Recurrent Pelvic Inflammatory Disease Research Articles

Pelvic Inflammatory Disease Mimicking Ovarian Cancer: A Case Series from A Tertiary Cancer Center

AbstractThe female pelvis has a complex anatomy, and benign adnexal diseases can present as malignant ovarian masses clinically and radiologically. Between 1 June 2011 and 28 September 2022, we included in this study all the patients who were diagnosed initially with suspicious ovarian masses in the Department of Surgical Oncology, Oncology Center, Mansoura University, Egypt, and after surgical exploration revealed pelvic inflammatory disease and we assessed their diagnostic, operative, and postoperative outcomes. In this case series we had 41 patients of a total of 803 cases with suspicious adnexal mass that revealed pelvic inflammatory disease after surgical exploration, abdominal pain was the common presentation in 53.7% of the cases, and low-grade fever was reported in seven cases. The serum cancer antigen 125 was elevated in 70.7% of the cases. Unilateral adnexal mass was found in 30 cases and 11 cases had bilateral adnexal masses. We followed up on the patients within 47 months (range 12–88 months); recurrent pelvic inflammatory disease has developed in one case after 62 months and ovarian cancer has developed in another case after 80 months. We concluded that benign adnexal masses such as tubo-ovarian abscess secondary to pelvic inflammatory disease should be considered a differential diagnosis in patients with radiological suspicious adnexal masses when the tumor markers such as cancer antigen 125 are normal or mildly elevated, especially in premenopausal women, and the clinical presentations are not specific to either benign or malignant adnexal diseases.

Endometriosis is a risk factor for recurrent pelvic inflammatory disease after tubo-ovarian abscess surgery.

PurposeTo evaluate the clinical outcomes and prognosis of patients undergoing laparoscopic surgery for tubo-ovarian abscess (TOA) and identify risk factors for pelvic inflammatory disease (PID) recurrence. MethodsWe conducted a retrospective cohort analysis including 98 women who underwent laparoscopic surgery for TOA at the Department of Obstetrics and Gynecology at the Bern University Hospital from January 2011 to May 2021. The primary outcome studied was the recurrence of PID after TOA surgery. Clinical, laboratory, imaging, and surgical outcomes were examined as possible risk factors for PID recurrence.ResultsOut of the 98 patients included in the study, 21 (21.4%) presented at least one PID recurrence after surgery. In the univariate regression analysis, the presence of endometriosis, ovarian endometrioma, and the isolation of E. coli in the microbiology cultures correlated with PID recurrence. However, only endometriosis was identified as an independent risk factor in the multivariate analysis (OR (95% CI): 9.62 (1.931, 47.924), p < 0.01). With regard to the time of recurrence after surgery, two distinct recurrence clusters were observed. All patients with early recurrence (≤ 45 days after TOA surgery) were cured after 1 or 2 additional interventions, whereas 40% of the patients with late recurrence (> 45 days after TOA surgery) required 3 or more additional interventions until cured.ConclusionEndometriosis is a significant risk factor for PID recurrence after TOA surgery. Optimized therapeutic strategies such as closer postsurgical follow-up as well as longer antibiotic and hormonal therapy should be assessed in further studies in this specific patient population.

Xanthogranulomatous Oophoritis in the Setting of Post-IVF Twin Pregnancy with History of Endometriosis: A Rare Case Report with Review of Literature

AbstractXanthogranulomatous inflammation is an uncommon, nonneoplastic, chronic process in which the affected organ is destroyed by massive cellular infiltration of foamy histiocytes admixed with multinucleated giant cells, plasma cells, fibroblasts, neutrophils, and foci of necrosis. The organs most commonly affected by this entity are kidney and gallbladder. Only a few cases involving the ovary have been reported. The etiology of this entity is unknown, but the associated risk factors are infection, inappropriate antibiotic therapy, use of intrauterine contraceptive device, abnormalities in lipid metabolism, endometriosis, leiomyoma, and recurrent pelvic inflammatory disease. The current case was a 31-year-old female with post-in vitro fertilization (post-IVF) twin pregnancy, who presented with pain in the abdomen, provisionally diagnosed as ovarian mass with suspicion of malignancy. Patient was treated with antibiotics and an elective lower segment cesarean section was planned, due to lower abdominal pain and the presentation of both fetuses being breech. Patient underwent exploratory laparotomy with right oophorectomy and left double-J stenting, in view of left hydronephrosis. Diagnosis of xanthogranulomatous oophoritis was established on histopathological examination. There is only a single case; previously documented from India, in the setting of primary infertility. The present case report stresses that the condition may affect women of any age group and may be encountered in pregnancy, as has been observed in this case. Hence, thinking about this differential diagnosis in the cases presenting with similar complaints, would be of great value to avoid misdiagnosing them.

Assessment of ovarian reserve and role of its determining factors in patients with endometriomas combined with pelvic inflammatory disease

Resume. Endometriosis affects from 10% to 50% of women of reproductive age and is one of the most common diseases in gynecology. One of its most common kinds – ovarian endometrial cysts – accounts from 17% to 44% of all patients. The aim of the study was to evaluate the parameters of the ovarian reserve in patients with endometriomas combined with pelvic inflammatory disease. Research materials and methods. Two groups of patients were formed: group I included 45 women with endometriomas combined with pelvic inflammatory disease; group II consisted of 45 patients with isolated endometriomas. Generally accepted criteria were used to assess the ovarian reserve: FSH level, AMH &gt; 1.0 n/ml, number of follicles D, volume of both ovaries. Statistical calculations included the method of calculating the odds ratio (OR) and its 95% confidental interval (95% CI).&#x0D; Research results and their discussion. The frequency of the decrease in main parameters of the ovarian reserve showed a deviation in two-thirds of cases in women of group I (68.9%), which is 2.2 times more common (p&lt;0.05). AMH parameters showed a deviation by 3.6 times compared to the control group, and by 1.7 times compared to the parameters of group II (p&lt;0.05). The average level of FSH in blood serum of women in group I was 2.0 times higher than the control indicators, and 1.5 times higher than the indicators of patients in group II. The number of antral follicles &lt; 5 in group II was in 22.2% of observations; and in group 1 – in 91.1% (p&lt;0.05). The endometrioma itself demonstrated a significant influence on the parameters of the ovarian reserve: in the case of a significant share of multiple bilateral endometrial cysts (OR=5.65; 95% CI: (1.71-18.67); p&lt;0.05), their large sizes (OR=7.94; 95% CI: (3.0-21.0); p&lt;0.05), combination with pelvic inflammatory disease, (OR=29.42; 95% CI: (6.33 -146.72); p&lt;0.05) and tubo-ovarian tumours (OR=6.96; 95% CI: (1.44-33.51); p&lt;0.05), as well as aggressive consequences during surgical intervention on both ovaries (OR=8.26; 95% CI: (2.65-25.79); p&lt;0.05). Conclusions. About half of the patients with endometriomas combined with pelvic inflammatory disease note a decrease in the ovarian reserve. Statistically reliable factors are multiple and large ovarian endometrial cysts, a combination with recurrent pelvic inflammatory disease, tubo-ovarian tumours and surgical interventions on the ovaries.

Pelvic Inflammatory Diseases- An Ayurvedic Perspective.

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

Secondary Infertility in Port Harcourt: Pattern and Socio-Dermographic Relationship

Background: Secondary Infertility is viewed as a social stigma, especially in Nigeria, due to the high premium placed on procreation. Observation suggests that this condition is on the increase in our environment. Hence, the need to determine the pattern and the relationship between the socio-demographic factors with infective causes of this condition; which will subsequently allow the tailoring of the individual investigation and subsequent treatment.&#x0D; Objective: To determine the prevalence and pattern as well as the relationship between the socio-demographic factors with infective causes of secondary infertility among women who attended the gynaecological clinic of the University of Port Harcourt Teaching Hospital (UPTH) between January 2012 and December 2016&#x0D; Methods: This is a retrospective descriptive study design, based on findings from the folders, admission and outpatient registers, of infertile couples presenting at the gynaecology clinic of the University of Port Harcourt Teaching Hospital, over a five-year period (January 2012 – December 2016). Data were collected from all documented and laboratory findings. The data extracted from the case records were the socio-demographic characteristics of the patient, the duration of infertility as well as the causes. They were analyzed using SPSS version 20.&#x0D; Results: The mean age of women was 33.14±4.93 years. The prevalence of secondary infertility was 12% of all outpatient gynaecological consultation. The mean duration of secondary infertility was 3 years.&#x0D; The infective causes of secondary infertility [recurrent pelvic inflammatory disease(PID), sexually transmitted infections(STI), post abortal sepsis, puerperal sepsis, HIV/AIDS, mumps orchitis were commoner among the 31-40 years’ category, (45.8%), the infective causes were also commoner among women with primary level of education, (62.5%, p-value=0.001) as well as women who were self-employed (49%, p-value=0.041). Recurrent pelvic inflammatory disease was identified in majority of cases (37.1%). Abnormal semen analysis, hyper-prolactinaemia and uterine fibroid, also contributed significantly to infertility; 18.5%, 19.7% and 24.3% respectively.&#x0D; Conclusion: Infective causes are at the root cause of secondary infertility; the more educated the couple, the higher their socioeconomic status, the lesser the impact of infection on secondary infertility.

Impact of chronic cervicitis on recurrent pelvic inflammatory disease

Pelvic inflammatory disease (PID) is a sexually-transmitted infection (STI); and, as such, sometimes it is difficult to treat because of partner(s) issues. PID generally is accompanied by chronic cervicitis (CC). We observed that in spite of patients strictly complying with their therapy, there are some individuals that develop recurrent disease; and we tried to establish a relationship between CC and its recurrence in such patients. This study was prospectively designed. Patients in one group were treated with electrocauterization and another group who did not receive this therapy was retrospectively compared by reviewing their clinical records. Patients with CC and PID who did not undergo electrocauterization had 82% recurrence rate compared to those who underwent electrocauterization, who showed a 24% recurrence rate. We concluded that patients who had CC with different manifestations and who underwent electrocauterization or cervical fulguration developed significantly less recurrence of PID.

Assessment of quality of life and psychological condition of women with chronic inflammatory processes of the pelvic organs on the background of pelvic pain

The objective: was to assess the psychological status and quality of life of women in the treatment of recurrent pelvic inflammatory disease with chronic pelvic pain syndrome.Materials and methods. We observed 100 women of reproductive age who suffered from chronic pelvic pain syndrome in chronic inflammatory processes of the pelvic organs. All women were prescribed antibacterial therapy in combination with antihypoxants and antiplatelet agents. The first group included women (n=48) who were prescribed analgesics domestically due to existing contraindications to the use of non-steroidal anti-inflammatory drugs. The second group of women (n=52) received a rectally non-steroidal anti-inflammatory drug. The second group of women (n=52) received a rectally nonsteroidal anti-inflammatory agent. Patients were interviewed 3 months after treatment: using the Visual Analog Scale (VAS), the McGill Questionnaire, the Spielberger–Hanin Questionnaire, the Depression Center of the US Center for Epidemiological Research, the Beck Depression Rating Scale, and the SF-36 Questionnaire.Results. According to the results of the assessment of quality of life and changes in psychological state, we noticed the following differences. In the group of women who received analgesic medium before muscle therapy, the change in muscle changed but slightly compared with the group of women who were offered the use of nonsteroidal anti-inflammatory drugs. Indicators of quality of life and psychological condition in women of the second group have significantly improved.Conclusions. The results of this study indicate the relationship and comprehensive approach in the treatment of pelvic inflammatory disease, which is accompanied by pelvic pain.

Risk factors for recurrent Pelvic Inflammatory Disease

ObjectivePelvic inflammatory disease (PID) is a common infection which can result in severe long term morbidity, such as chronic pelvic pain and infertility. The morbidity increases in correlation to the number of PID events. Our study aim to assess the risk factors for recurrence of pelvic inflammatory disease. MethodsA retrospective case control study was conducted using data for all women who were admitted to a tertiary medical center for a recurrent PID over a duration of 15 years. Women who had a recurrent PID were compared to women admitted for PID treatment without further recurrence. Forward stepwise multivariate logistic regression analysis was subsequently carried out. ResultsThe study included 133 women of whom 33 had recurrent PID. Women in the recurrent PID group had a higher rate of previous pelvic surgery (12 (36 %) vs. 20 (20 %), adjusted odds ratio [OR] 2.2 (95 % confidence interval CI 1.06–5.4, p = 0.05) and more had intrauterine devices (IUD) still in place if they had been previously present (5 (71.4 %) vs. 9(25.7 %), OR 7.2, (95 % CI 1.18–43.9), p = 0.02). The majority were treated with a combination of Ampicillin and Gentamycin, fewer received Augmentin or a cephalosporin base regimen (28 (84.8 %) vs 56 (56.0 %), OR 4.4, (95 % CI 1.5–12.3, p = 0.02), (1 (3.0 %) vs 27 (27.0 %), OR 0.08, (95 % CI 0.01-0.64), (4 (12.2 %) vs 17 (17.0 %)) respectively. In addition, invasive treatment had been required in more patients who later had a recurrent PID (6 (18.1 %) vs. 4(4.0 %), OR 5.3 (95 % CI 1.1.4-20.2), p = 0.007). Antibiotic regimens and invasive treatment were independently associated with recurrent PID (OR 2.69; 95 % CI 1.13–6.41, OR 2.10; 95 % CI 1.19–3.71, respectively). ConclusionAmong women with PID, special awareness should be given to women with previous pelvic surgery, who required an additional interventional treatment and have an IUD inserted. Efforts should be made to achieve treatment success and optimal prevention to prevent recurrent PID.

Reproductive outcomes of patients being hospitalised with pelvic inflammatory disease

This study aimed to investigate the prevalence and the predictors of the adverse reproductive outcomes in patients who had been hospitalised with pelvic inflammatory disease (PID). The retrospective cohort study was conducted by contacting all the patients admitted with PID or tubo-ovarian abscess (TOA) during January 2004 and December 2011. Those who were sexually active and aged 14–40 years were included. The exclusion criteria were no intention to conceive or undergoing hysterectomy, bilateral salpingo-oophorectomy, bilateral complete or partial salpingectomy. At a follow-up duration of 69 [IQR 51–93] months, of 94 eligible participants, 24 (25.5%) met the criteria of infertility, 15 (16.0%) had recurrent PID and 13 (13.8%) reported chronic pelvic pain. Less than half had subsequent pregnancies including 30 live births, seven miscarriages and one ectopic pregnancy. There was no association between the adverse reproductive outcomes and length of hospital stay >6 days, surgical treatment and recurrent PID. After adjusting for age, parity, abortion, hospital stay, surgical treatment, TOA was the only negative predictive factor for live birth (aOR 0.23, 95%CI 0.07–0.79, p = .019). The high prevalence of adverse outcomes following PID or TOA should alert clinicians for proper long-term care.

Identification of novel microbes associated with pelvic inflammatory disease and infertility

ObjectivesAs pelvic inflammatory disease (PID) aetiology is not completely understood, we examined the relationship between select novel bacteria, PID and long-term sequelae.MethodsFastidious bacterial vaginosis (BV)-associated bacteria (Sneathia (Leptotrichia) sanguinegens, Sneathia...

Status of adolescent pelvic inflammatory disease management in the United States

Pelvic inflammatory disease (PID) is a common and serious reproductive health disorder and disease rates remain unacceptably high among adolescent girls and young adult women in the United States. Despite data demonstrating that women experience major adverse health outcomes after PID, national recommendations for management of adolescents have become increasingly less cautious in an era of cost-containment. In this review, we take an alternative look at published data on adolescents with PID to frame the next steps for optimizing management for this vulnerable population. Several findings emerge from review of the literature. First, there is limited evidence to guide the best practice strategies for adolescents with PID due to low enrolment of early and middle adolescents in national trials. Second, adolescents and adult women in the United States receive suboptimal treatment regimens per Centers for Disease Control and Prevention (CDC) standards. Third, available evidence suggests that adolescents are at an increased risk for poor adherence to CDC recommendations for self-care, reacquisition of sexually transmitted infections (STIs) and PID, and subsequent adverse reproductive health outcomes. Efforts to develop and integrate adolescent-focused, evidence-based strategies for PID management and prevention of subsequent STIs and recurrent PID are warranted.

Recurrent PID, Subsequent STI, and Reproductive Health Outcomes: Findings From the PID Evaluation and Clinical Health (PEACH) Study

PEACH trial data were used to evaluate the relationship between subsequent sexually transmitted infection and recurrent pelvic inflammatory disease on infertility and chronic pelvic pain (CPP). Recurrent pelvic inflammatory disease was associated with an almost 2-fold increase in infertility and more than 4-fold increase in CPP. Subsequent sexually transmitted infection was associated with CPP, but not infertility.

Microbial Correlates of Delayed Care for Pelvic Inflammatory Disease

We studied the microbial correlates of time to care and long-term outcomes among pelvic inflammatory disease (PID) patients, as delayed care may increase the risk for reproductive sequelae. Mean days of pain before care were compared by microbial pathogen (Chlamydia trachomatis only, Neisseria gonorrhoeae only, Mycoplasma genitalium only, coinfection with 2 or more pathogens, or no pathogens) among 298 women with histologically confirmed endometritis from the PID Evaluation and Clinical Health study. Times to pregnancy and recurrent PID were assessed over a mean of 84 months and compared between women who delayed care (≥14 days) and women who sought early care, in the entire cohort and in subsets defined by microbial infection. Analyses were adjusted for age and race, additionally time to pregnancy was adjusted for self-reported baseline infertility. Patients waited a mean of 7 days before seeking care for symptoms. Time to care was longest among women infected by C. trachomatis only (12.3 ± 9.4 days) and M. genitalium only (10.9 ± 8.9 days) and the shortest among women infected by N. gonorrhoeae only (4.6 ± 5 days) or coinfection (5.6 ± 5.1 days, P < 0.001). Rates of infertility, recurrent PID, and chronic pelvic pain were frequent overall (17%, 20%, and 36%) and tended to be higher, albeit nonsignificantly, after delayed care. Among women with clinically suspected PID, time to care was generally high. C. trachomatis and M. genitalium positive women had the longest times to care. Although reproductive morbidity was high in this cohort, associations with delayed care were nonsignificant.

Adverse Adolescent Reproductive Health Outcomes After Pelvic Inflammatory Disease

To compare longitudinal adolescent and adult reproductive outcomes after pelvic inflammatory disease (PID). Secondary analysis of longitudinal data from the Pelvic Inflammatory Disease Evaluation and Clinical Health study. A large multicenter randomized clinical trial assessing PID treatment strategies in the United States. Eight hundred thirty-one female patients aged 14 to 38 years with a diagnosis of PID. Adverse longitudinal outcomes were compared in adolescents (≤19 years) and adults (>19 years). Primary outcome measures included recurrent sexually transmitted infection at 30 days, recurrent PID, chronic abdominal pain, infertility, pregnancy, and times to recurrent PID and pregnancy. Cox proportional hazards modeling was used to examine the effect of young age on times to pregnancy and recurrent PID. Adolescents were more likely than adults to have positive results of sexually transmitted infection testing at baseline and at 30 days. There were no significant group differences in chronic abdominal pain, infertility, and recurrent PID at 35 or 84 months, but adolescents were more likely to have a pregnancy at both time points. Adjusted hazard ratios (95% confidence intervals) also demonstrated that adolescents had shorter times to pregnancy (1.48 [1.18-1.87]) and recurrent pelvic inflammatory disease (1.54 [1.03-2.30]). Adolescents may require a different approach to clinical care and follow-up after PID to prevent recurrent sexually transmitted infections, recurrent PID, and unwanted pregnancies.

Failure of cefoxitin and doxycycline to eradicate endometrial Mycoplasma genitalium and the consequence for clinical cure of pelvic inflammatory disease

Objectives:As Mycoplasma genitalium is associated with pelvic inflammatory disease (PID), we examined the efficacy of a commonly used PID antimicrobial in treating M genitalium upper genital tract infection.Methods:In the PID...

Chlamydia Antibodies, Chlamydia Heat Shock Protein, and Adverse Sequelae After Pelvic Inflammatory Disease: The PID Evaluation and Clinical Health (PEACH) Study

Among women with pelvic inflammatory disease (PID), we assessed the associations among antibodies to Chlamydia trachomatis elementary bodies (EB), antibodies to chlamydia heat shock protein (Chsp60), rates of pregnancy, and PID recurrence. Four hundred forty-three women with clinical signs and symptoms of mild to moderate PID enrolled in the PID Evaluation and Clinical Health Study were followed for a mean of 84 months for outcomes of time-to-pregnancy and time-to-PID recurrence. Antibodies to EB and Chsp60 were assessed in relation to these long-term sequelae of PID. Rates of pregnancy were significantly lower (adj. hazard ratio 0.47, 95% confidence interval 0.28-0.79) and PID recurrence higher (adj. hazard ratio 2.48, 95% confidence interval 1.00-6.27) after adjusting for confounding factors among women whose antibody titers to chlamydia EB measured in the final year of follow-up were in the highest tertile. Among women with mild to moderate PID, antibodies to C. trachomatis were independently associated with reduced rates of pregnancy and elevated rates of recurrent PID.

Discussion: ‘Predicting long-term PID sequelae with treatment markers’ by Trautmann et al

Discussion: ‘Predicting long-term PID sequelae with treatment markers’ by Trautmann et al

Do short-term markers of treatment efficacy predict long-term sequelae of pelvic inflammatory disease?

This study was undertaken to assess whether short-term markers, often used to measure clinical cure after treatment for pelvic inflammatory disease, predict sequelae of lack of pregnancy, recurrent pelvic inflammatory disease, and chronic pelvic pain. Women with mild-to-moderate pelvic inflammatory disease were assessed after treatment initiation at 5 days for tenderness (n = 713) and at 30 days for tenderness, cervical infections and endometritis (n = 298). Pregnancy, recurrent pelvic inflammatory disease, and chronic pelvic pain were evaluated after 84 months, on average. Pelvic tenderness at 5 and at 30 days significantly elevated the risk for developing chronic pelvic pain; tenderness at 30 days was also significantly associated with recurrent pelvic inflammatory disease. However, pelvic tenderness at 5 and at 30 days was only modestly clinically predictive of chronic pelvic pain or recurrent pelvic inflammatory disease (positive predictive values 22.1-66.9%). No short-term marker significantly influenced the likelihood of achieving a pregnancy. Tenderness at 5 or 30 days did not accurately predict the occurrence of pelvic inflammatory disease-related reproductive morbidities.

Mycoplasma Genitalium is Associated with Persistent and Recurrent Pelvic Inflammatory Disease

Mycoplasma Genitalium is Associated with Persistent and Recurrent Pelvic Inflammatory Disease