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

Chlamydia trachomatis infections are the most prevalent bacterial sexually transmitted infections (STI) recognized throughout the world. Worldwide, the magnitude of morbidity associated with sexually transmitted chlamydial infections is enormous. C.trachomatis is a common cause of urethritis and cervicitis, and sequelae include pelvic inflammatory disease (PID), ectopic pregnancy, tubal factor infertility, epididymitis, proctitis and reactive arthritis. The sharp worldwide increase in the incidence of PID during the past two decades has led to the secondary epidemics of tubal factor infertility and ectopic pregnancy. Chlamydial PID is the most important preventable cause of infertility and adverse pregnancy outcome. Chlamydial infections, like STI in general, are primarily a woman's health care issue since the manifestations and consequences are more damaging to the reproductive health in women than in men. Based on the available evidence, approximately 20% of women with chlamydial lower genital tract infection will develop PID, approximately 4% develop chronic pelvic pain, 3% infertility, and 2% adverse pregnancy outcome. However, these estimates are based on relatively weak evidence. Research on the link between C.trachomatis and male aspects of infertility has been much more limited. Currently recommended treatment regimens include azithromycin in a single dose or doxycycline for 7 days. These therapies are highly efficacious. Timely management of sex partners is essential for decreasing the risk for re-infection. Immunopathogenesis of C.trachomatis infection is one of the main focal points of current research into Chlamydia. Chlamydial infection fills the general prerequisites for disease prevention by screening, i.e. chlamydial infections are highly prevalent, usually asymptomatic, are associated with significant morbidity, can be reliably diagnosed, and are treatable. Screening programmes for C.trachomatis will be of paramount importance in the prevention of long-term sequelae. The cost of screening is only a fraction of the health care costs incurred due to complications resulting from undiagnosed and untreated chlamydial infections. Current strategies to control C.trachomatis still largely depend on clinic-based screening of symptomatic patients, and have not been successful. The development of highly sensitive and specific nucleic acid amplification tests for the diagnosis of chlamydial infections has been an important advance in the ability to conduct population-based screening programmes to prevent complications. Thus, the case for screening is clearly made, but much detail remains to be worked out.
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PMID:Chlamydia trachomatis: impact on human reproduction. 1058 82

Chlamydia trachomatis is one the most important sexually transmitted diseases; it can cause serious sequelae despite the absence of symptoms in some people. It's estimated that about 25% of women who have acute salpingitis become infertile, and chlamydial infection is the commonest cause. The introduction of screening programs for its detection are still a topic of discussion. The literature shows that the total cost of examination and treatment of complications known to be associated with genital chlamydial infection (PID, chronic pelvic pain, tubal factor infertility) is generally higher than the total cost of a large-scale Chlamydia screening program. The selection of a diagnostic test for detection of chlamydial genital infection depends on availability, local expertise, and prevalence of Chlamydia trachomatis in the test population. Cell culture is too expensive in nonendemic regions, so the use of non-culture techniques is very attractive. PCR (polymerase chain reaction) and LCR (ligase chain reaction) are actually the two most commonly used alternatives to conventional methods for detecting STD agents. In fact, PCR and LCR have proved useful for detection of Chlamydia trachomatis in cervical and urethral samples both in symptomatic and asymptomatic women. Recently, testing of first-void urine (FVU) specimens with these techniques has shown that the amplification tests are as sensitive as tests with endocervical swab cultures.
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PMID:Update on Chlamydia trachomatis. 1081 17

Clinical signs of pelvic inflammatory disease (PID) are not constant and are often limited to slight pelvic pain. Laparoscopy can lead to a rapid and correct diagnosis of PID. Intrapelvic bacteriologic samples can be obtained so as to administer the proper antibiotic. The exact nature of the lesions can be evaluated, and in severe cases, recent abscesses can be treated with good results for fecundity. Because the results in cases of long-standing abscess are not so good, laparoscopy should be performed at the onset of infection and not be reserved until after some weeks of inefficient medical treatment, especially in young women who have not completed their family. In primary chronic salpingitis, the lack of any clinical signs usually leads to a delay in diagnosis until women consult for fertility problems. The ideal point would be to detect some biologic or clinical change that may lead to diagnosis such as a positive anti-Chlamydia trachomatis (CT) serology or, in the future, positive anti-CT Hsp 60 antibody could be the key to detecting and treating silent salpingitis in young women, CT being the main microorganism involved in chronic salpingitis. Screening for C. trachomatis low genital tract infection is mandatory in young people in order to control the epidemic.
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PMID:PID: clinical and laparoscopic aspects. 1081 18

Infertility affects 10-15% of all couples. Pelvic infections are an important cause of infertility, primarily as a result of tubal damage. Damage to the fallopian tubes from infections may be due to adhesions, tubal mucosal damage, or tubal occlusion that interferes with normal ovum transport. The infections most commonly related to infertility include gonorrhea, chlamydia, and pelvic inflammatory disease. Tuberculosis also is a common cause of infertility in Third World nations. Sequelae resulting from these infections include ectopic pregnancy, infertility, chronic pelvic pain, hydrosalpinx, and tuboovarian abscess. Neisseria gonorrhoeae and Chlamydia trachomatis are the primary causes of pelvic inflammatory disease. Chlamydial infections may be asymptomatic, and the resulting salpingitis is often referred to as silent pelvic inflammatory disease. Polymicrobial infection with other organisms such as anaerobes or facultative aerobes may be initiated by gonorrhea, chlamydia, or both. Early recognition of infection, prompt institution of appropriate antibiotic therapy, and proper follow-up are important to prevent the sequelae of pelvic inflammatory disease. Surgical intervention may be needed to treat immediate or long-term sequelae of infection. Prevention of pelvic infections should be a high priority. Fortunately, treatment options such as tubal microsurgery and assisted reproductive technologies offer couples reproductive options even when infertility occurs as the result of a previous pelvic infection.
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PMID:Infections and infertility. 1102 72

Chlamydia trachomatis and Neisseria gonorrhoeae are 2 very common sexually transmitted organisms, whose clinical manifestations in women can range from an asymptomatic carrier state to active pelvic inflammatory disease with known serious sequelae, including chronic pelvic pain, infertility, and ectopic pregnancy. The economic and clinical burden of these 2 infectious organisms are significant in the sexually active population. New developments in diagnosis and treatment of these infections raise great hope that substantial reduction in morbidity and disease prevalence rates can be achieved. Herpes simplex virus is probably better publicized and more feared in the sexually active population, and is far more prevalent than previously recognized; fortunately, however, it is not generally associated with significant morbidity. This article will review the current diagnoses and treatments of these conditions and consider some of the issues surrounding the impact of screening asymptomatic sexually active individuals. The treatment guidelines will emphasize the 1998 Guidelines for Treatment of Sexually Transmitted Diseases from the Centers for Disease Control and Prevention.
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PMID:Diagnosis and treatment of common sexually transmitted diseases in women. 1106 Oct 63

Chlamydia trachomatis causes largely asymptomatic infections that can lead to pelvic inflammatory disease, infertility, ectopic pregnancy, and chronic pelvic pain. Screening women routinely is critical to controlling the epidemic of this disease. Testing innovations now make diagnosis easier, and simple treatment regimens may improve compliance with medications and increase cure rates, but testing and treatment must be coupled with improved screening efforts and effective partner services. Ongoing research may point to other interventions that will increase our success in fighting chlamydial infections.
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PMID:Chlamydia trachomatis infection in women: bad news, good news, and next steps in prevention. 1150 44

Although bacterial prostatitis is a common diagnosis, well documented infections of the prostate are uncommon. Culture studies of prostate tissue led our group to hypothesize that bacterial colonization/invasion of the prostate gland might occur more commonly than is appreciated by standard microbiological techniques. Specific polymerase chain reaction (PCR) assays were used for each of the pathogens previously implicated in chronic prostatitis as well as broad-spectrum PCR assays to identify tetracycline resistance genes and bacterial ribosomal-encoding genes (16S rDNAs), followed by cloning and sequencing of the PCR products. Only ten (8%) of the 135 patients with chronic prostatitis had positive specific PCR assays including: Mycoplasma genitalium in four men, Chlamydia trachomatis in three and Trichomonas vaginalis in two, as well as one man positive for both M. genitalium and C. trachomatis. In contrast to the specific probes, the broad-spectrum PCR assays had a substantial proportion of positives. We found evidence of tetracycline resistance in 25% of patients. 16S rDNA-encoding sequences in 77% of the subjects. The tetracycline resistance positives were a subset of the 16S rDNA positive patients. Patients with 16S rDNA-encoding sequences were significantly more likely to have expressed prostatic secretion leukocytes. Many patients with chronic prostatitis/chronic pelvic pain syndrome have a wide variety of bacterial DNA-encoding sequences despite extensive negative microbiological investigations. Understanding the precise role of infection in this syndrome may well lead to better methods to elucidate the microbiology of the prostate in health and disease.
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PMID:Prostatitis: what is the role of infection. 1213 36

The etiology of pelvic inflammatory disease (PID) is speculated upon based on reported incidence and epidemiological studies. In Western society, the incidence of PID (annual) is 1% among women aged 15-34 years and 2% in the high risk group of women aged 15-24 years. The annual incidence in the US is higher, at least 2% among fecund sexually active women aged 13-44 years. The medical consequences of PID are infertility, ectopic pregnancy, and chronic pelvic pain. Causative agents include Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis and various other aerobic and anaerobic microorganisms; however, the natural genital flora of females is so varied that determining actual causative agents is difficult. some case-control studies have determined risk factors for PID; these include particularly current or prior use of IUD, prior pelvic surgery, sexual activity (including number of partners), race, and prior PID acute infection. PID is not a sexually transmitted disease, but rather is classified as sexually derived. Use of barrier methods and oral contraceptives protects against PID. IUD use greatly increases the risk of PID, probably because of the avenue the device provides for organisms to ascend from the lower to the upper genital tract. The role of males in PID etiology is currently the subject of much discussion. It is theorized that the mechanical action of penis insertion in intercourse helps to move causative agents to the upper genital region; also, semen may carry vaginal flora through the cervical opening into the uterus and tubes. Menstruation and PID are closely associated, perhaps because the cervix dilates during bleedings. Research areas include: determination of role of sexual activity (and number of partners) in PID etiology; evaluation of events of menstruation that are predisposing; evaluation of relationship between bacteriosperma and lower and upper genital infections; relationship of particular contraceptive methods to PID incidence; and breakdown of risk factors.
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PMID:The etiology of pelvic inflammatory disease. 1217 34

330 women with a median age of 30.15 (+- 9.5) years sought gynecological consultation for advice on contraception and for cervical carcinoma screening. Anamnesis explored the presence of dysuria, dyspareunia, secretions, and pelvic pain, the number of partners, and type of contraceptive used. Endocervical samples were collected by means of tampon and the specimens were analyzed for 48 to 120 hours to find antigens of Chlamydia trachomatis (C.T.) by a solid phase immunoenzymatic test. Peripheral blood samples were also taken from all women to look for antibodies of C.T. and also the indirect immunoperoxidase test was used to search for specific antibodies of C.T. (IgM, IgA, IgE, IgG). The chi-square test was applied for statistical analysis. None of the women who used oral hormonal contraceptives or condoms were infected (presence of antigens and positivity for IgM and/or IgE and/or IgA), however, 36 of 90 IUD users (40%) were infected, 18 of 132 women who used no contraceptives whatsoever (13.7%) were also infected. 91% of the subjects had a single partner. In view of these findings the use of the condom and oral contraceptives is recommended with proper instruction about their potential side effects.
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PMID:[Chlamydia trachomatis genital infections and contraception]. 1228 18

The real prevalence of pelvic inflammatory disease (PID) is unknown since many women are either asymptomatic or have atypical symptoms. It is often difficult to detect, manage, and prevent PID. Since PID has obstetric, gynecologic, and contraceptive-related causes, its prevalence is quite high. About 70% of PID hospital admissions in sub-Saharan Africa are a result of reproductive tract infections (RTIs) while this figure is 34% in Asia and 31% in developed countries. Only 10-20% of lower RTIs ascend into the upper genital tract and an even smaller percentage of women with PID develop chronic sequelae. Still, just 1 episode carries an increased risk of a tubal infertility, ectopic pregnancy, chronic pelvic pain, considerable pain during coitus, a new episode, and menstrual irregularities. Neisseria gonorrhoea and Chlamydia trachomatis are the most common causative organisms of PID. In Africa, the risk factors for PID are the same as they are for sexually transmitted diseases (STDs): multiple sex partners, young age at first intercourse, high frequency of coitus, and a high rate of acquiring new partners. The largest percentage of women with RTIs are monogamous women who are infected and constantly reinfected by their promiscuous husbands. The primary means to prevent PID are promotion of safer sexual behavior and condom usage. Secondary measures include accessible, acceptable, and effective STD services and education and counseling during case management. WHO suggests that STD treatment become part of the primary health care system. It has developed flow charts on syndromic diagnosis for urethral discharge in men and genital ulcer disease in women. Health workers should assume increased PID risk if the partner has had a history of urethral discharge and/or treatment for gonorrhea or nongonococcal urethritis. Partner notification is also needed for case management, but stigmatization in some countries poses a problem. WHO also recommends use of drugs which have a 95% STD cure rate.
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PMID:Pelvic inflammatory disease. 1234 39


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