Severe Pelvic Inflammatory Disease Research Articles

Pelvic inflammatory disease in women with endometriosis is more severe than in those without

To determine the incidence and severity of acute pelvic inflammatory disease (PID) or tubo-ovarian abscess (TOA) in hospitalised women with and without a history of endometriosis. Retrospective analysis of hospital records retrieved for all women hospitalised with PID or TOA between January 2008 and December 2011 in a tertiary referral centre. Women were compared with regard to a history of endometriosis for demographic, clinical and fertility data. 26 (15%) of the 174 women hospitalised due to PID or TOA were excluded because of age older than 45years, leaving 148 for analysis. The mean age was 35.7±9.3years and mean duration of hospitalisation was 5.9±3.7days. The women were divided into two groups: Group 1 with endometriosis (n=21) and Group 2 without endometriosis (n=127). Women in Group 1 as compared with Group 2 were significantly more likely to have undergone a fertility procedure prior to being admitted to the hospital with PID (9/27 (45%) vs 22/121 (17%), P<0.001); particularly in vitro fertilisation (IVF) (7/ 27 (33%) vs 12/121 (9%), P<0.006); Women in Group 1 more frequently experienced a severe and complicated course involving longer duration of hospitalisation (8.8±4.7 vs 4.4±2.3days, P<0.0001) and antibiotic treatment failure (10/27 (48%) vs 8/121 (6%), P<0.0001). Pelvic inflammatory disease in women with endometriosis is more severe and refractory to antibiotic treatment, often requiring surgical intervention. It is likely that endometriosis is a risk factor for the development of severe PID, particularly after IVF treatment.

Under-Reporting of Pelvic Inflammatory Disease in Hawaii: A Comparison of State Surveillance and Hospitalization Data

Hawaii is one of only 19 states for which pelvic inflammatory disease (PID) is a mandated notifiable disease. In order to assess the completeness of PID reporting, we compared the number of hospitalized PID cases in the state of Hawaii with the total number of PID cases reported to the Hawaii State Department of Health surveillance system from 2007 through 2010. While 828 unique PID cases were diagnosed in Hawaii hospitals, only 240 unique PID cases were reported through the state's surveillance system. Severe PID underreporting was seen despite mandatory reporting laws.

Stérilet et infections pelviennes sévères. Étude monocentrique en continu de 70 cas en cinq ans

BackgroundEvaluation of relation between uterine devices and severe pelvic inflammatory disease. Patients and methodsMedical and surgical data for 5 years were collected in an universitary center. ResultsSeventy patients were found whose seven needed reanimation and ten, two or more surgical procedures. Risks factors were old age (>45 years) and time exposure (>5 years). Discussion and conclusionSevere pelvic inflammatory disease and uterine devices in not uncommon association. Prolonged use seems to be a risk factor.

Pathogenesis, Diagnosis, and Management of Severe Pelvic Inflammatory Disease and Tuboovarian Abscess

Severe pelvic inflammatory disease and tuboovarian abscesses (TOAs) are common pelvic infections requiring inpatient admission. There are few large randomized trials guiding appropriate clinical management of TOA, including antibiotic selection and timing of surgical management and drainage. The pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and TOA are summarized and reviewed from the most current literature.

P27 An audit on the management of pelvic inflammatory disease (PID)

BackgroundThe 2005 (revised in 2011) UK national guidelines on the management of PID state two auditable outcomes: (1) Proportion of women receiving treatment with a recommended regimen—target 95%. (2) Proportion of named male contacts screened for infection and/or treated—target 0.4 (large urban centres) or 0.6 (other centres) per index case. The guidelines also recommend patients with moderate or severe PID are reviewed after 72 h and all patients are reviewed after 2–4 weeks.AimsTo audit the management, follow-up and partner notification (PN) of PID in our clinic.MethodsRetrospective notes review of PID cases presenting between December 2009 and July 2011. Data were collected on drug treatment, follow-up and PN. Cases with a sexually transmitted infection (STI) were compared to cases with no STI identified.ResultsOf 130 PID cases identified, 58 had an STI diagnosed of whom seven hadNeisseria gonorrhoeae(GC) and 57 hadChlamydia trachomatis(CT). Six cases had both GC and CT. One patient had no documentation of drugs prescribed and one received only Doxycycline (see abstract P27 table 1).Abstract P27 Table 1Management of patients diagnosed with PIDSTI identified (n=58)No STI identified (n=72)Partner notification (PN) Partner notified21 (36.2%)19 (26.4%) Partner notified and treated20 (34.5%)5 (6.9%) PN recommended6 (10.3%)0 No documentation of PN31 (53.5%)53 (73.6%)Treatment prescribed Doxycycline and metronidazole46 (79.3%)59 (81.9%) Macrolide and metronidazole6 (10.4%)7 (9.7%) Ofloxacin and metronidazole (GC cover)5 (8.6%)5 (7.0%) Cephalosporin prescribed (GC cover)40 (69.0%)44 (61.1%)Follow-up Follow-up advised in 3 days00 Follow-up advised in 2–4 weeks47 (81%)69 (95.8%) Follow-up attended47 (81%)29 (40.3%)ConclusionBASHH guidelines recommend GC cover for all PID cases but the proportion receiving this was 72.9%. All cases diagnosed with GC received GC cover. PN rates did not reach national recommendations and this may be related to diagnostic uncertainty especially when no STI is apparent. PN was better in cases with a STI where health advisers were involved than in cases without an STI, seen by doctors. No patients were advised to return for follow-up within 3 days but the majority returned within 2–4 weeks. Those with an STI diagnosed were significantly more likely to attend follow-up p&lt;0.0001.

P61 IM ceftriaxone for all pelvic inflammatory disease: to give or not to give?

AimTo audit the care of Pelvic Inflammatory Disease (PID) in a city centre Genitourinary medicine clinic.Objectives(1) To assess the effectiveness of PID treatment offered by evaluating the auditable outcomes recommended...

Vaginal Hysterectomy (Nonprolapsed) and Its Impact on a Patient with Gynecologic Menstrual Disorders: Experience in a Tertiary Care Hospital in Bangladesh

Abstract Introduction: Hysterectomy is a common gynecologic operation in woman all over the world. Alhough there are numerous benefits of vaginal over abdominal hysterectomy, all large-scale surveys of hysterectomy practice have shown that 70%–80% of all hysterectomies are performed abdominally. The rationale for this study is the statement that the vaginal route is to be preferred every time the anatomic conditions allow it and every time the nature of the lesions to be treated does not contraindicate it. Aims: The aims of this study were to evaluate the feasibility and complication rate of vaginal hysterectomy in women with enlarged uteri and other traditionally considered contraindications to abdominal surgery. Materials and Methods: Three hundred consecutive women with an enlarged uterus weighing between 280 and 2000 g and/or with the following commonly considered contraindications to vaginal surgery: previous pelvic surgery; history of severe pelvic inflammatory disease; moderate or severe endometrio...

Manejo laparoscópico de la enfermedad pélvica inflamatoria severa: reporte de tres casos y revisión de la literatura

Objetivo: hacer una revisión de la literatura sobre la utilidad de la laparoscopia en el tratamiento del absceso tubovárico en términos de mejoría, estancia y fertilidad posterior.Materiales y métodos: se presentan tres casos de pacientes con enfermedad pélvica inflamatoria severa que consultaron a una institución privada de referencia ubicada en Medellín (Colombia), a quienes se les practicó una laparoscopia operatoria, además de la administración de un antibiótico parenteral como manejo. Se realizó una búsqueda en la base de datos Medline vía PubMed con las palabras clave:“tubo-ovarian abscess, treatment, laparoscopy, fertility”. Se realizó además una búsqueda de textos clásicos y guías de manejo.Resultados: se encontraron 49 artículos de los cuales 13 eran relevantes al problema en cuestión. De estas publicaciones, 8 eran artículos de revisión, 4 series de casos, y 1 un estudio de cohortes retrospectivas.Conclusión: el manejo laparoscópico conservador del absceso tubovárico en el período inicial de la enfermedad, adicional a los antibióticos, surge como una alternativa que podría mejorar los resultados a corto y largo plazo. Se requieren estudios de alta calidad que respalden esta observación.

Recommendations and rationale for the treatment of pelvic inflammatory disease

Pelvic inflammatory disease (PID) is one of the most common serious infections of nonpregnant women of reproductive age. Management of PID is directed at containment of infection. Goals of therapy include the resolution of clinical symptoms and signs, the eradication of pathogens from the genital tract and the prevention of sequelae including infertility, ectopic pregnancy and chronic pelvic pain. The choice of an antibiotic regimen used to treat PID relies upon the appreciation of the polymicrobial etiology of this ascending infection including Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and other lower genital tract endogenous anaerobic and facultative bacteria, many of which are associated with bacterial vaginosis. Currently available evidence and the CDC treatment recommendations support the use of broad-spectrum antibiotic regimens that adequately cover the above named microorganisms. The outpatient treatment of mild-to-moderate PID should include tolerated antibiotic regimens consisting of an extended-spectrum cephalosporin in conjunction with either azithromycin or doxycycline. Clinically severe PID should prompt hospitalization and imaging to rule out a tubo–ovarian abscess. Parenteral broad-spectrum antibiotic therapy with activity against a polymicrobial flora, particularly Gram-negative aerobes and anaerobes, should be implemented.

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection-caused inflammatory continuum from the cervix to the peritoneal cavity. Most importantly, it is associated with fallopian tube inflammation, which can lead to infertility, ectopic pregnancy, and chronic pelvic pain. The microbial etiology is linked to sexually transmitted microorganisms, including Chlamydia trachomatis, Neisseria gonorrheae, Mycoplasma genitalium, and bacterial vaginosis-associated microorganisms, predominantly anaerobes. Pelvic pain and fever are commonly absent in women with confirmed PID. Clinicians should consider milder symptoms such as abnormal vaginal discharge, metrorrhagia, postcoital bleeding, and urinary frequency as potential symptoms associated with the disease, particularly in women at risk of sexually transmitted infection. The diagnosis of PID is based on the findings of lower genital tract inflammation associated with pelvic organ tenderness. The outpatient treatment of mild-to-moderate PID should include tolerated antibiotic regimens with activity against the commonly isolated microorganisms associated with PID and usually consists of an extended spectrum cephalosporin in conjunction with either doxycycline or azithromycin. Clinically severe PID should prompt hospitalization and imaging to rule out a tuboovarian abscess. Parenteral broad-spectrum antibiotic therapy with activity against a polymicrobial flora, particularly gram-negative aerobes and anaerobes, should be implemented. Screening for and treatment of Chlamydia infection can prevent PID.

Imaging pelvic inflammatory disease

Pelvic inflammatory disease (PID) encompasses a range of infections of the female genital tract that may be asymptomatic, or range from mild non-specific symptoms to fulminant life-threatening disease. Infection can involve the endometrium, fallopian tubes or ovaries and can occasionally spread to involve the peritoneum. Mostly PID is diagnosed clinically and treated without the need for imaging. Where imaging is required, it is mainly for the assessment of non-specific clinical symptoms and signs in which PID is a differential diagnosis, or for the complications of more severe PID infections. The high resolution of ultrasound makes it highly sensitive for the evaluation of the gynaecological organs including the fallopian tubes when abnormal, and is usually the first imaging investigation obtained. Other types of imaging including computed tomography, magnetic resonance imaging and hysterosalpingography are also used, mainly in more complex cases. The imaging appearances of PID on all modalities are discussed in this review to obtain an overall picture of imaging this disease.

Role of d-dimer testing in severe pelvic inflammatory disease: a new usable marker to assess the need for fertility-impairing surgery?

Pelvic inflammatory disease (PID), like many other inflammatory diseases, can be characterized by an inflammation-induced activation of the coagulation cascade, resulting in the production of D-dimers. In this study it is demonstrated how high levels of D-dimers, assayed at the time of hospitalization, are encountered in patients diagnosed with PID and how the levels of this parameter are significantly higher in patients, which due to the severity of the disease, needed surgical treatment. Therefore the d-dimer is shown to be an important parameter to be considered in the therapeutic counseling of severe forms of PID.

Topical negative pressure in managing severe peritonitis: A positive contribution?

To assess the use of topical negative pressure (TNP) in the management of severe peritonitis. This is a four-year prospective analysis from January 2005 to December 2008 of 20 patients requiring TNP following laparotomy for severe peritonitis. There were 11 males with an average age of (59.3 +/- 3.95) years. Nine had a perforated viscus, five had anastomotic leaks, three had iatrogenic bowel injury, and a further three had severe pelvic inflammatory disease. TNP and the VAC(R) Abdominal Dressing System were initially used. These were changed every two to three days. Abdominal closure was achieved in 15/20 patients within 4.53 +/- 1.64 d. One patient required relaparotomy due to residual sepsis. Two patients with severe faecal peritonitis due to perforated diverticular disease received primary anastomosis at second look laparotomy, as sepsis and their general condition improved. In the remaining 5/20 cases, the abdomen was left open due to bowel oedema and or abdominal wall oedema. Dressing was switched to TNP and VAC GranuFoam. Three of the five patients returned a few months later for abdominal wall reconstruction and restoration of intestinal continuity. Two patients developed intestinal fistulae. All 20 patients survived. The use of TNP is safe. Further studies are needed to assess its value in managing these difficult cases.

Gonococcal peritonitis diagnosed post laparotomy in a 38-year-old woman: a case report

A 38-year-old South African lady with a background history of cervical intra-epithelial neoplasia and recent colposcopy presented to the emergency department with severe abdominal pain. Initial investigations were non-diagnostic and despite empirical antibiotic therapy the patient developed peritonism. Post-laprotomy the diagnosis of severe pelvic inflammatory disease and peritonitis secondary to infection with Neisseria Gonorrhoea was made.

Incidence of Fitz-Hugh–Curtis Syndrome in Adolescents Who Have Pelvic Inflammatory Disease

Purpose We determined the incidence of Fitz-Hugh–Curtis syndrome (FHCS) in adolescents who had mild to moderately severe pelvic inflammatory disease (PID). Design Prospective cohort study. Setting Harris County Juvenile Detention Center, April 2000–April 2006. Participants Incarcerated female adolescents. Intervention In patients who met accepted criteria for the diagnosis of PID, we determined the proportion that had right upper quadrant pain that responded to therapy for PID. They were diagnosed as having FHCS. Results The 117 subjects' mean age (SD) was 15.6 (1.8) years; 37% were Hispanic, 34% black, and 26% white. 5/117 (4.3%, 95% confidence interval 1.4–9.7%) had symptomatic FHCS. Fifteen (13%) of all subjects, including 1 with FHCS, had fever and/or nausea and vomiting (moderately severe PID): none had generalized peritonitis or tubo-ovarian abscess (severe PID). Thirty-four had chlamydial, 4 gonorrheal, and 9 combined infections. All improved with standard outpatient PID therapy. Conclusion FHCS was uncommon (4%) in adolescents who had mild to moderate PID and chlamydia as the most common pathogen.

Candida krusei pneumonia as a complication of a tuboovarian abscess treatment – case report

Background: Frequency of infections, caused by Candida glabrata and Candida krusei, which are more resistant to fluconazole, is increasing among hospitalised patients, especially among patients in intensive care units (ICU). Systemic Candida infections are particularly dangerous. Pneumonia, caused by Candida species, most commonly albicans, rarely others, is a serious infection especially for immunocompromised patients. It’s often fatal. We present a case report of a serious lung infection with fluconazole resistant Candida krusei in a 42-year-old previously healthy patient with perforated tuboovarian abscess (TOA), consecutive severe sepsis and septic shock. Patient used intrauterine device (IUD) for 17 years without any gynaecological controls. Ascending genital infection with E.colli and Staph. chromogenes led to TOA. In spite of empirical antibiotic treatment, surgical and intensive care supportive therapy of affected organs, patient’s condition critically deteriorated until exact fungus specification was made and specific antifungal therapy for Candida krusei with voriconazol was started. After that patient’s condition improved. Conclusions: Connection between patient’s age, IUD use duration and severity of the pelvic inflammatory disease (PID) was seen as multiorgan septic dysfunction with dominant lung failure. Candida pneumonia is rare with non-neutropenic patients. Especially with »non albicans« species. We believe Candida krusei infection in our patient is related to general weakness and immunocompromised condition because of prolonged and severe PID. Candida krusei infection needs immediate specific antifungal treatment. It was the first Candida krusei infection in our ICU.

Women and Human Immunodeficiency Virus: Unique Management Issues

Women currently account for an increasing proportion of the US population infected with human immunodeficiency virus (HIV). Although women suffer from similar HIV-related complications as men, they also can have unique gynecologic manifestations, such as cervical dysplasia or severe pelvic inflammatory disease. Other gender-specific management issues include contraception and pregnancy. Fortunately, today the perinatal HIV transmission rate can be lowered to less than 2% with appropriate management. More couples, including those discordant for HIV infection, are opting to pursue conception. Providers caring for HIV-infected women should be knowledgeable about reproductive choices, including the full array of available options. Strategies shown to improve access of health care to HIV-infected women include integrating gynecologic services with primary care, daily availability of medical services, provision of transportation, and provision of on-site childcare.

OC197: Transvaginal ultrasound findings in women with moderate to severe pelvic inflammatory disease

OC197: Transvaginal ultrasound findings in women with moderate to severe pelvic inflammatory disease

Fecundity and morbidity following acute pelvic inflammatory disease treated with doxycycline and metronidazole.

We studied fecundity and late sequelae of 39 women who had laparoscopic and microbiological sampling-proven acute pelvic inflammatory disease (PID) treated with the same antimicrobial regimen. The grade and etiology of index PID were classified using laparoscopy, endometrial biopsy and microbiological cultures from the cervix, endometrium and tubes: 20 had mild and 19 severe PID. The mean (SD) follow-up period after the index PID was 125 (44) [range 8-204] months. The primary end-point was pregnancy. All other or recurrent infections or other diseases related to the infection, including infertility, were evaluated. Twenty (51%) women had laparotomy or second laparoscopy during follow-up and findings were evaluated. Chlamydia trachomatis was isolated in 38% of all cases. Eleven (28%) of 39 women avoided conception or it was no longer possible. Twenty-eight women had tried to conceive after the index PID and 25 (89%) of them had at least one pregnancy. Twenty-five women had 56 pregnancies, 33 (59%) of which ended in delivery, 9 (16%) miscarried, 13 (23%) were induced abortion and only one (1.8%) tubal pregnancy occurred. Etiologic factors or severity of PID made no difference to the conception rate. Patients with mild or moderate salpingitis had a high conception rate. Endometriosis was found in 6 (30%) out of 20 women with second laparoscopy or laparotomy. Hysterectomy had been performed in 4 cases. Precise diagnosis of acute PID is the cornerstone for the treatment of the condition. Combination regimens, including drugs against the most common factors underlying acute PID against both aerobic and anaerobic microbes, prevent late sequelae in cases with mild or moderate salpingitis but not in cases with tubal or pelvic abscess.

Severity of pelvic inflammatory disease as a predictor of the probability of live birth

OBJECTIVE: Our aim was to study the association between severity of pelvic inflammatory disease at laparoscopy and the probability of achieving a live birth, while accounting for subsequent episodes of pelvic inflammatory disease. STUDY DESIGN: Beginning in 1960 a cohort of 1288 women in Lund, Sweden, who had clinical symptoms of acute pelvic inflammatory disease and who desired pregnancy was followed for up to 24 years. All participants underwent laparoscopy and were categorized by degree of salpingitis: mild ( n = 371), moderate ( n = 580), or severe ( n = 337) pelvic inflammatory disease. Cumulative live birth rates, obtained by life-table analysis, and proportional hazards ratios were compared among women by severity of pelvic inflammatory disease, while accounting for subsequent episodes. RESULTS: The cumulative proportion of women achieving a live birth after 12 years was 90% for women with mild, 82% for women with moderate, and 57% for women with severe pelvic inflammatory disease. The occurrence of subsequent episodes in women with mild pelvic inflammatory disease did not diminish their long-term probability of live birth, whereas it significantly lowered the probability of live birth in women with severe pelvic inflammatory disease. Women with severe disease and subsequent episodes were eight times more likely to fail to achieve live birth compared with women with a single pelvic inflammatory disease episode with mild disease (relative risk 8.1; 95% confidence interval 3.0 to 22.2). CONCLUSIONS: Increasing severity of pelvic inflammatory disease correlates with a lower long-term probability of live birth. Subsequent episodes have a greater impact on women with severe pelvic inflammatory disease at the index episode compared with those with milder disease. (Am J Obstet Gynecol 1998;178:977-81.)