Pelvic Inflammatory Disease Research Articles

Multimodality imaging of acute gynecological emergencies-a pictorial essay.

Gynecological emergencies can often present with a myriad of non-specific signs and symptoms, posing a diagnostic challenge to the clinician. They can be grossly divided into uterine or adnexal pathologies. Uterine pathologies can be secondary to intracavitary accumulation of blood [like in patients with transverse vaginal septum, Robert's uterus, accessory and cavitated uterine mass, unicornuate uterus with contralateral non-communicating functional horn], bleeding per vaginum [like in patients with retained products of conception, enhanced myometrial vascularity], pyometra [secondary to pelvic inflammatory disease, cervical obstruction secondary to benign and malignant causes] or complications of fibroids [like red degeneration, torsion of subserosal fibroid]. The adnexal pathologies can range from ectopic pregnancy in a urine pregnancy test (UPT) positive patient to haemorrhagic ovarian cyst, ovarian torsion, ruptured dermoid cyst and tubo-ovarian abscess in a UPT negative patient. Multimodality imaging including ultrasound (USG), computed tomography (CT) scan and magnetic resonance imaging (MRI) can narrow down the differentials and help in formulating an accurate diagnosis. The objective of this article is to familiarize the readers with multimodality imaging findings in common as well as uncommon acute gynecological emergencies and provide an algorithmic imaging approach for acute gynecological emergencies. USG is typically used as the first line diagnostic modality in diagnosis of acute gynecological emergencies. CT scan & MRI are helpful as a problem-solving tool in acute gynecological emergencies when USG findings are indeterminate.

Factors Associated With Pelvic Infection After Pre-Peritoneal Pelvic Packing for Hemodynamically Unstable Pelvic Fractures.

Background: Preperitoneal pelvic packing (PPP) and external fixation has led to improved mortality after devastating pelvic trauma. However, there is limited literature on infection after this intervention. We aim to study the risk factors associated with pelvic infection after PPP. Patients and Methods: A retrospective review of patients who underwent PPP at a single level 1 trauma center was performed. Results: Over the 18-year study period, 222 patients were identified. Twenty-three percent of patients had an open fracture. Pelvic angiography was performed in 24% of patients with 16% requiring angioembolization (AE). The average time to packing removal was two (one to two days) days, although 10% of patients had their pelvis re-packed. Overall infection rate was 14% (n = 31); if pelvic re-packing was performed, the infection rate increased to 45%. Twenty-two of the patients with an infection required additional procedures for their infection, and ultimately hardware removal occurred in eight patients. On univariable analysis, patients with pelvic infections had more open fractures (55% vs. 17%; p < 0.01), underwent AE more frequently (29% vs. 14%; p = 0.04), were more likely to undergo repacking (32% vs. 6%; p < 0.01), and had packing in place for longer (2 [1,2] vs. 2 [2,3]; p = 0.01). On logistic multivariable regression analysis, open fracture (odds ratio [OR], 5.8; 95% confidence interval [CI], 2.4-14.1) and pelvic re-packing (OR, 4.7; 95% CI, 1.2-18.5) were independent risk factors for pelvic infection. Conclusions: Pelvic infection after PPP is a serious complication independently associated with open fracture and re-packing of the pelvis. Re-intervention was required in most patients with infection.

Modified Hongteng Baijiang decoction enema improves sequelae of pelvic inflammatory disease by regulating the LIF/JAK2/STAT3 pathway and gut microbiota.

The sequelae of pelvic inflammatory disease (SPID) are major causes of secondary infertility. Modified Hongteng Baijiang decoction (MHTBD) has produced positive results in the treatment of patients with chronic pelvic inflammatory disease; however, its role in SPID remains elusive. Therefore, this study clarified the role of MHTBD in SPID pathogenesis. The main components in MHTBD were analyzed by using liquid chromatography‒mass spectrometry (LC/MS). An SPID rat model was established, and the rats were treated with different doses of MHTBD (0.504 g of raw drug/kg, 1.008 g of raw drug/kg, and 2.016 g of raw drug/kg). Endometrial pinopodes were observed via scanning electron microscopy, endometrial thickness and inflammatory cell infiltration were assessed via HE staining, and the expression of estrogen receptor (ER), progesterone receptor (PR), integrin β3 (ITGB3), and CD31 in the endometrium was detected by using immunohistochemistry. Western blot analysis was used to detect the protein expression of LIF, JAK2, p-JAK2, STAT3, and p-STAT3 in the endometrium. Moreover, the changes in the gut microbiota were analyzed via 16S rRNA sequencing. MHTBD improved endometrial receptivity, attenuated endometrial pathologic damage, reduced inflammatory cell infiltration, decreased ER and PR expression in the endometrium, and promoted the expression of LIF, p-JAK2, and p-STAT3 in the endometrium (p < .05) in SPID rats. Additionally, MHTBD treatment affected the composition of the gut microbiota in SPID rats. Furthermore, MHTBD attenuated endometrial receptivity and pathological damage in SPID rats by promoting the LIF/JAK2/STAT3 pathway. MHTBD attenuates SPID in rats by promoting the LIF/JAK2/STAT3 pathway and improving the composition of the gut microbiota. MHTBD may be a valuable drug for SPID therapy.

Doxycycline Prophylaxis to Prevent Sexually Transmitted Infections in Women

(Abstracted from N Engl J Med 2024;389:2331–2340) Around the globe, bacterial sexually transmitted infections (STIs) are increasing, with 374 million estimated annual infections of Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum. The burden of STI sequelae is disproportionately endured by women, with resulting effects such as chronic pain, pelvic inflammatory disease, ectopic pregnancy, infertility, pregnancy/fetal complications, and increased risk of human immunodeficiency virus (HIV) acquisition.

Side effects of Sexually Transmitted Infections (STIs) on female fertility: diagnostic and treatment strategies – a literature review

Sexually transmitted infections (STIs) have detrimental effects on overall health and can cause infertility in males and females. Untreated infections like gonorrhea or chlamydia may lead to pelvic inflammatory disease (PID), causing damage and obstruction of the fallopian tubes. Human papillomavirus (HPV) infections, particularly high-risk strains, may progress to cervical cancer, requiring invasive treatments and may cause fertility loss. Herpes simplex virus (HSV) outbreaks can disrupt sexual contact, affecting conception attempts. Syphilis, is another sexually transmitted disease, if left untreated, can lead to epididymitis and erectile dysfunction in males, indirectly influencing fertility. Early detection and treatment of these STIs are crucial to protect infertility in males and females.

Comparative analysis of endometrium after using levonorgestrel-releasing intrauterine system and copper intrauterine device

BACKGROUND: To date, the risks of pelvic inflammatory diseases, including chronic endometritis, associated with the use of various intrauterine contraceptives, have remained debatable. AIM: The aim of this study was to conduct a comparative analysis of the endometrial status in women of reproductive age after the use of copper- or levonorgestrel-releasing intrauterine device. MATERIALS AND METHODS: Morphological and immunohistochemical studies of endometrial biopsies obtained by aspiration Pipelle biopsy were performed after intrauterine device extraction in 18 patients who used a copper-containing intrauterine device and in 12 women who used the levonorgestrel-releasing intrauterine device Mirena. Monoclonal mouse antibodies to CD20, CD138, and α-smooth muscle actin (DAKO, Denmark) were used. Criteria for inclusion of patients in the study are reproductive age, use of an intrauterine device for five years, absence of complications associated with the intrauterine device during its use. Exclusion criteria are a history of pelvic inflammatory diseases, sexually transmitted infections, habitual miscarriage, two or more intrauterine interventions. RESULTS: After using a copper-containing intrauterine device, signs of chronic inflammation were found in the endometrium such as cytogenic stroma fibrosis with pronounced infiltration by inflammatory cells, positive expression of CD138 (33.3% of observations), CD20 (88.9% of observations with an average number of 27.4 ± 5.7), α-smooth muscle actin (up to 70% of the cytogenic stroma area), and the presence of lymphatic follicles consisting of B lymphocytes (33.3% of observations). During the use of the levonorgestrel-releasing intrauterine device, decidual transformation of cytogenic stroma cells, as well as secretion and atrophy of the glandular epithelium, were found in the endometrium. CD20-positive cells were detected in five out of 12 cases (41.6% of observations with an average number of 12.8 ± 4.6). Expression of CD138 and α-smooth muscle actin was not detected in any of the cases. CONCLUSIONS: The use of a copper-containing intrauterine device is associated with a high risk of developing chronic endometritis. The absence of signs of chronic inflammation in the endometrium after the use of a levonorgestrel-releasing intrauterine device is probably due to the protective effect of levonorgestrel on the uterine mucosa. Thus, levonorgestrel-releasing intrauterine devices, in comparison with copper-containing intrauterine devices, have a favorable safety profile relative to the endometrium and can be recommended for women of reproductive age, including those who have not given birth.

Pelvic inflammatory disease: A silent threat to female fertility

Pelvic inflammatory disease (PID) is a clinical condition of significant importance, given its potential to generate serious sequelae if it is not properly identified and treated. Among these sequelae is infertility, the relationship between which and the presence of PID is well established. The incidence of infertility is particularly exacerbated by persistent, recurrent and inadequately treated infections, causing considerable psychological distress for the women and couples affected. A proactive approach to the early identification and treatment of PID is fundamental to mitigating the risk of infertility and its emotional repercussions. In addition, raising awareness of risk factors and adopting preventative measures are equally crucial in promoting women's reproductive health and reducing the incidence of PID-related complications.

Risk factors and outcomes of ectopic pregnancies at lautech teaching hospital, ogbomoso, nigeria: five years review

An ectopic pregnancy is a frequently occurring gynecological illness that poses a significant risk to the mother's health and can be life-threatening. It is the most prevalent emergency during early pregnancy and is connected with a high incidence of maternal morbidity and mortality globally. The objective of this study is to analyze the risk factors and outcomes of ectopic pregnancies at Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, located in Ogbomoso, Southwestern Nigeria, over a period of five years. This study is a retrospective analysis of women who were admitted and treated for ectopic pregnancy at LAUTECH Teaching Hospital, Ogbomoso, between January 1, 2016, and December 31, 2020. Sociology-demographic variables, risk factors, clinical features, postoperative outcomes, and duration of hospital stay were obtained from medical records using a structured proforma. Data were analyzed with IBM SPSS version 24 to compute frequencies, percentages, means and inferential statistics for hypothesis testing. The occurrence of ectopic pregnancy accounted for 5.23% of all admissions related to gynecological issues, with an incidence rate of 1.68%. The patients’ mean age was 29.84. The most often reported symptom was amenorrhea, with a prevalence of 100%. This was followed in sequence by abdominal pain (96.4%), dizziness (80.9%), fainting attack (60.9%), and shoulder tip discomfort (60%). The most prevalent risk factors observed were pelvic inflammatory disease (61.8%), prior abdominal surgery (43.6%), patient's number of previous pregnancies (41.8%), and history of induced abortion (38.2%). There were no deaths registered. The most often encountered complication was hypovolemic shock. Ectopic pregnancy is still a serious reproductive health issue for women in this region, serving as one of the primary causes of maternal morbidity throughout the early stages of pregnancy. To effectively address the increasing problem of pelvic inflammatory disease and unwanted pregnancy in this specific area, it is crucial to intensify efforts in promoting reproductive health advocacy initiatives.

Clinical Updates in Sexually Transmitted Infections, 2024.

Sexually transmitted infections (STIs) continue to increase in the United States with more than 2.5 million cases of gonorrhea, chlamydia, and syphilis reported to the Centers for Disease Control and Prevention in 2022. Untreated STIs in women can lead to adverse outcomes, including pelvic inflammatory disease, infertility, chronic pelvic pain, and pregnancy complications such as ectopic pregnancy, early pregnancy loss, stillbirth, and neonatal transmission. STI-related guidelines can be complex and are frequently updated, making it challenging to stay informed on current guidance. This article provides high-yield updates to support clinicians managing STIs by highlighting changes in screening, diagnosis, and treatment. One important topic includes new guidance on syphilis screening, including a clarified description of high community rates of syphilis based on Healthy People 2030 goals, defined as a case rate of primary or secondary syphilis > 4.6 per 100,000. Reproductive aged persons living in counties above this threshold should be offered syphilis screening. Additionally, American College of Obstetricians & Gynecologists now recommends syphilis screening three times during pregnancy regardless of risk-at the first prenatal visit, during the third trimester, and at delivery. In addition, new guidance to support consideration for extragenital screening for gonorrhea and chlamydia in women at sites such as the anus and pharynx is discussed. Other topics include the most recent chlamydia, gonorrhea, trichomoniasis, and pelvic inflammatory disease treatment recommendations; screening and treatment guidance for Mycoplasma genitalium; genital herpes screening indications and current diagnostic challenges; and the diagnosis and management of mpox in women and during pregnancy.

Ultrahigh-performance liquid chromatography Q-Exactive-Orbitrap mass spectrometry and molecular network analysis alongside network pharmacology to elucidate the active constituents and mechanism of action of Huahong tablet in treating pelvic inflammatory disease.

Huahong tablet, a commonly used clinical Chinese patent medicine, shows good efficacy in treating pelvic inflammation and other gynaecological infectious diseases. However, the specific composition of Huahong tablets, which are complex herbal formulations, remains unclear. Therefore, this study aims to identify the active compounds and targets of Huahong tablets and investigate their mechanism of action in pelvic inflammatory diseases. We utilised ultrahigh-performance liquid chromatography Q-Exactive-Orbitrap mass spectrometry and the relevant literature to identify the chemical components of Huahong tablets. The GNPS database was employed to further analyse and speculate on the components. Potential molecular targets of the active ingredients were predicted using the SwissTargetPrediction website. Protein-protein interaction analysis was conducted using the STRING database, with visualisation in Cytoscape 3.9.1. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed using the DAVID database. Additionally, a traditional Chinese medicine-ingredient-target-pathway network was constructed using Cytoscape 3.10.1. Molecular docking validation was carried out to investigate the interaction between core target and specific active ingredient. A total of 66 chemical components were identified, and 41 compounds were selected as potential active components based on the literature and the TCMSP database. Moreover, 38 core targets were identified as key targets in the treatment of pelvic inflammatory diseases with Huahong tablets. GO and KEGG enrichment analysis revealed 986 different biological functions and 167 signalling pathways. The active ingredients in Huahong tablets exert therapeutic effects on pelvic inflammatory diseases by acting on multiple targets and utilising different pathways. Molecular docking confirmed the high affinity between the specific active ingredients and disease targets.

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is defined as infection-induced inflammation of the upper female genital tract. Infection is usually ascending from the lower genital tract and may involve any combination of endometritis, salpingitis, parametritis, tubo-ovarian abscess, and pelvic peritonitis. Young women under the age of 25 are more likely to develop PID, with most cases being caused by sexually transmitted infections such as Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium. Diagnosis is primarily clinical and can be difficult, with symptoms ranging from asymptomatic to serious illness, and may be non-specific. Early diagnosis and treatment can potentially prevent both short-term complications, including tubo-ovarian or pelvic abscess, and long-term complications, such as chronic pelvic pain, infertility and ectopic pregnancy. This article aims to discuss the clinical presentation, diagnosis and management using a clinical case scenario as an example within the primary care setting using the latest evidence available.

Case Report On Rare Co-Occurrence of Complicated Acute Appendicitis and Ovarian Cyst Rupture

Acute appendicitis is the most common surgical emergency, and is also the most common cause of non-gynecological pelvic pain. Female patients presenting with abdominal pain in the presence of an underlying gynecological pathology such as ectopic pregnancy, threatened abortion, ovarian cyst, tubo-ovarian abscess or pelvic inflammatory disease can mimic acute appendicitis, potentially complicate the clinical picture and affect the diagnostic accuracy. Open or laparoscopic surgery is the mainstay of management for Complicated Appendicitis. Our patient was operated having signs and symptoms of pelvic peritonitis, with intraoperative finding of pelvic cavity blood with right ruptured ovarian simple cyst. She also had significant appendiceal abscess contained by omentum, terminal ilium, cecum and sigmoid colon with eaten up appendix in the abscess. This is a rare co-occurrence of appendiceal abscess with ruptured ovarian cyst, only one previous published case report of acute appendicitis with ruptured ovarian cyst.

Association between bacterial vaginosis, Chlamydia trachomatis infection and tubal factor infertility in Bukavu, Democratic Republic of Congo

BackgroundTubal factor infertility (TFI) is common in sub-Saharan Africa and often secondary to pelvic inflammatory disease (PID). Anaerobes associated with bacterial vaginosis (BV) are also found in PIDs widely dominated by Chlamydia trachomatis (C. trachomatis), whose role in TFI is better demonstrated than that of BV.ObjectivesTo determine the prevalence of BV and C. trachomatis and to investigate the association between BV, C. trachomatis and TFI.MethodsWe included 137 patients treated for infertility between January 2020 and November 2021. Cases were defined as women with infertility aged 18-45 years presenting with TFI (n = 52), and controls as infertile women in the same age groups without TFI (n = 85). Data on social habits, life style and infertility parameters were collected, and we performed screening for BV and C. trachomatis. Multiple regression was used to measure associations.ResultsThe prevalence of BV and C. trachomatis was 42.3% (58/137) and 23.4% (32/137), respectively. BV (61.5% vs 30.6%, p<0.001) and C. trachomatis (48.1 vs 8.2%, p<0.001) were more frequent in cases of TFI.BV and C. trachomatis increased the risk of TFI approximately 4-fold [aOR: 3.77 (1.61-8.83), p=0.002] and 14-fold [aOR: 13.77 (4.59-41.27), p<0.001], respectively.ConclusionBV and C. trachomatis infection are strongly associated with TFI in Bukavu. Prevention and screening should be implemented to reduce the risk of TFI.

IL-17C is a driver of damaging inflammation during Neisseria gonorrhoeae infection of human Fallopian tube

The human pathogen Neisseria gonorrhoeae ascends into the upper female reproductive tract to cause damaging inflammation within the Fallopian tubes and pelvic inflammatory disease (PID), increasing the risk of infertility and ectopic pregnancy. The loss of ciliated cells from the epithelium is thought to be both a consequence of inflammation and a cause of adverse sequelae. However, the links between infection, inflammation, and ciliated cell extrusion remain unresolved. With the use of ex vivo cultures of human Fallopian tube paired with RNA sequencing we defined the tissue response to gonococcal challenge, identifying cytokine, chemokine, cell adhesion, and apoptosis related transcripts not previously recognized as potentiators of gonococcal PID. Unexpectedly, IL-17C was one of the most highly induced genes. Yet, this cytokine has no previous association with gonococcal infection nor pelvic inflammatory disease and thus it was selected for further characterization. We show that human Fallopian tubes express the IL-17C receptor on the epithelial surface and that treatment with purified IL-17C induces pro-inflammatory cytokine secretion in addition to sloughing of the epithelium and generalized tissue damage. These results demonstrate a previously unrecognized but critical role of IL-17C in the damaging inflammation induced by gonococci in a human explant model of PID.

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.

Acupoint Catgut Embedding for Treatment of Chronic Pelvic Pain due to the Sequelae of Pelvic Inflammatory Disease.

Chronic pelvic pain caused by the sequelae of inflammatory pelvic disease is a common clinical condition of pelvic pain in women. At present, the main challenges in its treatment are the limited effectiveness of pain relief and the frequent recurrence of symptoms, which significantly impact patients' quality of life and impose a considerable psychological burden on them. It is a clinically challenging disease. After summarizing years of treatment experience, the author's team discovered that acupoint catgut embedding demonstrated notable clinical efficacy in managing chronic pelvic pain stemming from pelvic inflammatory disease sequelae. Compared to existing Western medicine treatment methods, acupoint catgut embedding offers advantages such as a good analgesic effect, lower recurrence rate, economic benefits, and a relatively straightforward procedure. This article provides a comprehensive guide on embedding absorbable catgut into patients' acupoints for the treatment of chronic pelvic pain in females resulting from the sequelae of pelvic inflammatory disease.

Risks of Vaginally and Sexually Transmitted Infections With Contraceptive Vaginal Rings Compared to Oral Contraceptives [ID 2683643

INTRODUCTION: Use of combined contraceptive vaginal ring (CCVR) has been found to upregulate immune-related genes in the endocervix and mediators within the cervicovaginal fluid. Attachment and infection rates of certain pathogens within this tract can vary based on hormones within the local environment. Rat studies have shown treatment with estrogen prior to chlamydial infections was protective. Continued clinical safety analyses are critical as CCVR use continues to increase. We calculated risk of vaginal infections associated with CCVR compared to oral contraceptive pills (OCPs) via retrospective chart review. METHODS: De-identified data was collected from TriNetX. Using ICD-10 and RxNorm codes, study cohorts included women receiving etonogestrel and ethinyl estradiol CCVRs without segesterone, versus women on OCPs without vaginal hormones. Cohorts (n=30,796 each) were matched for age, race, and ethnicity. Statistical analysis within 1 year of CCVR placement used risk ratios (RRs); P&lt;.05 was considered significant. RESULTS: Combined contraceptive vaginal rings showed increased risk of HSV-2 (RR 1.790; P&lt;.0005), acute vaginitis (RR 1.722; P&lt;.0005), subacute/chronic vaginitis (RR 1.904; P&lt;.0005), subacute/chronic vulvitis (RR 1.969; P&lt;.0005), acute vulvitis (RR 1.894; P&lt;.0005), candidiasis (RR 1.464; P&lt;.0005), trichomoniasis (RR 2.162; P&lt;.0005), and pelvic inflammatory disease (PID) (RR 2.984; P&lt;.0005). Combined contraceptive vaginal rings showed a decreased risk of chlamydia (RR 0.760; P=.047). There were no differences in risk of gonorrhea, syphilis, HIV, or anogenital warts between the CCVR and OCP cohorts CONCLUSION: In this chart review, women using CCVRs had increased risks for HSV-2, vaginitis, vulvitis, PID, trichomoniasis, and candidiasis and decreased risk of chlamydia compared to OCPs. Further study of local hormone delivery on the vaginal mucosa is warranted.

Risks of Infections With Contraceptive Vaginal Rings Compared to No Hormone Use [ID 2683646

INTRODUCTION: Alterations in the vaginal microbiome by hormones, foreign bodies, intercourse, etc., can affect the body’s susceptibility to infection. The effect of combined contraceptive vaginal rings (CCVRs) on the vaginal microbiome needs more study. We aim to explore the outcomes of CCVRs on vaginal health and infection risk when compared to women without hormone use to better understand the effect of these devices. METHODS: De-identified data were collected from TriNetX. Using ICD-10 and RXNorm codes, populations were selected for women receiving etonogestrel and ethinyl estradiol CCVR without segesterone use, versus sexually active women of reproductive age on no hormonal contraceptives. Cohorts were matched for age at index, race, and ethnicity. Statistical analysis within 1 year of CCVR placement using risk ratios (RRs); P&lt;.05 was considered significant. RESULTS: Cohort sizes were 274,743 each. Combined contraceptive vaginal ring usage showed an increased risk of gonorrhea (RR 1.221; P=.012), HSV-2 (RR 1.229; P&lt;.0005), acute vaginitis (RR 1.314; P&lt;.0005), subacute/chronic vaginitis (RR 1.708; P&lt;.0005), acute vulvitis (RR 1.708; P&lt;.0005), subacute/chronic vulvitis (RR 1.722; P&lt;.0005), pelvic inflammatory disease (RR 1.184; P&lt;.0005), anogenital warts (RR 1.314; P&lt;.0005), and candidiasis (RR 1.402; P&lt;.0005) when compared to women receiving no hormonal contraception. Combined contraceptive vaginal ring showed significant decreased risk of chlamydia (RR 0.786; P&lt;.0005), syphilis (RR 0.493; P&lt;.0005), and HIV (RR 0.434; P&lt;.0005). Trichomoniasis was statistically insignificant. CONCLUSION: Women on etonogestrel and ethinyl estradiol CCVRs have an increased risk of gonorrhea, HSV-2, vaginitis, vulvitis, PID, anogenital warts, and candidiasis, with a decreased risk of chlamydia, syphilis, and HIV when compared to women receiving no hormonal contraception. Further investigation could be useful in developing multipurpose prevention technologies.

Comparison of Conventional Pap Smear With Liquid-based Cytology for Screening of Cancer Cervix

Abstract Objective: The objective of the study was to compare conventional Pap smear (CPS) and liquid-based cytology (LBC) by the split technique method in terms of satisfactory/unsatisfactory smear, the prevalence of inflammatory smear, and cellular atypia. Materials and Methods: This cross-sectional study was carried out between 2017 and 2019 after obtaining ethics committee approval. A total of 200 women were recruited for the study attending the gynecology outpatient clinic with various symptoms, such as discharge per vaginum, dysmenorrhea, infertility, and pain abdomen, and after obtaining written informed consent. Pregnant women, women with pelvic inflammatory disease, and cases with obvious cervical lesions or growth were excluded. Pap smear was taken with a Rovers Cervex-Brush. The split sample technique was followed wherein using one side of the brush conventional slide was prepared and fixed with cytospray. The brush head was detached and suspended in the preservative fluid for LBC. Both CPS and LBC were sent for examination. The same experienced pathologist examined the samples. The qualitative variables were compared using the Mcnamer test to compare the prevalence of unsatisfactory smear, inflammatory smear, and cellular abnormalities between CP and LBC. The categorical variables were presented in number and percentage (%) and continuous variables were presented as mean ± standard deviation and median. P &lt; 0.05 was considered statistically significant. Results: The maximum number of patients (62.5%) belonged to the fourth decade of life. The mean age was 39 years. A total of 93% of women were from the urban areas while 7% belonged to the rural areas. The majority of the women (78.5%) were multiparous and around 43% were second para. Pap smear reports were satisfactory in 93.5% of women in CPS, while 99% of reports were satisfactory in LBC. The difference between CPS and LBC in terms of the prevalence of satisfactory/unsatisfactory smear was statistically significant with a P = 0.0064. Dense inflammation reported by all LBC smears was reported as the same in CPS. The strength of agreement between CPS and LBC was not strong in terms of different grades of inflammation with a kappa value of 0.24. There was no difference in the reporting of cellular atypia between both methods. Conclusions: CPS and LBC are equal in terms of detection of inflammation and epithelial cell abnormality. Infections were also detected by both the screening methods CPS and LBC. The only thing which makes LBC better is the rate of satisfactory smears and the benefit of adding human papillomavirus DNA testing possible only in LBC.

Undermining the Translational Potential of Clinical Research With Adolescents and Young Adults: Differential Enrollment in Randomized Clinical Trials During COVID-19.

COVID-19 stay-at-home orders and research restrictions halted recruitment and follow-up of clinical research patients. Although clinical research has resumed, it is an open question whether research participation has returned to levels similar to those before COVID-19. We used data from the TECH-PN (NCT No. NCT03828994) study, a single-center randomized controlled trial enrolling 13- to 25-year-olds with mild-moderate pelvic inflammatory disease (PID) receiving ambulatory care. We examined enrollment patterns before COVID-19 and during/after COVID-19 among those assessed for eligibility by estimating the average rate of recruitment visits for each period. We focused on this monthly rate by pandemic status, the length of stay (LOS) by pandemic status, as well as the relationship between the LOS and patient demographics. Descriptive analyses were conducted, including Student t test to compare rates between time periods and a χ2 test to compare the proportion refusing enrollment. The monthly enrollment rate during/after the pandemic was significantly lower than before COVID-19 (4.8 per month compared with 7.4 per month, P < 0.001). However, eligible participants' age, race, and insurance type were similar before and during/after the pandemic. Among eligible patients, LOS for receiving PID care was slightly increased, from a median of 5.4 to 6.4 hours ( P = 0.650), and the rate of refusal to participate among those eligible was similar (23% vs. 27%, P = 0.362). There were a similar number of ineligible patients because of inpatient admissions during both periods. COVID-19 pandemic restrictions negatively impacted recruitment into this randomized controlled trial. Enrollment differences may reflect ongoing perceptions of restrictions in care access or a hesitancy to use health services. More research is needed to stabilize access to ambulatory sexually transmitted infection/PID care and access to clinical trials.