reported lifetime PID prevalence (10.0% versus 10.3%). However, the lifetime prevalence of PID among black women was 2.2 times that among white women if no previous STI was diagnosed (6.0% versus 2.7%). These findings suggest that PID is prevalent and associated with previous STI diagnoses; therefore, it is important for clinicians to screen female patients for chlamydia and gonorrhea to reduce the incidence of PID.

Successful management of diverse types of heterotopic pregnancies

Heterotopic pregnancy is a rare complication of pregnancy. It can be a life threatening condition and can be easily missed if the diagnosis is overlooked. There is an increase in cases of heterotopic pregnancy in the last decade due to an increase in the incidence of pelvic inflammatory disease, tubal surgeries, pharmacologic ovulation stimulation, and assisted reproductive techniques. A timely diagnosis and intervention can save the life of the patient as well as the intrauterine pregnancy, which can be continued for a successful outcome. Here, we present three cases of heterotopic pregnancy that presented to our hospital over a period of 6 years with different clinical presentations who were treated with successful outcome.

Assessing Trends in Chlamydia Positivity and Gonorrhea Incidence and Their Associations With the Incidence of Pelvic Inflammatory Disease and Ectopic Pregnancy in Washington State, 1988-2010.

Chlamydia and gonorrhea screening for women is beneficial if it prevents serious reproductive sequelae, such as pelvic inflammatory disease (PID) and ectopic pregnancy (EP). We assessed trends in PID and EP among women in Washington and their association with gonorrhea incidence and chlamydia positivity in a screened population of women over a 23 year period. Using data on chlamydia positivity from the Infertility Prevention Project, gonorrhea incidence from state surveillance, and PID and EP hospitalizations from hospital discharge records, we assessed trends in each condition over time. In addition, we estimated total incidence of PID and EP by incorporating information on outpatient-treated cases in alternative populations using a Bayesian approach that accounted for uncertainty in the estimates. We assessed associations between each infection and PID/EP using a linear regression model that accounts for year-to-year correlation in data points. We observed substantial declines in both infections and in each outcome over time. For every 2% decrease in chlamydia positivity, there was a 35.7/100,000 decrease in estimated total PID incidence (P = 0.058) and 184.4/100,000 decrease in estimated total EP (P = 0.149). For every 32/100,000 decline in gonorrhea incidence, there was a 16.5/100,000 decrease in total PID (P = 0.292) and 159.8/100,000 decrease in total EP (P = 0.020). The associations with inpatient PID and EP were highly significant for both chlamydia and gonorrhea. These ecological data note concurrent and substantial declines in chlamydia positivity and gonorrhea incidence, and in PID and EP incidence in Washington from 1988 to 2010 during a time when widespread chlamydia screening was ongoing.

2015 European guideline on the management of Chlamydia trachomatis infections.

Chlamydia trachomatis infections, which most frequently are asymptomatic, are major public health concerns globally. The 2015 European C. trachomatis guideline provides: up-to-date guidance regarding broader indications for testing and treatment of C. trachomatis infections; a clearer recommendation of using exclusively-validated nucleic acid amplification tests for diagnosis; advice on (repeated) C. trachomatis testing; the recommendation of increased testing to reduce the incidence of pelvic inflammatory disease and prevent exposure to infection; and recommendations to identify, verify and report C. trachomatis variants. Improvement of access to testing, test performance, diagnostics, antimicrobial treatment and follow-up of C. trachomatis patients are crucial to control its spread. For detailed background, evidence base and discussions, see the background review for the present 2015 European guideline on the management of Chlamydia trachomatis infections (Lanjouw E, et al. Int J STD AIDS. 2015).