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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The frequency of infection following induced first-trimester abortion is 3-5%. Duration of hospitalization is often five days, and the total costs per abortion were 5,400 Dkr (approximately pounds 500) in Denmark in 1979. Sequelae of postabortal infection are similar to and occur with the same frequency as sequelae to "spontaneous" pelvic inflammatory disease. Thus, secondary infertility was found in 10% of women with postabortal infection, spontaneous abortion in 22%, dyspareunia in 20%, and chronic pelvic pain in 14%. The risk of ectopic pregnancy is probably also increased. Surgical scrub cannot sterilize the endocervix and, as a consequence, abortion is performed in a contaminated field. The presence of pathogenic bacteria, i.e. Chlamydia trachomatis, therefore increases the risk of postoperative infection. The organism is found in approximately 7% of those applying for abortion and the risk of sustaining infection is 20%. Other risk factors are previous pelvic inflammatory disease, vaginal infection, first pregnancy and young age. Prophylactic antibiotics halve the incidence of infection, but by applying prophylaxis to risk groups only, the amount of prescriptions can be reduced. Prophylaxis need only be administered peroperatively, and tetracyclines, metronidazol, and penicillin/pivampicillin have been found to be effective. Women applying for abortion should be examined for C. trachomatis and positive cases treated no later than at the time of the abortion.
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PMID:[Preventive antibiotics in induced first-trimester abortion]. 146 1

During a study of women with laparoscopically investigated pelvic pain, genital tract specimens were examined for Chlamydia trachomatis using a direct fluorescent antibody (DFA) technique (MicroTrak, Syva) and culture. Some smears, particularly those from the upper genital tract, contained an inadequate number of cells when examined by the DFA technique and many cell monolayers were destroyed by the specimens. To obtain results for such samples, or to confirm the original DFA result, additional specimens which had been frozen at -70 degrees C or in liquid nitrogen were centrifuged at high speed and the resulting deposit examined by the DFA technique. By this means, 32 negative results were confirmed for specimens from 10 chlamydia-negative patients with pelvic inflammatory disease or with high chlamydial antibody titres, and 26 negative results were confirmed for 19 patients who were positive at other sites. In addition, three chlamydia-positive and six chlamydia-negative results were obtained for sites where the original smear for DFA testing had been inadequate (few epithelial cells) and six specimens that were negative originally were found to be positive. Thus, of 73 specimens that were either inadequate or negative by DFA testing originally, 9 (12%) were positive by DFA testing after centrifugation.
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PMID:Detection of Chlamydia trachomatis by direct immunofluorescence improved by centrifugation of specimens. 174 21

Researchers enrolled 600 prostitutes from an AIDS control and prevention program in a study to determine the prevalence of Chlamydia trachomatis in prostitutes and other sexually transmitted diseases (STDs). The prostitutes worked in the port city of Santos, Brazil where many people use intravenous (IV) drugs. Only 45 prostitutes met the study criterion of 5-100 sexual partners/day. Health practitioners took sera from each woman to test for HIV-1, HIV-2, hepatitis B surface antigen (HBsAg) and antibody (HBsAb), Treponema species (syphilis), and C. trachomatis. All the women tested positive for C. trachomatis. This high percentage may have been due to previous contact with the microbe and not necessarily due to an active infection. 42% had been exposed to Treponema. 20% were HBsAb seropositive and 9% HBsAg seropositive. 9% tested positive for HIV-1 and 2% for HIV-2. In another study in Campinas, Brazil, HIV-1 and seropositivity was 21.5% for prostitutes and transvestites. In addition, in a study in metropolitan Sao Paulo, HIV infection prevalence varied from 18-73% among 935 women and 22% among prostitutes. 58% of the prostitutes in Santos had had sexual intercourse with bisexuals or IV drug users. 44% had previously experienced an STD. 42% used IV drugs. 42% practiced both oral and vaginal sex. 36% practiced oral, vaginal, and anal sex. Only 22% limited themselves to oral sex. Since C. trachomatis can cause infertility, chronic pelvic pain, and spontaneous abortion and since every prostitute in the study had been exposed to it, health workers should institute regular STD screening for prostitutes.
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PMID:Seropositivity to Chlamydia trachomatis in prostitutes: relationship to other sexually transmitted diseases (STDs). 210 Oct 95

Serologic markers were evaluated to determine if they could aid in the differential diagnosis of pelvic inflammatory disease in 48 consecutive women seeking evaluation for pelvic pain. On the basis of clinical and microbiologic parameters, 29 patients (60.4%) were diagnosed as having pelvic inflammatory disease. Neisseria gonorrhoeae only was isolated from the cervix of eight (27.6%) patients with pelvic inflammatory disease, five (17.2%) had only Chlamydia, and two (6.9%) had Neisseria and Chlamydia, whereas in 15 (48.3%) patients no pathogen was isolated. Interferon-gamma was present in significantly more sera (p less than 0.025) from patients with pelvic inflammatory disease (65.5%) than from women without pelvic inflammatory disease (15.8%). Sera from 10 healthy women lacked detectable interferon-gamma. In patients with only Neisseria, seven (87.5%) had circulating interferon-gamma; three (60%) of the women with only Chlamydia, one (50%) woman with Neisseria and Chlamydia, and eight (57.1%) with no identified pathogens were also positive for interferon-gamma. Sera from 11 of 28 patients with pelvic inflammatory disease (39%) but only one of 19 sera from women without pelvic inflammatory disease (5%) also inhibited the Candida-induced proliferation of control lymphocytes. This immunosuppressive activity was prevented by immunoprecipitation of interferon-gamma by anti-interferon-gamma antibody but not by treatment with anti-interferon-alpha antibody. The persistence of interferon-gamma in the sera of patients with pelvic inflammatory disease may aid in the differential diagnosis of this disease and increase our understanding of the pathogenesis of microbial-mediated tubal damage.
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PMID:Interferon-gamma in the diagnosis and pathogenesis of pelvic inflammatory disease. 211 Oct 96

Infections caused by Chlamydia trachomatis are the most common sexually transmitted diseases occurring in developed countries. Among women, chlamydia-mediated diseases include urethritis, cervicitis, endometritis, and salpingitis. Sequelae include infertility, pelvic pain, ectopic pregnancy, and perinatal infection. Aspects of epidemiology, pathogenesis, diagnosis, treatment, and prevention are discussed.
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PMID:Chlamydial infection in women. 268 46

During the 18-month period from December 1, 1985 to May 31, 1987 Chlamydia trachomatis was the most-common sexually-transmitted agent to be identified at the Royal Women's Hospital, Melbourne. It was isolated from 4% of all specimens for which such culture was requested and was found five-times more frequently than was Neisseria gonorrhoeae. A review of the clinical presentation and the management of the 100 public patient for this period whose cervical specimens were found to give positive results for the presence of chlamydiae revealed that 77% of the women were less than 25 years of age, 78% of the women were single and 65% of the women were nulliparous. Thirty-five women were asymptomatic carriers of chlamydiae. Of the remaining 65 patients with symptoms, 46% experienced pelvic pain, 39% experienced a vaginal discharge and 26% experienced irregular bleeding. The importance of abnormal bleeding is emphasized. In patients who presented for therapeutic abortions, morbidity occurred in 19% of those who were carriers of Chl. trachomatis; accordingly, screening for chlamydiae as routine is recommended in such patients. Furthermore, because of the risk of pelvic inflammatory disease and its consequences, it is important not only to treat female patients in whom chlamydiae have been isolated, but also to treat and to follow-up their sexual partners simultaneously.
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PMID:Chlamydia trachomatis infections--the Royal Women's Hospital experience. 271 99

One hundred sixty-one women undergoing laparoscopy for infertility of obstructive origin (fallopian tube stenosis or obstruction and periadnexal adhesions) had thorough bacteriologic studies, including Chlamydia trachomatis cultures, of their lower and upper genital tracts. Peritoneal or tubal fluid cytologic features and biopsies of fallopian tubes or adhesions were also studied after each laparoscopy. The serum of each woman was titrated for evidence of C. trachomatis infection. The sera of a control group of 51 women with ovarian infertility but normal fallopian tubes according to laparoscopy and hysterosalpingogram were titrated in an identical manner. The current study confirms previous studies that showed a strong correlation between infertility due to fallopian tube factors and positive C. trachomatis cultures or serologic studies. The current study suggests that C. trachomatis infection does not correlate with a past history of salpingitis or pelvic pain, but that current C. trachomatis infection, as assessed by positive culture, does correlate with gross and histologic evidence of chronic inflammation.
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PMID:Microbiologic study of chronic inflammation associated with tubal factor infertility: role of Chlamydia trachomatis. 295 1

The Authors report the results of a microbiological study of 99 patients who had undergone laparoscopy for infertility and/or pelvic pain. In 64% of the cases the microbiological study gave a positive result and in 45% of these 2 or more microorganisms were isolated; this high positive result was due to the presence of microorganisms with low pathogenicity on the cervical and urethral swabs. The microbiological study, B.S.R. and the leucocytes did not show any significant correlation with the pelvic pathologies found by means of laparoscopy. The only exception to this was Chlamydia T. which gave positive results, both in the direct and indirect test, in 22% of the patients, and which was found most often in the cases where laparoscopy had shown pelvic phlogisis.
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PMID:Results of a microbiological study of 99 patients undergoing laparoscopy due to sterility and/or pelvic pain. 295 62

Health workers took urethral samplers from 218 men with urethritis and 1850 women to screen for Chlamydia trachomatis using culture and immunofluorescence. All the men and women presented themselves at the Hospital Provincial de Franceville in semirural Gabon. 18% of men, 18% of women with vaginal discharge, 14% of women with pelvic pain, 10% of infertile women, and 10% of postpartum women tested positive for C. trachomatis infection. Postpartum women less than 21 years old had a significantly higher chlamydial prevalence than did older postpartum women (18 vs. 5%; p .05). Chlamydial prevalence among 21-25 year old postpartum women was significantly lower than among same age women presenting with other conditions (5% vs. 15% for infertile women, 21% for women with pelvic pain, and 2% for women with vaginal discharge; p .01). Except for postpartum women, older than 25 chlamydia prevalence decreased after age 25. The sensitivity of immunofluorescence ranged from 77% for infertile women to 93% for postpartum women. Its specificity ranged from 97% for women with discharge or pelvic pain to 100% for men. Thus, the direct immunofluorescence test corresponded well with culture. The isolation rates for asymptomatic women neared those of symptomatic women, indicating that most women with C. trachomatis infections have no or very mild symptoms and do no seek medical attention. This most likely jeopardizes their fertility.
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PMID:Urogenital Chlamydia trachomatis in Gabon: an unrecognised epidemic. 306 Apr 22

An analysis of published studies of the effect of antibiotic prophylaxis associated with vacuum aspiration abortion includes an examination of risk factors for pelvic inflammatory disease (PID), cervical and vaginal flora present in early pregnancy and in PID, the effect of surgical scrub and of prophylaxis on flora, principles of antibiotic prophylaxis, and economic costs of PID. From several prospective studies, it is clear that nulliparas, women with a history of PID, those bearing Chlamydia trachomatis are at risk of post-abortion infection. No risk was associated with pelvic pain, dysmenorrhea, social class, insertion of an IUD, or timing of resumption of coitus. After an extensive enumeration of microbes found in nonpregnant, pregnant, and PID female genital tracts, it was concluded that only C. trachomatis and N. gonorrheae are clearly associated with PID, while the importance of several other microbes is unclear. Quantitative counts of organisms in any condition are lacking. PID is polymicrobial; different organisms probably account for noniatrogenic PID and post-surgical PID. There is evidence that surgical cleansing of the vagina has no bearing on incidence of post-abortal PID, since the responsible organisms come from the endocervix. 5 controlled clinical trials demonstrated that antibiotic prophylaxis is warranted; that penicillin/ampicillin selectively reduced PID in women with PID history; that imidazoles preferentially reduce PID in the general population without PID history. No lasting side effects or emergence of resistant organisms was reported. The treatment was cost effective, cutting health costs and labor losses 5-8%, and reducing the incidence of spontaneous abortion, secondary infertility, and chronic pain.
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PMID:Pelvic inflammatory disease following induced first-trimester abortion. Risk groups, prophylaxis and sequelae. 327 98


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