Prevention Of Pelvic Inflammatory Disease Research Articles

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.

Место иммуномодуляторов в лечении воспалительных заболеваний органов малого таза

Pelvic inflammatory diseases (PID) are widespread in the population of women of reproductive age. The special properties of pathogens of urogenital infections, immune dysfunction of host systems often lead to the formation of chronic inflammation, especially in women with asymptomatic infection infections, sexually transmitted infections, and patients with subclinical PID. Chronic pelvic inflammatory disease, in turn, are associated with numerous disorders reproductive system, including infertility, miscarriage, chronic pelvic pain. Prevention of chronic inflammation and its negative consequences is early detection and adequate treatment as STDs and PID, especially their subclinical variants. Unfortunately, antibiotics do not always justify the hopes placed in it, partly because of rising resistance of pathogens, in part due to their own side effects, including an immunosuppressive action. To optimize antibiotic therapy and prevention of pelvic inflammatory disease and relapse in the treatment regimen immunomodulators may be used. Since a key role in the immune response to infectious implementation is played by phagocytic link, inclusion in therapy azoximer bromide, providing a full function of phagocytes, seems reasonable and appropriate.

Direct and Indirect Effects of Screening for Chlamydia trachomatis on the Prevention of Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) results from the ascending spread of microorganisms, including Chlamydia trachomatis, to the upper genital tract. Screening could improve outcomes by identifying and treating chlamydial infections before they progress to PID (direct effect) or by reducing chlamydia transmission (indirect effect). We developed a compartmental model that represents a hypothetical heterosexual population and explicitly incorporates progression from chlamydia to clinical PID. Chlamydia screening was introduced, with coverage increasing each year for 10 years. We estimated the separate contributions of the direct and indirect effects of screening on PID cases prevented per 100,000 women. We explored the influence of varying the time point at which clinical PID could occur and of increasing the risk of PID after repeated chlamydial infections. The probability of PID at baseline was 3.1% by age 25 years. After 5 years, the intervention scenario had prevented 187 PID cases per 100,000 women and after 10 years 956 PID cases per 100,000 women. At the start of screening, most PID cases were prevented by the direct effect. The indirect effect produced a small net increase in PID cases, which was outweighed by the effect of reduced chlamydia transmission after 2.2 years. The later that progression to PID occurs, the greater the contribution of the direct effect. Increasing the risk of PID with repeated chlamydial infection increases the number of PID cases prevented by screening. This study shows the separate roles of direct and indirect PID prevention and potential harms, which cannot be demonstrated in observational studies.

O22.2 Direct and Indirect Effects of Screening For Chlamydia Trachomatis on the Prevention of Pelvic Inflammatory Disease: Mathematical Modeling Study

BackgroundPelvic inflammatory disease (PID) results from the ascending spread of microorganisms, including Chlamydia trachomatis, to the upper genital tract. The timing of ascending infection is unknown. Screening can prevent PID...

Comparative effectiveness of a rapid point-of-care test for detection of Chlamydia trachomatis among women in a clinical setting

ObjectivesTo compare the effectiveness and cost-effectiveness of a promising new point-of-care (POC) chlamydia test with traditional nucleic acid amplification testing (NAAT), and to determine the characteristics that would make a...

Screenings for Chlamydia trachomatis Antigen among HIV and non-HIV Patients with Symptoms of Urogenital Tract Diseases at The Federal Medical Centre Gombe, Nigeria.

C. trachomatis a sexually transmitted bacterial pathogen and the leading cause of bacterial sexually transmitted diseases (STDs) world wide can lead to serious complications in women and infants with untreated infections. Symptoms are normally unspecific, as such rapid screening tests with high specificity, though not confirmatory are highly valuable in converting its menace as large number of patients at high risk can be screened within a short period with ease in sample collection and patient management at very low cost. Three hundred urogenital swab samples; including 93 urethral swabs and 207 endocervical swabs were aseptically collected from patients with symptoms of urogenital tract diseases attending federal medical centre Gombe from January to March, 2010. Among them were 33 HIV patients and 267 non-HIV patients. All the swabs were subjected to Chlamydia antigen screening using NovaAE One-Step Chlamydia trachomatis rapid immunochromatography antigen screening testing kits. In general, 11(3.7%) patients were found positive in this study. In the non-HIV patients, 2.6% were positive, with highest frequency of 3.1% recorded at the age group 21-30years. However in the HIV-patients, 12.1% were positive, with the highest frequency of 18.2% recorded at the age group 31-40years. The findings from this work has stressed the importance of rapid screening as a presumptive technique and call for use of more reliable confirmatory testing procedures in the prevention of pelvic inflammatory disease (PID), cervical carcinoma and other STDs. We also call for establishing a relationship between Chlamydia trachomatis and HIV infection in the locality.

Pelvic inflammatory disease in adolescents

We discuss the epidemiology, risk factors, microbiology, diagnosis, treatment and prevention of pelvic inflammatory disease in adolescents. Young age is one of the most important risk factors for sexually transmitted diseases and pelvic inflammatory disease. Sexually active adolescents have the highest incidence of Chlamydia trachomatis, Neisseria gonorrhoeae, and pelvic inflammatory disease of any sexually active age group. Long-term sequelae of pelvic inflammatory disease include ectopic pregnancy, tubal factor infertility, tubo-ovarian abscesses and chronic pelvic pain. Subclinical pelvic inflammatory disease is responsible for a significant portion of these long-term sequelae. New (2006) Centers for Disease Control and Prevention treatment guidelines for pelvic inflammatory disease are available. One of the best methods of prevention of pelvic inflammatory disease is to screen and treat sexually active adolescents for chlamydial infection. Implementation of nucleic acid amplification assays allows screening of adolescents via self-collected urine or vaginal swab samples. Pelvic inflammatory disease is a highly preventable source of reproductive morbidity for adolescents. It is prudent that clinicians provide counseling regarding healthy sexual behaviors, STD prevention, and contraception whenever an adolescent presents in need of STD screening or evaluation for pelvic inflammatory disease.

Gender-based differences in fertlity beliefs in adolescents

Background: Asymptomatic women receive direct benefit from chlamydia screening related to prevention of pelvic inflammatory disease (PID) and infertility. Asymptomatic men may receive no direct fertility-related benefits from such screening, other than knowing they may be preventing PID and infertility in their female sex partners. Little information is available about adolescents’ beliefs about fertility in women and its link to STDs and whether men and women differ in their beliefs. This information may be useful for developing messages intended to motivate youth to seek STD screening while they are asymptomatic.

The accuracy and efficacy of screening tests for Chlamydia trachomatis: a systematic review.

Screening women for lower genital tract infection with Chlamydia trachomatis is important in the prevention of pelvic inflammatory disease, ectopic pregnancy and infertility. This systematic review aims to state clearly which of the available diagnostic tests for the detection of C. trachomatis would be most effective in terms of clinical effectiveness. The review included all studies published from 1990 onward that evaluated diagnostic tests in asymptomatic, young, sexually active populations. Medline and Embase were searched electronically and key journals were hand-searched. Further studies were identified through the Internet and contact with experts in the field. All studies were reviewed by two reviewers and were scored by Irwig's assessment criteria. Additional quality assessment criteria included a documented sexual history and recording of previous chlamydial infection. The reviews were subjected to meta-analysis and meta-regression. The 30 studies that were included examined three types of DNA-based test--ligase chain reaction (LCR), PCR and gene probe--as well as enzyme immuno-assay (EIA). The results showed that while specificities were high, sensitivities varied widely across the tests and were also dependent on the specimen tested. Pooled sensitivities for LCR, PCR, gene probe and EIA on urine were 96.5%, 85.6%, 92% and 38%, respectively, while on cervical swabs the corresponding sensitivities of PCR, gene probe and EIA were 88.6%, 84% and 65%. Meta-analysis demonstrated that DNA amplification techniques performed best for both urine and swabs in low prevalence populations. We conclude that nucleic acid amplification tests used on non-invasive samples such as urine are more effective at detecting asymptomatic chlamydial infection than conventional tests, but there are few data to relate a positive result with clinical outcome.

Prevention of pelvic inflammatory disease by the control of C. trachomatis infection

Objectives: To determine if there is evidence to indicate that screening for Chlamydia trachomatis (chlamydia) is an effective intervention in the prevention of pelvic inflammatory disease (PID). Methods: A systematic review was made of the literature to assess the effectiveness of screening asymptomatic young women for lower genital tract infection with C. trachomatis in the prevention of PID and its major sequelae tubal infertility and ectopic pregnancy. Results: There is considerable literature describing screening for lower genital tract infection with C. trachomatis, but only two randomized controlled trials, two ecological studies and one case-controlled trial were identified. These studies were graded and the evidence pooled. The suggestion that screening for chlamydia is an effective intervention in the prevention of PID is supported by Grade 2 evidence (level B recommendation). However, there are large gaps in the literature. Only small numbers of women have been studied and the follow-up periods are short. The studies have been conducted using mainly culture of cervical swabs to diagnose chlamydial infection and not the more recent nucleic acid based tests. The risk of a woman developing PID following detection of lower tract infection with C. trachomatis is still uncertain. Conclusions: There is evidence to support a level B recommendation that screening for chlamydia using culture is effective in preventing PID in the short term. Further randomized controlled trials are required to assess screening using nucleic acid based tests and involving longer follow-up periods.

Prevention of pelvic inflammatory disease

Prevention of pelvic inflammatory disease

Screening of men for sexually transmitted infection and partner notification

There is a widely held public perception that sexually transmitted infections declare themselves by producing symptoms. If this were true, screening would not be necessary. In 1951, the US Commission on chronic illness defined screening as: The presumptive identification of unrecognized disease or defects by the application of tests, examinations or other procedures which can be applied rapidly. Screening tests sort out apparently well persons who probably have a disease from those who probably do not. A screening test is not intended to be diagnostic. Persons with positive or suspicious findings must be referred to their physicians for diagnosis and necessary treatment. Screening in the sphere of reproductive health has been directed predominantly at women, especially in relation to breast and cervical screening. The medical profession has a greater awareness of asymptomatic cervical infection in women. The paper by Scholes et al. (1996) on prevention of pelvic inflammatory disease by screening for cervical chlamydial infection was the first report that screening women for cervical chlamydial infection reduces the risk of developing pelvic infection considerably. This paper has highlighted the potential benefits of screening for sexually transmitted infection, although screening is only part of the management process. Accurate diagnosis, investigation for other pathogens, adequate treatment with an appropriate antibiotic and partner notification (also called contact tracing) are essential if prevalence of infection and complications are to be reduced. Secondary prevention by early detection of sub-clinical disease through screening or case finding is required to prevent lower genital tract infection from ascending to the upper genital tract in women. Once symptoms develop in pelvic infection, substantial damage to the Fallopian tubes has already occurred. Little can be gained by tertiary prevention of more effective antimicrobial therapies. The importance of partner notification in preventing exposure to organisms resulting in repeat episodes of pelvic infection through continuing stimulation of the immune system has been highlighted by Paavonen (1996). There is ample evidence showing that asymptomatic infection is also common in men, particularly with the organism Chlamydia trachomatis, the commonest bacterial sexually transmitted infection in the UK. Screening should be targeted at those groups in which there is likely to be a prevalence of infections such as gonorrhoea, chlamydial urethritis or non-specific urethritis, to prevent pelvic infection and its sequelae most cost effectively. What screening should be undertaken in men? In relation to fertility, screening should identify the organisms that can, if present in the genital tract of women, cause pelvic infection, with the possible sequelae of reduced fertility and ectopic pregnancy. These organisms usually cause urethritis in men. Urethritis may be caused by the organism Neisseria gonorrhoeae or by other organisms, in which case the condition is referred to as non-gonococcal urethritis (NGU). Gonorrhoea Gonorrhoea is diagnosed presumptively on taking a urethral swab and identifying Gram-negative intracellular diplococci in the polymorphonuclear cells (PMN) present on a Gram-stained slide. The diagnosis is made by the growth of N. gonorrhoeae on an appropriate medium and identification of the organism by confirmatory tests. Gonorrhoea usually causes symptoms of urethral discharge and mild dysuria in about 90% of men with urethral infection. However, infection in the oropharynx produces symptoms in only about 20% of cases and > 66% of men with anorectal gonorrhoea have no symptoms of infection. Gonorrhoea is considered of high infectivity, and risk of transmission for a female having intercourse with an infected male is higher than that for a male having intercourse with an infected female (Thelin et al., 1980).

Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection: Scholes D, Strergachis A, Heidrich FE, et al. N Engl J Med. 1996;334:1362–1366

Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection: Scholes D, Strergachis A, Heidrich FE, et al. N Engl J Med. 1996;334:1362–1366

Prevention of Pelvic Inflammatory Disease by Screening for Cervical Chlamydial Infection

Scholes, Delia; Stergachis, Andy; Heidrich, Fred E.; Andrilla, Holly; Holmes, King K.; Stamm, Walter E. Author Information

"Prevention of Pelvic Inflammatory Disease by Screening for Cervical Chlamydial Infection".

Background Chlamydia trachomatis is a frequent cause of pelvic inflammatory disease. However, there is little information from clinical studies about whether screening women for cervical chlamydial infection can reduce the incidence of this serious illness. Methods We conducted a randomized, controlled trial to determine whether selective testing for cervical chlamydial infection prevented pelvic inflammatory disease. Women who were at high risk for disease were identified by means of a questionnaire mailed to all women enrollees in a health maintenance organization who were 18 to 34 years of age. Eligible respondents were randomly assigned to undergo testing for C. trachomatis or to receive usual care; both groups were followed for one year. Possible cases of pelvic inflammatory disease were identified through a variety of data bases and were confirmed by review of the women's medical records. We used an intention-to-screen analysis to compare the incidence of pelvic inflammatory disease in the two group...

Introductory Address

Pelvic inflammatory disease is a common infection that, from an etiologic point of view, is strongly correlated with the presence of sexually transmissible microorganisms. A part from exposure to such agents, risk factors include youth, minor gynecologic surgery, earlier episodes of salpingitis, and the use of intrauterine contraceptive devices. For the prevention of pelvic inflammatory disease, consideration of these risk factors is important. The vast majority of fallopian-tube infections are caused by the ascending spread of sexually transmissible agents or endogenous vaginal organisms through the genital tract. The multitude of etiologic agents must be considered in the choice of therapy, and double or triple treatment regimens may be appropriate.

Surveillance, prevention, and control of sexually transmitted agents associated with pelvic inflammatory disease

Control and prevention of pelvic inflammatory disease would result from successful control of Neisseria gonorrhoeae and genital Chlamydia trachomatis infections. The same control system applies to both, but while this system is well documented in gonorrhea control, there is still no evidence that it is effective for C. trachomatis infections. Primary prevention of PID should be realized through a reduction of the incidence of gonorrhea, and the available techniques—(1) contact tracing and epidemiologic treatment, (2) screening and case finding, (3) preventive measures, (4) health education, and (5) training of the health workers—are discussed. Secondary prevention of PID can be achieved through good management of uncomplicated infections due to N. gonorrhoeae and C. trachomatis. The approach must be adapted to local conditions and should be different in developing countries compared to countries with a specialized health care system for sexually transmitted disease. Good management of PID is crucial in preventing sequelae and most important are tracing and treating the male contacts of patients with PID. Measures of tertiary prevention attempt to rehabilitate the patient; the main sequelae after PID are ectopic pregnancy and infertility. Surgical techniques can restore tubal function, but these methods are complicated and have a low success rate.