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

Presented is the first case report of intraperitoneal Neisseria gonorrhoea infection after tubal ligation. The patient, a 34-year-old women who underwent bilateral tubal ligation 10 years prior to presentation, complained of right lower quadrant pain, fever, chills, anorexia, and constipation. Prior to sterilization, she had been treated at least 3 times for pelvic inflammatory disease (PID). Laparotomy revealed 200 mL of free pus in the abdominal cavity, induration of the proximal stump of the right fallopian tube, and a tuboperitoneal fistula. the intraperitoneal culture was positive for N gonorrhoea and pathology demonstrated acute salpingitis. Treatment with ampicillin, gentamicin, and clindamycin eliminated the infection, although uterine and adnexal tenderness persisted at the 6-week follow-up. Falk's postulate that cornual resection prevents reinfection with PID of the upper genital tract apparently cannot be extended to isthmic interruption of the lower and upper tracts. Since this case demonstrates that there can be ascending gonococcal infection in women with prior tubal sterilization, PID should be part of the differential diagnosis of all sterilized women who present with acute pelvic pain.
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PMID:Gonococcal peritonitis after tubal ligation. A case report. 177 35

Although an estimated 67 million US women douche, little is known about who practices vaginal douching and for what purposes. These questions were addressed in a study of 618 women 18-50 years of age who sought gynecological care at 4 sites (a hospital-based academic practice, 2 private practices, and a women's center) between July 1986-June 1987. 366 (59%) of these women had douched at some time. Of these women, 85% douched less than once a month, 12% douched at least once a month but less often than once a week, and 3% douched at least once a week. Women who douched were more likely to be black, less educated, younger, and of lower socioeconomic status and less likely to use spermicides or barrier contraceptives than their counterparts who did not report this practice. A comparison of the symptoms and reproductive histories of the subgroups in this study revealed two main trends. First, symptoms indicative of vaginal infection were significantly more common among women who douched; discharge was 3 times as common and vaginal irritation and abdominal or pelvic pain were twice as frequent than in non-douchers. Second, women who douched were more likely to have characteristics reflecting a high risk of sexually transmitted diseases (STDs); a history of prior gonorrhea, trichomoniasis, pelvic inflammatory disease, or other STD and the existence of 2 or more sexual partners in the previous month were reported significantly more frequently than in nondouchers. All of these characteristics increased in prevalence with increases in the frequency of douching. Two thirds of women stated they douched for reasons of hygiene. Although douching does not appear to be adopted to prevent or treat infection, symptoms of infection may affect the frequency of this practice.
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PMID:Vaginal douching. Who and why? 195 17

There are few studies from family practice offices summarizing experience with culture-proven gonorrhea. Seventy-nine such cases were identified over a six-year period in a family practice model office in Gainesville, Florida, a rate of 5.8 cases per 10,000 patient visits. Ninety-six percent of the patients in the study had limited financial resources by insurance classification. The most commonly recognized presentations in men were complaints of discharge or dysuria or both. Nine (15%) of the women gave a history of contact with a person said to have a sexually transmitted disease, but none of the men did. Of the 62 women, gonorrhea was found on routine cervical culture in only two (3%), 38 (61%) had pelvic pain, and 40 (65%) had discharge as an initial complaint. Fifty-one of the patients (88%) reported symptomatic improvement with treatment, and seven (12%) reported no improvement by the treatment. Post-treatment gonorrhea cultures were positive in two (3%), negative in thirty-three (42%), not done in seventeen (22%), and twenty-seven of the patients (34%) did not return for scheduled follow-up. Difficulties in treating patients with gonorrhea in this population appeared to be largely related to problems with patient follow-up.
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PMID:Gonorrhea care in a clinic for low-income patients. 205 12

Women with laparoscopically verified acute salpingitis (AS) were studied, and 151 were classified as having: chlamydia-associated AS (C-AS), gonococcal-associated AS (G-AS), and nonchlamydial, nongonococcal-associated AS (NCNG-AS). Patients with G-AS were more often febrile (rectal temperature greater than 38 degrees C) and more often had a moderately elevated erythrocyte sedimentation rate (ESR) (16 to 30 mm/hr) compared to other patients. Women with NCNG-AS were more likely to have a normal ESR and a mild inflammatory reaction laparoscopically. C-AS women were more likely to have had pelvic pain for more than 3 days before seeking treatment and to have an ESR of greater than 30 mm/hr on admission. Predisposing factors to AS, such as insertion of intrauterine device, hysterosalpingography, and curettage within 4 weeks of admission, were more common in the C-AS group. The tubal inflammatory changes in the C-AS group were generally more severe than expected from the relatively benign clinical course.
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PMID:Differences in some clinical and laboratory parameters in acute salpingitis related to culture and serologic findings. 645 Nov 76

The study objective was to record the incidence of Chlamydia trachomatis infections among patients admitted for legal abortion in Ullevaal Hospital (Oslo, Norway) and to follow those women harboring chlamydia, particularly those in whom it caused postoperative infections. 218 women admitted consecutively for abortion in the 1st trimester in 1980 were included in the study. The abortion procedure used was dilatation and vacuum aspiration. The diagnosis of pelvic inflammatory disease (PID) was made on the clinical basis of pelvic pain, adnexal masses, increased erythrocyte sedimentation rate, and fever. Patients who developed acute salpingitis were treated with doxycycline. Patients who harbored C trachomatis were recalled for follow up about 3 months after the abortion. Of the 218 patients, C trachomatis was isolated from the cervix in 30 (13.8%), N gonorrheae in 2 (2.8%), and both C trachomatis and N gonorrheae in 2. 7 of the 30 (23.3%) patients harboring C trachomatis developed PID. All the infections occurred in the 1st 2 weeks after the abortion. None of the patients with cervical gonorrhea developed salpingitis. 21 of the chlamydia positive patients attended for follow up 3 months after the abortion. Of the 7 patients with pelvic infection, 6 attended. 4 of these women had an appreciable rise in chlamydial IgG antibody titre while 2 had raised but unchanged titres. Another 4 patients had a 4-fold or more rise in titre but no clinical evidence of infection. Study findings indicate that patients harboring C trachomatis in the cervix at abortion are at high risk of developing postoperative infections and that C trachomatis is a major etiological agent in salpingitis occurring after abortion.
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PMID:Therapeutic abortion and Chlamydia trachomatis infection. 680 51

Chlamydia trachomatis was recovered from the fallopian tubes of ten women with acute salpingitis. The median age of the patients was 19 years. The duration of pelvic pain before consulting a physician ranged from three to 27 days (median, seven days). Half of the patients complained of irregular bleeding, and nine reported increased vaginal discharge. One patient had a rectal temperature of greater than 38 C, and one had an erythrocyte sedimentation rate of less than 15 mm/hr. At laparoscopy, mild inflammatory changes were seen in the tubes of three patients, five had moderately severe inflammation, and two had pelvic peritonitis. C. trachomatis could not be isolated from the cervix of two patients. Paired sera were available from eight patients, six of whom had a significant rise in titer of IgG antibodies to C. trachomatis. Two women had IgM antibodies. Two other women, who harbored Neisseria gonorrhoeae in the cervix, had antibodies to gonococcal pili; one had a significant decrease in titer. This latter patient was one of the patients with a stationary titer of antibodies to C trachomatis. One patient had a stationary titer of antibodies to Mycoplasma hominis. In general, chlamydial salpingitis seems to have relatively benign symptoms. Neither the failure to isolate C. trachomatis from the cervix nor a stationary titer of antibodies to the organism precludes a chlamydial etiology of acute salpingitis.
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PMID:Acute salpingitis with Chlamydia trachomatis isolated from the fallopian tubes: clinical, cultural, and serologic findings. 725 92

Pelvic inflammatory disease (PID) is a common infection in women of reproductive age. PID is actually a spectrum of disease, beginning with cervicitis and progressing to endometritis and eventually salpingitis. Sequelae include ectopic pregnancy, infertility, chronic pelvic pain, hydrosalpinx, and tubo-ovarian abscess. Neisseria gonorrhoeae and Chlamydia trachomatis are the primary causes of PID. Chlamydial infection may be asymptomatic, and the resulting salpingitis is often referred to as "silent PID." Polymicrobial infection with other organisms (eg, anaerobes, facultative aerobes) may be initiated by gonorrhea, chlamydial infection, or both. Early recognition of infection, prompt institution of appropriate antibiotic therapy, and proper follow-up are important to prevent the sequelae of PID. Patient education is essential to reduce the incidence of PID.
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PMID:Pelvic inflammatory disease. Current diagnostic criteria and treatment guidelines. 843 60

Induced abortion is one of the most frequent surgical procedures in the UK. Even though it is considered safe, it sometimes has complications and long-term sequelae. Pelvic inflammatory disease (PID) is the most prevalent complication and can lead to chronic pelvic pain, pain during intercourse, infertility, and a higher risk of ectopic pregnancy. Chlamydia trachomatis is perhaps the leading etiologic agent for PID among women who have undergone induced abortion and who develop PID. Gonorrhea is another major etiologic agent for PID. Strategies used to try to reduce pelvic infection revolve around administration of antibiotic prophylaxis based on demographic features and on the presence of certain organisms in the genital tract that may increase their risk (e.g., C. trachomatis and Neisseria gonorrhoeae) and universal antibiotic prophylaxis for all women undergoing abortion. Most of the literature suggests that antibiotic prophylaxis does provide some protection against PID but does not clearly indicate who should be screened and for which pathogens and who should be treated and with which antibiotics. Demographic features useful for identifying who should receive antibiotic prophylaxis are: a history of PID, single status, nulliparity, and youth (especially reliable for chlamydial infection). Screening for bacterial vaginosis involves diagnosis based on 3 of 4 criteria: characteristic vaginal discharge, positive amine test, raised vaginal pH, and the presence of clue cells on microscopy of wet or stained preparations of vaginal discharge. Since C. trachomatis is the most important pathogen, drugs sensitive to it should be administered: tetracyclines and erythromycin. Screening women seeking abortion for sexually transmitted diseases (STDs) provides an opportunity to educate them about STDs and treatment compliance and to contact their partners for investigation, treatment, and contact-tracing to reduce the STD-infected pool in the community.
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PMID:Preventing pelvic infection after abortion. 854 9

The prevalence of sexually transmitted diseases (STDs) and the frequency of genitourinary symptoms and signs were assessed in 1233 female prostitutes aged 18-45 years, of mean age 26, in Yaounde and Douala. Researchers recorded the physical signs and symptoms experienced by the study subjects within 14 days prior to the physical examination provided as part of the study. The women were tested for gonorrhea, chlamydia infection, and trichomoniasis, with doctors' clinical impressions compared to laboratory test findings. 20% had cervicitis; gonorrhea (11%), chlamydia (12%), or both (3%). 20% had a positive wet mount test for trichomoniasis; 10 subjects were diagnosed with gonorrhea, chlamydia, and trichomoniasis; 65.1% reported abnormal vaginal discharge; and 44.7% reported pelvic pain. Clinical diagnosis for cervicitis and trichomoniasis in this study had sensitivities of less than 50% and specificities of greater than 65%. STDs are therefore common among prostitutes in Cameroon and clinical diagnosis was not an accurate predictor of infection at the individual level.
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PMID:Prevalence and prediction of sexually transmitted diseases among sex workers in Cameroon. 969 96

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


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