Severe Pelvic Inflammatory Disease Research Articles

Characteristics of Acute Pelvic Inflammatory Disease in Surgically Treated Females Over Ten Years - A Single-Center Study

Background: Pelvic inflammatory disease (PID) is a public health problem that demands rapid diagnosis and treatment and may severely impair female reproductive health. Objective: To analyze anamnestic information, laboratory findings, and clinical and microbiological features of patients with severe acute PID that underwent a surgical procedure. Methods: This retrospective study enrolled 97 cases that were surgically treated in the Department of Obstetrics and Gynecology, University Hospital „ Sveti Duh“ between 2009 and 2019. Results: Most women were within the age group 35-44 (38.14%). Lower abdominal pain was the most common symptom (92.78%). Compared to intraoperatively confirmed PID, C-reactive protein (CRP) yielded the highest sensitivity (88.10%) while cervical motion tenderness possessed the highest specificity (53.85%). The tubo-ovarian abscess was detected in 35.05% of intraoperative specimens, mainly occurring in women between 45-54 years (P=0.017) and absent between 15-24 (P=0.012) and 25-34 years (P=0.049). The length of hospital stay was influenced by the number of symptoms (ρ=0.316, P=0.002), admission CRP levels (ρ=0.620, P<0.001), and admission body temperature (ρ=0.386, P<0.001). Out of 59.30% of positive cultures, one pathogen was isolated in 70.59%, mainly Escherichia coli (41.18%). Admission CRP levels impacted the efficacy of microbiologic isolation (P=0.001). The empirical treatment was mostly based on the clindamycin/gentamicin combination (51.72%). Conclusion: Severe clinical picture that requires surgical treatment can be expected in women >35 years. Longer hospital stay was associated with more symptoms, higher CRP, and temperature values on admission. It is important to have a low threshold for diagnosis and to consider both aerobic and anaerobic pathogens when selecting antibiotic treatment.

A New Marker for the Diagnosis of Acute Pelvic Inflammatory Disease: Immature Granulocyte.

The goal is to assess the role of immature granulocytes (IG) in the diagnosis of acute pelvic-inflammatory-disease (PID) and to determine whether they are useful for discriminating mild/moderate and severe PID. Patients admitted with the diagnosis of acute PID were retrospectively assessed. Diagnosis was based on CDC criteria. Patients were grouped as severe and mild/moderate PID based on need for hospitalization. Control group consisted of patients in whom PID was excluded by laparoscopy. Sample size was calculated with statistical methods. IGs were compared within the groups. Cutoff values were determined for prediction of diagnosis and severity of acute PID. There were 74 severe, 32 mild/moderate acute PID, and 41 control patients. Thirty patients had surgery following no response to antibiotic treatment or tubo-ovarian abscess. IGs were significantly higher in the severe group compared to mild/moderate and control groups. ROC analysis showed IG counts (≥ 0.035 µL) and percentages (≥ 0.35%) were significantly effective in predicting acute PID and were associated with severity when they were ≥ 0.055 µL and ≥ 0.42%, respectively. IG count ≥ 0.085 was found to have 58.6% sensitivity and 63.1% speci-ficity for prediction of surgical intervention need. IGs are components of simple CBC tests and are easily obtainable, cheap markers. They were found to be elevated in acute PID and correlated significantly with the severity of the disease. These markers may serve as adjunctive markers for the diagnosis of acute PID and may be useful in discrimination between mild/moderate and severe PID.

Endometrioma increases the risk of antibiotic treatment failure and surgical intervention in patients with pelvic inflammatory disease

To evaluate the outcome of pelvic inflammatory disease (PID) in patients with endometriosis with and without ovarian endometrioma. A retrospective cohort study. A single university-affiliated tertiary center. A total of 116 patients with endometriosis hospitalized because of PID between the years 2011-2021. Fifty-nine patients with an ovarian endometrioma component were compared with 57 patients with endometriosis without endometrioma. None. The primary outcome was severe PID defined as the need for surgical intervention or drainage. Secondary outcomes included tubo-ovarian abscess, number of hospitalization days, a positive cervical bacterial culture or urine sexually trasmitted disease polymerase chain reaction (STD PCR) test, and readmission because of partially treated or relapsing PID. PID in patients with endometrioma was found less likely to respond to antibiotic treatment with increased risk for surgical intervention or drainage compared with endometriosis patients without endometrioma (adjusted odds ratio, 3.5; confidence interval, 1.25-9.87). On admission, patients with endometrioma were older (26.5 vs. 31.0) and less likely to have an intrauterine device (19.3% vs. 5.1%) compared with patients without endometrioma. The rate of the tubo-ovarian abscess (52.5% vs. 19.3%) was significantly higher in patients with endometrioma. Readmission rate, positive bacterial culture, and hospitalization duration were higher in the endometrioma group; however, they did not reach statistical significance. Recent oocyte retrieval and patient's age were not associated with an increased risk of severe PID. Endometrioma patients with PID are less likely to respond to antibiotic treatment and present a higher risk for surgical intervention.

Performance of a rapid molecular test to detect Chlamydia trachomatis and Neisseria gonorrhoeae in women with pelvic inflammatory disease

ObjectiveThe aim of this study was to investigate the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in women with pelvic inflammatory disease (PID) and the usefulness and cost-effectiveness of a rapid molecular test for the diagnosis and clinical management of PID. MethodsThis observational study included 75 patients with mild-to-moderate PID (n=33), severe PID (n=29) and non-specific lower abdominal pain (NSAP) (n=13). CT/NG infections were analyzed using a standard and a rapid test. A cost analysis was carried out. ResultsSamples of 19 patients (25.3%) were CT/NG positive. Concordance between rapid and standard tests was 100%. No significant differences were observed in the incidence of CT/NG in mild-to-moderate compared to severe PID. Costs differed according only to disease severity. ConclusionsRapid molecular tests could help with the diagnosis of PID in sexually active women in clinical settings in which a standard technique is not available.

Different Outcomes of Pelvic Inflammatory Disease after Transvaginal Oocyte Retrieval in Patients with and without Endometriosis and the Factors Influencing Its Treatment: A Retrospective Study of 66 Cases

Background: Even though endometriosis is an important risk factor for pelvic inflammatory disease (PID), it is still not clear whether endometriosis influences PID after ultrasound-guided transvaginal oocyte retrieval (TVOR). Therefore, this work was designed to explore whether endometriosis will influence PID after TVOR and study the influencing factors of receiving drainage treatment to improve the outcomes of patients with PID. Methods: A retrospective study was conducted between 2004 and 2017. Data were collected from Women’s Hospital, Zhejiang University School of Medicine, China. This study included 66 patients with acute PID symptoms after TVOR with or without endometriosis. The independent factors predicting drainage treatment were determined using univariate and multivariate logistic regression analyses, and their optimal cut-off points were ascertained using a receiver operating characteristic curve. Results: Among 66 cases, there were 53 women without endometriosis and 13 women with stage III or IV endometriosis. The significantly higher maximum body temperature (p = 0.047), longer days of fever (p = 0.043) and duration of intravenous (IV) antibiotic use (p = 0.001), and more receiving drainage treatment (p = 0.002) were found in the patients with endometriosis. In vitro fertilization (IVF) cycles (odds ratio [OR] = 6.055, 95% confidence interval [CI] = 1.360–26.961, p = 0.018), puncture cyst during TVOR (OR = 60.167, 95% CI = 2.477–1461.619, p = 0.012), and pre-treatment C-reactive protein (CRP; OR = 1.022, 95% CI = 1.003–1.041, p = 0.022) were significant independent risk factors for drainage treatment. The optimal cut-off for IVF cycles and pre-treatment CRP for patients receiving drainage treatment were 2 and 40.3 mg/L, respectively. Conclusions: Patients with endometriosis had more severe PID outcomes after TVOR, requiring more attention during treatment. Early drainage treatment is recommended for patients with pre-treatment CRP levels higher than 40.3 mg/L, puncture cyst during TVOR, and those receiving more than 2 IVF cycles.

Performance of a rapid molecular test to detect Chlamydia trachomatis and Neisseria gonorrhoeae in women with pelvic inflammatory disease

ObjectiveThe aim of this study was to investigate the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in women with pelvic inflammatory disease (PID) and the usefulness and cost-effectiveness of a rapid molecular test for the diagnosis and clinical management of PID. MethodsThis observational study included 75 patients with mild-to-moderate PID (n=33), severe PID (n=29) and non-specific lower abdominal pain (NSAP) (n=13). CT/NG infections were analyzed using a standard and a rapid test. A cost analysis was carried out. ResultsSamples of 19 patients (25.3%) were CT/NG positive. Concordance between rapid and standard tests was 100%. No significant differences were observed in the incidence of CT/NG in mild-to-moderate compared to severe PID. Costs differed according only to disease severity. ConclusionsRapid molecular tests could help with the diagnosis of PID in sexually active women in clinical settings in which a standard technique is not available.

Antibiotic therapy for pelvic inflammatory disease

Antibiotic therapy for pelvic inflammatory disease

Inflammation calls for more: Severe pelvic inflammatory disease with or without endometriosis. Outcomes on 311 laparoscopically treated women

ObjectiveTo study possible associations between endometriosis and pelvic inflammatory disease (PID). DesignRetrospective cohort analysis over 14 consecutive years, based on medical records and insurance coding in a tertiary care endometriosis reference center. SettingTertiary care reference center for endometriosis. PatientsRetrospective analysis on all women submitted to laparoscopy in our Unit Main Outcome MeasuresIntra-operative data about complications and fertility-impairing procedures, intra-, peri- and post-operative complications. InterventionsRetrospective disease codes–triggered chart analysis. ResultsThe study population was divided into two groups: Group 1 included women with PID and no endometriosis (n = 115); Group 2 included women with PID and endometriosis (n = 96). Endometriosis had a prevalence of 63 % in patients submitted to surgery for PID, significantly higher than the one reported in general population and than the one reported in a Tertiary Care Endometriosis Unit.A significantly higher number of salpingectiomes was needed in group 2 patients (208 versus 80, p < 0.0001). ConclusionsThis study seems to confirm an higher prevalence of pelvic inflammatory disease in endometriosis patients.Intra-operative findings of PID with associated endometriosis show more aggressive patterns

Surgical Management of Severe Pelvic Inflammatory Disease: Laparoscopy or Laparotomy?

Treatment of women with severe pelvic inflammatory disease (PID) and tubo-ovarian abscesses is complex, typically including broad-spectrum antibiotics

Laparoscopic Compared With Open Surgery for Severe Pelvic Inflammatory Disease and Tubo-Ovarian Abscess

To compare operative outcomes of laparoscopic surgery compared with laparotomy in patients with moderate to severe pelvic inflammatory disease (PID). Using the Diagnosis Procedure Combination database, a national inpatient database for acute-care inpatients in Japan, we performed a large, nationwide retrospective cohort study. We identified all patients aged 18 years or older who were diagnosed with PID with or without tubo-ovarian abscess and were admitted to a participating hospital from July 2010 to March 2016. We excluded patients who were pregnant, had cancer, or for whom data were missing. We compared outcomes between patients who underwent laparoscopic surgery compared with laparotomy. Propensity score-matched analyses were performed to compare operative outcomes including postoperative length of stay, surgical complications, in-hospital deaths, and revision surgery. Of 27,841 patients with PID, 4,419 (15.9%) underwent surgical intervention. From among 749 women undergoing laparoscopy and 3,670 women undergoing laparotomy for PID, 740 pairs were created for propensity score matching. The laparoscopic group had shorter operation duration (125 vs 166 min), fewer blood transfusions (4.7% vs 10.0%), and shorter length of hospital stay (median 5 days vs 7 days; all P<.001) compared with the laparotomy group. There were no significant differences between groups for in-hospital deaths, surgical complications, and revision surgery. Laparoscopic surgery may have clinical advantages over laparotomy in patients diagnosed with severe PID.

60. Tubo-ovarian Abscess in Non-sexually Active Adolescent Girls: A Case Series

A tubo-ovarian abscess (TOA) is a complex infectious mass involving the fallopian tubes and ovaries, which may extend to nearby abdominal organs, often resulting from severe pelvic inflammatory disease (PID). Data regarding TOAs and PID in non-sexually active females is limited primarily to case studies. Early treatment is important for future quality of life, specifically to minimize chronic pelvic pain and maximize fertility. We investigated risk factors and common causes of TOAs in non-sexually active females, in order to aid in earlier diagnosis, treatment, and improved outcomes.

Benefits of second-look laparoscopy in the management of pelvic inflammatory disease

ObjectiveTo evaluate the benefits of second-look laparoscopy (SLL) in pelvic inflammatory disease (PID). Study designA 5- year retrospective study conducted at Clermont-Ferrand University Hospital and included all patients who had undergone SLL following a PID. Data collection comprised patient and disease characteristics, type of initial medical or surgical treatment, adhesion (AFS) and tubal (MAGE) scores recorded during SLL and outcomes following subsequent pregnancies. Results76 patients who had received SLL were included. A higher rate of severe adhesions was recorded during SLL in patients with stage 3 PID, than for women with stage 1 and 2 (63.6% versus 25%, p = 0.01). A higher rate of Mage scores of 4 were also found in patients with stage 3 PID (25.8% versus 0%, p = 0.001). Multivariate analysis revealed that women at stage 3 are 17 times more likely to have a high level of adhesions than patients at stage 1 (OR [95% CI] = 17.4 [1.7; 1]). A Mage score of 1was found to be associated with higher pregnancy and live birth rates. Conclusion(s)SLL seems presents benefits for the preservation of fertility in cases of severe PID with tubo ovarian abcess and may be proposed to patients with stage 3 salpingitis and desire for pregnancy. Further prospective randomized study should be done to confirm these results.

Estimated burden of Chlamydia trachomatis female infection and consequent severe pelvic inflammatory disease, Italy, 2005-2016.

Chlamydia trachomatis (Ct) is the leading sexually transmitted infection (STI) across Europe. In Italy, Ct prevalence is low in general population, but predominance of asymptomatic infections, passive voluntary reporting, variable diagnostic criteria and coding practices can lead to considerable underestimation, preventing assessment of real burden of disease and health intervention. We analysed data on female genital Ct infection registered in STI sentinel surveillance systems in Italy from 2005 through 2016 and found 3305 women. Among them, those aged 20-24 years had the highest disability-adjusted life years (DALYs) estimation equal to 106.77 DALYs per 100 000-stratum specific population. Through the study period, incidence rate (IR) for female Ct infection increased significantly from 2.9 to 7.1 per 100 000 resident population. Besides, we analysed data on pelvic inflammatory disease (PID) reported from the National Hospital Information system (NHIS) in the same period. We found 287 women hospitalised with concurrent PID and Ct infection. We recommend targeted screening programmes in women aged 20-24, definition of nationwide active surveillance system, standardisation of diagnostic criteria and ICD-9CM coding practices.

Working together to improve the evidence base: abridged Cochrane reviews in SexuallyTransmittedInfections

The systematic review by Savaris and colleagues1 is important for two reasons. First is the review of the treatment of pelvic inflammatory disease (PID), a common condition for which the...

Antibiotic therapy for pelvic inflammatory disease: an abridged version of a Cochrane systematic review and meta-analysis of randomised controlled trials

ObjectiveTo assess the effectiveness and safety of antibiotic regimens used to treat pelvic inflammatory disease (PID).DesignThis is a systematic review and meta-analysis of randomised controlled trials (RCTs). Risk of bias...

Antibiotic therapy for pelvic inflammatory disease.

Antibiotic therapy for pelvic inflammatory disease.

Xanthogranulomatous Salpingo-Oophoritis Mimicking an Ovarian Malignancy – A Series of 3 Cases and Review of Literature

Background: Xanthogranulomatoussalpingo-oophoritis is an uncommon form of chronic inflammation in the genitourinary tract. Its symptoms and radiological findings mimic ovarian malignancy or severe pelvic inflammatory disease. Case (s): We describe three cases of xanthogranulomatoussalpingo-oophoritis diagnosed in our hospital and review literature on clinical features and diagnostic pitfalls of this condition. Our first patient is a 45-year-old lady who presented with abdominal pain and fever. The second patient is a 51-year-old lady who presented similarly. The last patient is a 35-year-old lady who chronic pelvic inflammatory disease. From literature, risk factors include endometriosis, leiomyoma, pelvic inflammatory disease, intrauterine copper device (IUCD) in situ and previous surgery. Most patients had abdominal pain, fever and adnexal mass on examination. Most women were treated based on the working diagnosis of malignancy or severe pelvic inflammatory disease. Conclusion: Xanthogranulomatoussalpingo-oophoritis is a rare condition that is often mistaken for ovarian malignancy clinically and radiologically. Oophorectomy is the recommended treatment but most women are “over treated” with staging laparotomies and hysterectomies that render them infertile. The presence of fever, abdominal pain, identifiable risk factors, MRI characteristics and the use of intra-operative frozen-section may aid in the diagnosis.

Association Between Reduced Risk of Intracerebral Hemorrhage and Pelvic Inflammatory Disease.

This study examines whether pelvic inflammatory disease (PID) facilitates the development of intracerebral hemorrhage (ICH).By using outpatient claims data from the National Health Insurance Research Database (NHIRD) of Taiwan, we included the data of 25,508 patients who were newly diagnosed with PID between 1999 and 2004, and also from the Taiwan NHIRD, we randomly selected 102,032 women without PID, who were frequency-matched by age and entry-year and with 4 times the number of the PID patients, as the control cohort. We measured ICH risks associated with PID and comorbidities, including hyperlipidemia, diabetes, hypertension, ischemic heart disease, and atrial fibrillation, by the end of 2011.In comparison with the controls, the ICH hazard was less in the PID group with an adjusted hazard ratio (aHR) of 0.67 (95% confidence interval [CI]:0.50–0.90), which was noted by calculation with the Cox proportional regression model. The ICH risk in the PID patients reduced progressively with the advance of age, with aHRs of 0.75 (95% CI:0.41–1.39) and 0.50 (95% CI:0.29–0.88), respectively, in the age <35-year and age ≥50-year groups. ICH risk lowered gradually with the progress of PID severity, from mild PID with an aHR of 0.72 (95% CI:0.53–0.98) to severe PID with that of 0.30 (95% CI:0.10–0.92). PID patients without any comorbidites had lower ICH risk (aHR = 0.63, 95% CI:0.42–0.94) than the controls without any comorbidites did.Our findings revealed that PID is associated with reduced ICH development, especially for older patients.

Smoking, poor nutrition, and sexually transmitted infections associated with pelvic inflammatory disease in remote North Queensland Indigenous communities, 1998-2005.

BackgroundIndigenous women in remote North Queensland have a high prevalence of unhealthy lifestyle behaviors and associated health conditions such as sexual transmitted infections (STI). The association of severe pelvic inflammatory disease (PID) with these factors has not been studied. The purpose of this study is to associate the factors with severe PID, as indicated by hospitalization in a high risk population in North Queensland Indigenous communities.MethodsA cross-sectional association of 1445 Indigenous women using linked hospital separation and survey data during 1998–2005.ResultsThe mean age of participating women was 37.4 years, 60% were of Aboriginal and 40% were Torres Strait Island (TSI) people. More than half of them (52.5%) were smokers, 9.3% had chlamydia and 2.6% had gonorrhoea with the overall prevalence of STI among those less than 25 years of age being 23.9%. Among the 47 participants diagnosed with PID in the study period, 42.5% were under 25 years and 95.7% (45 cases) were under 55 years (OR 2.5, 95% CI 1.2-4.1 among women younger than 25 compared to those 25 years and over). PID was strongly associated with smoking (OR 3.1, 95% CI 1.4-9.2) independent of age, ethnicity, STI and folate status. Low red cell folate increased PID hospitalization by 4 times (95% CI 1.5-13.2 of lowest quartile compared to the highest quartile) regardless of age. Having a STI significantly increased the likelihood of severe PID by 2.2 times (95% CI: 1.03-4.5) in Indigenous women younger than 45 years, independent of smoking and folate level. The risk of PID hospitalization was higher for gonorrheal infections (OR 3.2, 955 CI 1.1-9.6) compared to chlamydial infections (OR 1.5 95% CI 0.7-3.5).ConclusionsYoung Indigenous women in North Queensland communities are at very high risk for STI and PID. Smoking, low folate, and STI are clustered, and are associated with PID hospitalizations. Much of this can be prevented with improved nutrition and access to preventive services, especially tobacco control, regular STI screening and treatment, as well as more investment in sexual health education and awareness.Electronic supplementary materialThe online version of this article (doi:10.1186/s12905-015-0188-z) contains supplementary material, which is available to authorized users.

Comparison of severe pelvic inflammatory disease, pyosalpinx and tubo-ovarian abscess.

Inflammation of the upper genital tract causes pelvic inflammatory disease (PID), which may be complicated by pelvic abscesses, such as pyosalpinx and tubo-ovarian abscess (TOA). This study aimed to determine the clinical differences between pyosalpinx and TOA in patients with PID. We retrospectively evaluated 458 female patients who were admitted to Hallym University Kang Dong Sacred Heart Hospital for a clinical diagnosis of PID from 1 January 2007 to 30 April 2012. Sociodemographic, clinical and laboratory data were compared among the non-abscess, pyosalpinx, and TOA groups. We identified 110 patients (24%) diagnosed with pelvic abscess associated with PID, including 34 with pyosalpinx and 76 with TOA. The pyosalpinx group had shorter hospital stays (P = 0.007), lower C-reactive protein levels (P = 0.015), smaller mass sizes (P < 0.001), and fewer surgical interventions (P < 0.001) than the TOA group. Pyosalpinx is a less severe form of PID that leads to shorter hospital stays and more favorable outcomes than TOA.