Treatment Of Pelvic Inflammatory Disease Research Articles

Laparoscopic treatment of pelvic inflammatory disease and infertility implications

Laparoscopic treatment of pelvic inflammatory disease and infertility implications

Common Bacterial and Viral Infections: Review of Management in the Pregnant Patient.

To review the treatment of common bacterial and viral infections occurring in the pregnant patient. A literature search of MEDLINE was performed (inception to October 2018). The Centers for Disease Control and Prevention website was utilized for additional information. Relevant English-language studies and those conducted in humans were considered. β-Lactams alone or in combination are the preferred treatment for many common infections in pregnancy, such as urinary tract infections, pelvic inflammatory disease (PID), gonococcal infections, syphilis, chancroid, upper- and lower-respiratory-tract infections, certain gastrointestinal infections, Group B Streptococcus, listeriosis, and intrauterine inflammation or infection. Macrolides, particularly azithromycin, are also utilized for the treatment of PID, chlamydia, gonococcal infections, chancroid, community-acquired pneumonia, and certain gastrointestinal infections. Other antibiotics or antivirals such as vancomycin, aminoglycosides, metronidazole, nitrofurantoin, fosfomycin, acyclovir, valacyclovir, and oseltamivir are included in the preferred therapy for some common bacterial and viral infections in pregnant patients as well. Relevance to Patient Care and Clinical Practice: This review synthesizes available evidence of treatments of common infections in pregnancy and provides a concise summary to guide clinicians on empirical treatment during pregnancy. There are limited data on clinical outcomes in pregnant patients with common bacterial and viral infections. Empirical management decisions require balance of benefit and risk to both mother and infant. Although few clinical practice guidelines have quality evidence for strong recommendations in this population, clinicians should weigh antimicrobial dosing, pharmacokinetics, safety, and established effectiveness to optimize antimicrobial therapy in pregnancy.

Metabonomic study of the protective effect of Fukeqianjin formula on multi-pathogen induced pelvic inflammatory disease in rats

BackgroundFukeqianjin formula has been effectively used in the treatment of pelvic inflammatory disease (PID) and the related complications in clinic. Although there have been some studies about the underlying mechanism that focus on its anti-inflammatory and immunoregulatory activities. But the mechanism is still not fully understood. The aim of this study was to investigate the alteration of plasma metabolic profiles in PID rats and the regulatory effect of Fukeqianjin formula on potential biomarkers.MethodsPelvic inflammatory model was established by intrauterine inoculation of multiple pathogens combined with mechanical injury of endometrium. Rats were randomly divided into normal group, model group, azithromycin group, high-and low-dose of Fukeqianjin formula treatment group (FF-H, and FF-L, respectively). After 14 days of intragastric administration, the plasm levels of interleukin-1β (IL-1β) and nitric oxide (NO) were measured. To further recognize and identify potential biomarkers and metabolic pathways, an ultra-performance liquid chromatography-quadrupole-Exactive Orbitrap-mass spectrometry (UPLC-Q-Exactive Orbitrap-MS) metabonomic method combined with multivariate analyses including principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA) and orthogonal partial least squares discriminant analysis (OPLS-DA), was employed to analyze the metabolic profiling.ResultsCompared with normal group, the plasma levels of IL-1β and NO were significantly increased in the PID model group (P < 0. 05), and obviously decreased after high-dose intervention of Fukeqianjin formula (P < 0. 01). The PCA, PLS-DA and OPLS-DA analysis showed that PID rats were clearly separated from normal rats. Compared with the PID model group, the metabolite profiles of Fukeqianjin formula treatment group was gradually restored to normal. Meanwhile, 14 potential metabolite biomarkers, which were mainly related to the metabolic pathways of intervening glycerophospholipid metabolism, linoleic acid metabolism/alpha-linolenic acid metabolism, amino acid metabolism, arachidonic acid metabolism, and unsaturated fatty acids biosynthesis, have been identified. Fukeqianjin formula exerts good regulatory effect on the abnormal metabolism of PID rats.ConclusionsIntrauterine inoculation of multiple pathogens combined with mechanical injury of endometrium could significantly disturb the plasma metabolic profiles of rats. Fukeqianjin formula has potential therapeutic effect on multi-pathogen-induced PID by ameliorating metabolism disorders and alleviating the inflammatory response.

Susceptibility of endometrial isolates recovered from women with clinical pelvic inflammatory disease or histologic endometritis to antimicrobial agents

The CDC recommended outpatient treatment of pelvic inflammatory disease (PID) is a single dose of ceftriaxone plus 14 days of doxycycline, with or without metronidazole. European guidelines (2017) include moxifloxacin plus ceftriaxone as a first line regimen, particularly for women with Mycoplasma genitalium-associated PID. However, the susceptibility of anaerobic bacteria associated with PID to moxifloxacin is unknown. Our objective was to evaluate the in vitro antibiotic susceptibility of facultative and anaerobic bacteria from the endometrium of women having symptomatic PID and/or histologically confirmed endometritis.

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...

Ozone therapy ameliorates inflammation and endometrial injury in rats with pelvic inflammatory disease

As a common cause of infertility, pelvic inflammatory disease (PID) is characterized by chronic pain, ectopic pregnancy as well as inflammation and infection of the female upper genital tract. Ozone water, also known as O3, has been previously reported to be a distinctly effective agent in treating inflammation. During the present study, we asserted the hypothesis that O3 could be applied by pelvic inflammation and works to regulate the expression of inflammatory factors including interleukin-6 (IL-6), IL-2 and tumor necrosis factor-α (TNF-α). In an attempt to evaluate the effect of O3 on PID, an acute PID rat model was subsequently established. O3 at concentrations of 45 μg/mL and 60 μg/mL in addition to levofloxacin (LVLX) was injected respectively into the PID rats in a bid to alter the contents of inflammatory factors and immunologic markers. Hematoxylin-eosin (HE) staining was applied to analyze endometrial inflammation. Reductions to the contents of IL-6 and TNF-α were recorded, while that of IL-2, IgA, IgG, IgM, C3 and C4, and E rosette formation rate and transformation rate of T lymphocytes exhibited notably elevated levels after the PID rats had been injected with 45 μg/mL O3, 60 μg/mL O3 or LVLX. The pathological condition of the endometrium in rats with PID was alleviated among the PID rats after injected with the 45 μg/mL O3, 60 μg/mL O3 or LVLX. Taken together, the key findings of the current study present evidence demonstrating that the administration of O3 to the pelvic cavity ameliorated the PID conditions among rat models via inhibition of the necrosis of the endometrial epithelial cells as well as alleviated the inflammatory reactions, highlighting a potential novel PID treatment target.

Diagnosis and management of tubo‐ovarian abscesses

Key content Tubo‐ovarian abscesses represent a severe form of pelvic inflammatory disease and carry high morbidity. Diagnosis is made by combining the clinical picture (fever, pelvic pain and pelvic adnexal mass) with raised inflammatory markers and radiological findings demonstrating an abscess. Initial management with intravenous antibiotics may not be successful. Surgical intervention may be indicated but the optimal timing is not clear and image‐guided drainage can be a possible alternative to surgery. Surgery may be conservative or involve pelvic clearance and will depend on the clinical situation. Learning objectives To be able to recognise and initiate prompt treatment of pelvic inflammatory disease and tubo‐ovarian abscesses. To understand appropriate antibiotic treatment and/or radiological drainage. To be able to identify indications for timely surgical intervention and explore the optimal surgical approach of laparoscopic versus open surgery. Ethical issues Delays in treatment may have adverse effects on future fertility. Who is appropriate for fertility‐preserving treatment?

Иммунотерапия как способ повышения эффективности комплексного лечения воспалительных заболеваний органов малого таза

Иммунотерапия как способ повышения эффективности комплексного лечения воспалительных заболеваний органов малого таза

The prevalence of ectopic pregnancy in Jos, north central Nigeria: A reproductive health challenge

Background: Ectopic pregnancy is a life threatening gynecological emergency with a rising incidence of maternal morbidity especially in resource poor settings. Most cases present in the emergency unit when ruptured.Objective: The objective of this study was to determine the prevalence, identifiable risk factors, clinical presentation and management outcome of ectopic pregnancy.Method: This was a retrospective review of cases of ectopic pregnancies seen and managed in the gynecological unit of Plateau State Specialist Hospital (PSSH) Jos from 1st September 2012 to 31st August, 2017. The medical records of the patients managed for ectopic pregnancy as well as the delivery register from the labor room, theater register and gynecological admissions during the study period were retrieved. The data were collected with the aid of data entry form designed for this purpose. The relevant data collected were analyzed using epi info 16 version and presented in tables.Results: During the period, a total number of 13,596 deliveries were recorded while there were 2067 gynecological admissions. One hundred and seventy two (172) patients had ectopic pregnancies accounting for 1.27% of all deliveries and 8.3% of gynecological admissions. The mean age of the patients was 29±5years. The peak age group was 20-25 years (32.0%); 92(53.5%) had secondary school as their highest level of education; 135(78.5%) were married and 49(28.4%) were multigravida. All the patients; 172(100%) presented with a history of abdominal pain while 8(4.7%) presented in shock. A total of 161(93.6%) were diagnosed based on history and clinical examination findings; 152(88.4%) had trans-abdominal scan and 12(7.0%) had abdominal paracentesis (though frowned at in modern day practice). The commonest identifiable risk factors for ectopic pregnancies were pelvic inflammatory disease(PID) in 111(64.5%) of patients followed by previous history of abortions in 17(9.9%) of patients. A total number of 169(98.3%) of the patients had total salpingectomy for ruptured ectopic pregnancies via open abdominal surgeries with 87(50.6%) done on the right fallopian tubes. Three (1.7%) of the patients had oophorectomy. Eighty one(47.1%) of the patients had blood transfusion with no case fatality.Conclusion: Ectopic pregnancy still remains a major health challenge among women of reproductive age group in Nigeria. Efforts should therefore be directed at prompt and timely management to reduce maternal morbidity and mortality in developing countries, availability and accessibility of contraceptive methods, accessibility to healthcare centers and affordable healthcare, proper treatment of PID, use of better technologies in management of cases and human capacity development.Keywords: Prevalence, reproductive age group, ectopic pregnancy, resource poor settings, life threatening, emergency

2017 European guideline for the management of pelvic inflammatory disease.

The European guideline for the management of pelvic inflammatory disease includes evidence-based advice on the investigation and treatment of pelvic inflammatory disease (PID). It has been updated to acknowledge the role of Mycoplasma genitalium as an important cause of PID with testing now recommended for women presenting with possible PID and for the male partners of women with confirmed M. genitalium infection. Recent evidence suggests that serious adverse events are uncommon when using moxifloxacin and its use is now recommended as a first-line therapy, especially in those women with M. genitalium PID. The potential utility of MRI scanning of the pelvis in excluding differential diagnoses has been highlighted. The use of doxycycline is now suggested as empirical treatment for male partners of women with PID to reduce exposure to macrolide antibiotics, which has been associated with increased resistance in M. genitalium.

Sustained Simultaneous Delivery of Metronidazole and Doxycycline From Polycaprolactone Matrices Designed for Intravaginal Treatment of Pelvic Inflammatory Disease

Poly(ɛ-caprolactone) (PCL) intravaginal matrices were produced for local delivery of a combination of antibacterials, by rapidly cooling a mixture of drug powders dispersed in PCL solution. Matrices loaded with different combinations of metronidazole (10%, 15%, and 20% w/w) and doxycycline (10% w/w) were evaluated in vitro for release behavior and antibacterial activity. Rapid “burst release” of 8%-15% of the doxycycline content and 31%-37% of the metronidazole content occurred within 24 h when matrices were immersed in simulated vaginal fluid at 37°C. The remaining drug was extracted gradually over 14 days to a maximum of 65%-73% for doxycycline and 62%-71% for metronidazole. High levels of antibacterial activity up to 89%-91% against Gardnerella vaginalis and 84%-92% against Neisseria gonorrhoeae were recorded in vitro for release media collected on day 14, compared to “nonformulated” metronidazole and doxycycline solutions. Based on the in vitro data, the minimum levels of doxycycline and metronidazole released from PCL matrices in the form of intravaginal rings into vaginal fluid in vivo were predicted to exceed the minimum inhibitory concentrations for N. gonorrhea (reported range 0.5-4.0 μg/mL) and G. vaginalis (reported range 2-12.8 μg/mL) respectively, which are 2 of the major causative agents for pelvic inflammatory disease.

Современный взгляд на проблему воспалительных заболеваний органов малого таза у женщин

The objective: to learn the efficacy of some fluoroquinolones II and III generation (combination drug Orcipol (ciprofloxacin with ornidazole) and Levoximed (levofloxacin) from World Medicine Pharmaceutical Company, UK) in the treatment of urogenital mixed infections in patients with pelvic inflammatory disease (PID) for vaginal sanitation and restoration of reproductive health. Patients and methods. A clinical examination and complex treatment of 50 patients of reproductive age for the first or second episode of PID of moderate severity was held. Patients of the 1st group (n=25) with mixed aerobic and anaerobic infections, Chlamydia were prescribed Levoximed for 7–14 days. Patients of the 2nd group (n=25) with mixed aerobic and anaerobic infections, bacterial vaginosis or trichomoniasis received a combined drug – Orcipol for 5–7 days. Results. The use of Levoximed and combined antibacterial therapy with Orcipol in the complex treatment of patients with PID was successful. The efficacy of Levoximed and Orcipol in the complex treatment of PID in the groups surveyed was comparable, and it was good in most cases – 92% in Group 1 and 88% in Group 2. Conclusions. The use of combined antibacterial therapy with the inclusion of drugs that overlap the spectrum of aerobic and anaerobic pathogens, protozoal sexually transmitted infections, is an important factor in the successful treatment of inflammatory diseases of the genitals in women. High clinical effectiveness of treatment with the use of drugs Levoximed and Orcipol in patients with PID can recommend them for widespread use in gynecological practice. Key words: pelvic inflammatory diseases, urogenital infections, Levoximed, Orcipol.

Current perspectives in the USA on the diagnosis and treatment of pelvic inflammatory disease in adolescents.

In this review, the epidemiology, diagnosis, and treatment of pelvic inflammatory disease (PID) are discussed from a USA perspective and the difficulties that USA adolescents face in recognizing and seeking care for PID and other sexually transmitted infections (STIs) are emphasized. Females aged 15–24 years have the highest incidence of cervical infection with Chlamydia trachomatis and Neisseria gonorrheae, the principal causes of PID. PID is common in this age group. However, the incidence of PID in the USA is not known, because it is not a reportable disease, and because clinicians vary in the criteria used for the diagnosis. The Centers for Disease Control and Prevention (CDC) recommended the following diagnostic criteria that include lower abdominal or pelvic pain and at least one of the following: adnexal tenderness or cervical motion tenderness or uterine tenderness. Because PID can have serious sequelae, the criteria emphasize sensitivity (few false-negatives) at the expense of specificity (some false-positives). Patients who have PID are usually treated in the outpatient setting, following the CDC’s Guidelines for the Treatment of Sexually Transmitted Diseases 2015. They receive one dose of an intramuscular cephalosporin, together with 2 weeks of oral doxy cycline, and sometimes oral metronidazole. Improvement should usually be evident in 3 days. The USA does not offer comprehensive sex education for adolescents in public or private schools. Adolescents are unlikely to recognize the symptoms of PID and seek medical treatment. Confidentiality is important to adolescents, and low cost or free sources of confidential care are uncommon, making it unlikely that an adolescent would seek care even if she suspected an STI. The CDC has concluded that screening programs for chlamydia and gonorrhea infection help prevent PID; however, the lack of appropriate sources of care makes adolescents’ participation in screening programs unlikely.

P140 A need to reinforce the importance of pregnancy testing and correct antibiotic regimen: a re-audit of pid management against bashh guidelines

IntroductionBASHH guidelines (2011) for the management of pelvic inflammatory disease (PID) recommend one of two antibiotic regimens for outpatient treatment. In addition, patients should be offered a pregnancy test and full screening for sexually transmitted infections (STI).Aim(s)/objectivesTo review PID management across the sexual health clinics, comparing it to the previous year’s audit and BASHH guidelines.MethodsData was retrospectively collected from December 2015 until March 2016. Data collected included whether pregnancy was excluded, STI screening, antibiotic regimen used, provision of written information, partner notification, and outcome at any follow up.Results51 patients were identified, 2 were excluded due to treatment by their GP. 100% of cases had at least one sign or symptom suggestive of PID. 47/49 (96%) of cases had STI screening; 41/49 (84%) had a HIV screen as part of this. Pregnancy was excluded in 22/49 (45%) of cases. A BASHH recommended antibiotic regimen was used in 28/49 (57%) of cases. Of the 21 of non-compliant cases, only 4/21 had a documented allergy or intolerance that precluded standard treatment.DiscussionSince the last audit, recommended antibiotic treatment for PID has improved, but remains low at 57%. Pregnancy exclusion was low at 45%, compared with 70% at the last audit. Differences in how healthcare professionals record information on the electronic system could partially account for this. Actions have been taken to improve treatment and pregnancy testing by giving individual feedback to the clinicians, with a re-audit planned to assess the outcome of these interventions.

Advantages and evidences research on Chinese medicine for treatment of pelvic inflammatory disease

Pelvic inflammatory disease is an infectious disease. At present, Western medicine is mainly treated with antibiotics. However, the situation of antibiotics abuse is so grim that the potential risks such as the imbalance of bacteria, the resistance of bacteria, the production of super bacteria and the increase of adverse reactions are becoming more and more serious. Therefore, it is urgent to find a way to supplement or substitute antibiotics for the treatment of this disease. Traditional Chinese medicine treatment of the disease is effective and has its unique advantages. This paper mainly discusses the advantages and evidences of traditional Chinese medicine (TCM) treatment of pelvic inflammatory disease, to further prove the effectiveness and safety of TCM treatment and to provide medical evidence of reducing antibiotics use.

Gender Differences in CDC Guideline Compliance for STIs in Emergency Departments

IntroductionSexually transmitted infections (STIs) are a common reason for emergency department (ED) visits. The objective of this study was to determine if there were gender differences in adherence to Centers for Disease Control and Prevention (CDC) STI diagnosis and treatment guidelines, as documented by emergency providers.MethodsWe performed a retrospective chart review to identify patients treated for urethritis, cervicitis, and pelvic inflammatory disease (PID) in the EDs of three hospitals in a Pennsylvania network during a calendar year. Cases were reviewed to assess for compliance with CDC guidelines. We used descriptive statistics to assess the distributions of study variables by patient sex. In the analysis we used Student’s t-tests, chi-square tests, and logistic regression. Statistical significance was set at p ≤ 0.05.ResultsWe identified 286 patient records. Of these, we excluded 39 for the following reasons: incorrect disease coding; the patient was admitted and treated as an inpatient for his/her disease; or the patient left the ED after refusing care. Of the 247 participants, 159 (64.4%) were female. Females were significantly younger (26.6 years, SD=8.0) than males (31.2, SD=11.5%), (95% confidence interval [CI] [2.0– 7.0], p=0.0003). All of the males (n=88) in the cohort presented with urethritis; 25.8% of females presented with cervicitis, and 74.2% with PID. Physician compliance for the five CDC criteria ranged from 68.8% for patient history to 93.5% for patient diagnostic testing, including urine pregnancy and gonorrhea/chlamydia cultures. We observed significant differences by patient sex. Fifty-four percent of the charts had symptoms recorded for female patients that were consistent with CDC characteristics for diagnostic criteria compared to over 95% for males, OR=16.9; 95% CI [5.9–48.4], p<0.001. Similar results were observed for patient discharge instructions, with physicians completely documenting delivery of discharge instructions to 51.6% of females compared to 97.7% of complete documentation in males, OR=42.3; 95% CI [10.0–178.6] p<0.001). We observed no significant sex differences in physician documentation for physical exam or for therapeutic antibiotic treatment.ConclusionThis retrospective study found patient gender differences in how emergency providers complied with documenting with regard to the 2010 CDC guidelines for the diagnosis and treatment of urethritis, cervicitis, and PID. Specifically medical records of men were more likely to have complete documentation of symptoms recorded (95% CI 5.9–48.4) and to have discharge instruction documentation (95% CI 10.0–178.6) than records of women.

INDICATORS OF THE FUNCTIONING OF THE ANTIOXIDANT SYSTEM OF BLOOD AND ORAL FLUID IN WOMEN SUFFERING FROM PELVIC INFLAMMATORY DISEASES

Aim. Evaluation of the features of functioning of the antioxidant system of blood and oral fluid in women suffering from chronic endometritis complicated by the bilateral salpingo-oophoritis. Materials and methods. 85 women participated in the study. The first group consisted of 30 practically healthy women. The second group included 29 patients with chronic endometritis in the exacerbation phase, the third group was represented by patients with a combined course of chronic endometritis and bilateral salpingo-oophoritis in the exacerbation phase (n=26). In the erythrocyte suspension and oral fluid, the activity of catalase and superoxide dismutase, glutathione peroxidase and glutathione reductase was assessed; in addition, the concentration of reduced glutathione was assessed in erythrocytes. Results. The obtained data reflect the development of an imbalance in the antioxidant system of blood and oral fluid that develops in patients with inflammatory diseases of the pelvic organs. Changes in the blood and oral fluid did not coincide completely, which was expressed by the relative insufficiency of superoxide dismutase activity in the blood (the ratio of activity of catalase and superoxide dismutase 1.3-1.8) and catalase in the oral fluid (the ratio of the activity of catalase and superoxide dismutase 0.5-0.8). It is also interesting to note that the studied indicators after the therapeutic measures characterized still more significant depletion of the antioxidant system, and for the most part it was characteristic of the oral fluid (the ratio of the activity of catalase and superoxide dismutase 0.05-0.1). This may be due to the intensive involvement of antioxidants in the recovery of the body. Conclusion. The results of the study suggest the prospect of additional metabolic correction of the antioxidant orientation to the standard therapy used for the treatment of pelvic inflammatory diseases. The pronounced changes in the biochemical parameters of the oral fluid make it possible to judge the possibility of using it for noninvasive laboratory evaluation of metabolic disorders in women with chronic endometritis and salpingo-oophoritis.

Evidence-Based Medicine Research on Prescriptions in Synopsis of the Golden Chamber in the Treatment of Pelvic Inflammatory Disease

Purpose: Based on the National Natural Science Foundation of China, we collect and sort out the literature published in approximately the last 30 years, which use prescriptions in Synopsis of the Golden Chamber to treat pelvic inflammatory disease (PID). This study provides theoretical basis for the treatment of PID; we recommend this achievement to colleagues. Method: Firstly, we searched and collected the literatures from last three decades in CNKI, Wanfang and VIP databases, which are about classical prescriptions treating endometriosis. Then, by screening all the literatures, we obtained the clinical research literatures and individual case reports. Finally, we went through the internal quality of the two categories of literatures to get the dominant prescriptions. Using a retrospective study of evidence-based medicine research, we comprehensively collect literature, standardize the disease spectrum, classify the evidence, and then evaluate the internal quality. Results: We refine 4 prescriptions which commonly are used in the treatment of PID; in other words, they are also the clinical symptoms of PID: Gui Zhi Fu Ling Wan symptom, which manifests blood stasis and cold-damp stagnancy; Dang Gui Shao Yao San symptom, which manifests disharmony of liver and spleen, qi-blood stasis and damp obstruction; Da Huang Mu Dan Tang symptom, which manifests the gathering toxic heat and qi-blood stasis; Yi Yi Fu Zi Bai Jiang San symptom, which manifests the internal toxic heat and qi-blood injury. Conclusion: This study is gospel for the patients with recurrent episodes of PID who can’t often use antibiotics. At the same time, it is also a green therapeutics which Chinese ancients dedicated to human medicine.

MRI in pelvic inflammatory disease: a pictorial review.

Pelvic inflammatory disease (PID) is an ascending infection of the female genital tract caused by the spread of bacteria from the vagina to the pelvic reproductive organs and occasionally the peritoneum. The most common causative organisms are sexually transmitted. PID is a significant source of morbidity among reproductive age women both as a cause of abdominal pain and as a common cause of infertility. Its clinical presentation is often nonspecific, and the correct diagnosis may first come to light based on the results of imaging studies. MRI is well suited for the evaluation of PID and its complications due to its superior soft tissue contrast and high sensitivity for inflammation. MRI findings in acute PID include cervicitis, endometritis, salpingitis/oophoritis, and inflammation in the pelvic soft tissues. Acute complications include pyosalpinx, tuboovarian abscess, peritonitis, and perihepatitis. Hydrosalpinx, pelvic inclusion cysts and ureteral obstruction may develop as chronic sequela of PID. The pathophysiology, classification, treatment, and prognosis of PID are reviewed, followed by case examples of the appearance of acute and subclinical PID on MR images.

Protection of flavonoids from Smilax china L. rhizome on phenol mucilage-induced pelvic inflammation in rats by attenuating inflammation and fibrosis

Pelvic inflammatory disease (PID), an infection and inflammation disorder of the upper genital tract, results in infertility in approximately 20% of cases. No antibiotic that can alleviate the sequelae of PID has been identified. Smilax china L. rhizome (SCR), which are widely used in functional food and folk medicine, exhibit multiple pharmacological activities, such as anti-inflammatory, antioxidant and antitumour activities. In this study, the flavonoids of SCR (FSCR) were purified and analysed by UPLC-PDA-MS. The therapeutic effects of FSCR in a rat PID model were evaluated. FSCR-treated PID rats exhibited significantly decreased inflammation, ameliorated fibrosis, and enhanced production of matrix metalloproteinase (MMP)-2 and MMP-9 in uteri. Moreover, the phosphorylation of ERK1/2 and Smad2/3 was markedly inhibited by FSCR. These results indicate that FSCR exhibits robust anti-inflammatory and anti-fibrosis effects, possibly via inhibition of the ERK1/2 and TGF-β-Smad2/3 signalling pathways, and may be an effective candidate natural medicine for PID treatment.