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

We describe the response of symptoms of chronic abacterial prostatitis/chronic pelvic pain syndrome (CAP/PPS) in a man treated with rectal prednisolone for concomitant ulcerative colitis. The temporal relationship of the symptoms of CAP/PPS to starting and stopping the topical corticosteroid over 2 treatment cycles lends further anecdotal support to our hypothesis that treatment of the immune-mediated response in this chronic condition has a beneficial effect upon symptomatic outcome.
Int J STD AIDS 2001 Nov
PMID:Variability of the symptoms of chronic abacterial prostatitis/chronic pelvic pain syndrome during intermittent therapy with rectal prednisolone foam for ulcerative colitis. 1158 17

We sought to determine current practice in the diagnosis and management of chronic prostatitis/chronic pelvic pain syndrome (CPPS) in genitourinary medicine departments in the UK, using a detailed questionnaire survey. Evaluable responses were received from 147 (69%) clinics. Seventy-nine (54%) clinics reported seeing >10 new CPPS patients per year. A broad range of investigations was reported to be used in the diagnosis of CPPS. Whilst 89 (61%) clinics reported using the four-glass test in diagnosis, 46 (32%) reported using the test in >90% of patients with CPPS, and 42 (29%) reported never using the test. In the treatment, doxycycline or ciprofloxacin were reported to be first line treatment by 98% clinics, mostly in 4-6 week courses; however, great variation was recorded in second-line choices and use of non-antibiotic approaches. This survey demonstrates that patients with CPPS are regularly diagnosed and managed in genitourinary clinics in the UK, with wide variations in diagnostic and treatment practices.
Int J STD AIDS 2002 Jun
PMID:Chronic prostatitis/chronic pelvic pain syndrome: national survey of genitourinary medicine clinics. 1201 17

As many as 85% of women with untreated pelvic inflammatory disease (PID) become infertile, almost 20% endure chronic pelvic pain which can be so severe that it prevents women from doing their daily tasks, and the permanent scarring and narrowing of the fallopian tubes caused by the condition increases a woman's risk of having a life-threatening ectopic pregnancy by 7- to 10-fold. Since sexually transmitted diseases (STD) cause most cases of PID, the prompt and effective treatment of STDs as well as preventing future cases can greatly reduce the incidence of PID and its consequences. Women frequently first seek help in primary health care facilities for their ailments. Health care providers at such facilities, however, often erroneously assume that laboratory tests are needed to diagnose and treat women with STDs or lower abdominal pain. Valuable time is lost when such providers refer women unnecessarily to hospitals or STD clinics for diagnosis and treatment. Providers should instead diagnose and treat patients on the basis of groups of symptoms, or syndromes, rather than for specific STDs. This syndromic approach may require treatment for several STDs concurrently since several STDs may cause a particular syndrome. Some guidelines are presented for diagnosing and treating PID. Finally, providing treatment at the primary care level also allows the opportunity for the attending practitioners to encourage monogamy and provide clients with condoms for the prevention of future disease.
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PMID:Health care providers can prevent and treat PID. 1217 15

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

The prevalence of genital actinomyces infection and possible routes of transmission in IUD users were analyzed in a high-risk population of predominantly indigent Mexican-American family planning clients. The Papanicolaou (Pap) smears of 12 (9%) of the 134 IUD users cultured were positive for actinomyces-like organisms. The IUD involved was the Lippes Loop in 7 cases, the Cu 7 in 2 women, the Dalkon Shield in another 2 cases, and the Saf-T-Coil in the final case. The duration of IUD use ranged from 1-10 years, with a mean of 6 years. Oral-genital sexual contact was the sexual preference in 3/4 of the women with actinomyces infection compared with under 2/3 of the general clinic population. Most of the women with actinomyces-like organisms had a concomitant condition, including gastroenteritis, cholecystitis, scabies, schizophrenia, drug abuse, anemia, herpes genitalis, venereal disease, and urinary tract infection. All of these women complained of vaginal discharge with pelvic pain during their initial visits. Eikenella corrodens was recovered in 1 of these cases and had an overall prevalence of 0.17% in the clinic population. Eikenella corrodens is found in the mouth, on dental plaques, and is not yet recognized as a normal inhabitant of the vagina or gastrointestinal tract. Oral-genital contact appears to be the mode of transmission of both actinomyces and Eikenella corrodens.
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PMID:IUDs and actinomyces. 1228 Aug 26

Although sexually transmitted diseases are a major public health problem at the international level, the relationship between contraception and pelvic infection is seldom examined. Numerous STDs are more difficult to diagnose, more frequent, and more serious in women than in men. Differential diagnosis between pelvic infection and other intraabdominal syndromes has been a concern for practitioners for years, and many pelvic infections are probably never diagnosed. Lower abdominal pain and sensitivity as well as fever, leucocytosis, accelerated sedimentation rate, inflammatory annexial mass evident on sonography, and microorganisms in the pouch of Douglass and presence of leucocytes in the peritoneal fluid are diagnostic criteria. Apart from errors in treatment resulting from errors in diagnosis, pelvic infections are often inadequately treated, especially in the initial phase before symptoms are confirmed. The exact incidence of pelvic infections in the US is unknown, but pelvic inflammatory disease (PID) accounted for over 200,000 hospitalizations per year between 1970-75. PID carries grave risks of subsequent ectopic pregnancy, chronic pelvic pain, and infertility which is more likely as the number of acute episodes increases. The female genital tract has diverse microenvironments propitious for growth of microorganisms of different types, aerobic and anaerobic. Each anatomic site has specific features conditioning bacterial growth. Histological modifications during the menstrual cycle and pregnancy affect the microbial flora. Except in the case of gonorrhea, it is not known how many female lower genital tract infections spread to the upper tract. Since 1970, several studies have domonstrated a growing diversity of cervical and vaginal flora in asymptomatic subjects. The principal risk factors for PID have been well described in the literature. All contraceptive methods except the IUD provide some degree of protection against PID. Even among IUD users the risk of PID is probably not greater than among women with a comparable risk of exposure to STDs. The protective effect of condoms has been recognized since the era of Casanova, but it is difficult to quantify. Studies describing the protective effects of spermicides used one against pelvic infection are very rare, and protective effects have usually been demonstrated only in vitro. Surfactants such as nonoxynol probably have viricidal properties against herpes simplex. Condoms and diaphragms have been seen to exercise a protective effect independent of spermicide, with relative risks of .6 and .4 compared to nonouse of contraception. There is as yet no consensus on changes in risk of PID during oral contraceptive (OC) use, but several studies have shown OCs to have a protective effect. Risks of PID in IUD users apparently stem from contamination during insertion or of the thread during prolonged use, but both possibilities remain controversial. The use of women not using contraception as controls in studies of relative risks of PId may not be appropriate because their sexual behavior and risks of exposure to STDs may differ. At the moment of ovulation, when the mucus is most receptive, IUDs do not place any barrier in the way of ascension of sperm and bacteria to the upper genital tract.
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PMID:[Contraception and pelvic infection in women]. 1234 Dec 41

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

Given the risks of congenital infections, the frequent occurrence of unintended pregnancy, and the lack of prenatal care in the first trimester, physicians should seek opportunities to discuss immunizations and disease prevention with women of childbearing age. Discussions of the following topics would be beneficial: 1. Encourage women to seek medical care at the first missed period. 2. Discuss safe sex and abstinence for prevention of sexually transmitted diseases. (See "Clinical Prevention Guidelines" in the CDC's 1998 Guidelines for Treatment of Sexually Transmitted Diseases.) 3. Encourage early medical care for vaginal discharge, pelvic pain, or possible exposure to sexually transmitted diseases. 4. Encourage good handwashing, especially before and after handling food or changing diapers. 5. Encourage the use of universal precautions when exposed to body fluids or blood. 6. Educate the patient on the importance of cooking food thoroughly and avoiding raw meat and unpasteurized dairy products. 7. Ensure vaccination against hepatitis B, rubella, and varicella.
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PMID:Congenital infections and preconception counseling. 1241 88

Sexually transmitted diseases (STDs) constitute a major health burden in the United States, causing pelvic inflammatory disease, ectopic pregnancy, infertility, chronic pelvic pain, genital lesions, genital neoplasms, adverse pregnancy outcomes, immune system dysfunction, liver disease, and even death. STDs disproportionately affect adolescents and young adults. Of the estimated 15 million STDs that occur annually each year in the United States, 4 million are among adolescents and 6 million among young adults. The current epidemic is complicated by the high asymptomatic carrier state associated with most STDs and the inadequate protection of condoms in preventing transmission. Sexually active individuals, particularly adolescents, must be educated on the ramifications of early onset of sexual activity and the health consequences of multiple sexual partners.
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PMID:Sexually transmitted diseases. 1472 72

The cause of category III A prostatitis, chronic prostatitis/chronic male pelvic pain syndrome category A (CP/CPPS A), is uncertain. Treatments for it are based on consensus opinion rather than on scientific data. Our aim was to examine the effect of zafirlukast, a leucotriene antagonist, on the symptoms of CP/CPPS A in our genitourinary (GU) medicine unit. CP/CPPS A was diagnosed by comparative white cell counts of split urine (Stamey) analysis or by finding an excess of polymorphs in expressed prostatic fluid. Symptom change was assessed by the National Institutes of Health Chronic Prostatitis Symptom Index (CPSI). Patients were given zafirlukast or placebo for four weeks in a random double-blind fashion. All patients also received doxycycline. In all, 31 patients were asked to participate and 17 entered the study. No difference in outcome could be shown between the active (10) and placebo (seven) patients. Zafirlukast cannot be demonstrated to be useful in the symptomatic treatment of CP/CPPS A. The problems of recruitment into this study (in spite of a large number of patients with prostatic type pain being seen in our unit) suggest that multicentre treatment trials using non-invasive diagnostic techniques such as the CPSI (rather than single GU medicine units diagnosing CP/CPPS A by uncomfortable direct prostatic testing) are likely to be the most effective and objective methods of undertaking treatment trials in the CP/ CPPS A field in the future.
Int J STD AIDS 2005 Mar
PMID:Treatment of category III A prostatitis with zafirlukast: a randomized controlled feasibility study. 1582 18


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