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Query: UMLS:C0242172 (pelvic inflammatory disease)
 3,755 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of sexually transmitted diseases continues to rise across the country. Because many cases are subclinical and asymptomatic, chlamydial, herpes simplex virus, and human papillomavirus (HPV) infections continue to spread at an alarming rate. These infections can lead to serious sequelae, such as pelvic inflammatory disease, infertility, and cervical dysplasia or carcinoma, so improved disease-control strategies are needed. Preventive efforts should include use of the latest diagnostic and therapeutic methods to uncover and eradicate subclinical chlamydial and HPV infections. In addition, notification of sexual partners should be encouraged. Education about prevention of sexually transmitted diseases should be incorporated into basic primary medical care for all sexually active patients.
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PMID:The 'other' sexually transmitted diseases. Chlamydial, herpes simplex virus, and human papillomavirus infections. 131 36

Infertility is secondary to pelvic adhesions in 15-20% of cases. Pelvic adhesions result from pelvic inflammatory disease, previous pelvic surgery, foreign bodies and previous appendicitis with pelvic abscess. As a result of the insult to the peritoneal surfaces of the pelvic organs, the concentrations of peritoneal fluid leukotriene, B4 and prostaglandin E2 are increased. Also, there is a decrease in plasminogen activity. The end result will be the formation of fibrin deposits, which will end in the formation of pelvic adhesions. The diagnosis of adhesions can be achieved by a high index of suspicion in patients with a history of pelvic infections or surgery. A pelvic examination with fixation of the uterus and/or adnexa is also highly suggestive. A hysterosalpingogram might lead to a suspicion of the presence of pelvic adhesions; however, there is some degree of false-positive and -negative results. The definitive diagnosis depends on laparoscopy. The use of an internationally accepted classification, such as that of the American Fertility Society, allows investigators to compare the results of treatment. Various adjuvants have been used following lysis of adhesions to prevent their recurrence; they yield various results. The most significant recommendation is to prevent the occurrence of adhesions by following the principles of microsurgical technique during every surgical procedure.
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PMID:Pathophysiology of pelvic adhesions. Modern trends in preventing infertility. 137 47

Pelvic inflammatory disease is a common serious complication of the sexually transmitted pathogens Neisseria gonorrhoeae and Chlamydia trachomatis. There are more than 800,000 cases of pelvic inflammatory disease annually accounting for approximately 200,000 hospital admissions for acute and chronic infections. Early accurate diagnosis and treatment are essential to prevent the serious sequelae including ectopic pregnancy, tubal disease infertility, chronic pain, and disability requiring multiple hospitalizations and surgery. Although clinical models to aid in the diagnosis and management of pelvic inflammatory disease have been developed by numerous investigators, all have lacked the sensitivity and specificity to be helpful to the clinician. Laparoscopy, considered by many to be the "gold standard" for diagnosis, is underutilized, and the definition of pelvic infection differs between investigators. Improved patient compliance and safety may be seen if single-agent therapy for acute pelvic inflammatory disease becomes a reality. In a small prospective randomized study, oral ofloxacin was as effective as cefoxitin plus doxycycline for outpatient treatment of chlamydial and gonococcal pelvic inflammatory disease. Treatment of tuboovarian abscess appears to be successful with single agent and combination therapy. Risk factors for developing postabortion endometritis continue to be identified, and the most efficacious prophylactic antibiotic regimen has not been determined to date.
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PMID:Pelvic inflammatory disease. 139 39

From 1960 10 1984, 2,501 women underwent diagnostic laparoscopy (index laparoscopy) because of a clinical suspicion of acute pelvic inflammatory disease (PID). Of these women, 1,844 had abnormal laparoscopic findings (patients) and 657 had normal findings (control subjects). The reproductive events after index laparoscopy of 1,732 patients and 601 control subjects were followed. The patients and control subjects were followed for a total of 13,400 and 3,958 woman-years, respectively. During the follow-up period, 1,309 (75.6%) of the patients and 451 (75.0%) of the control subjects attempted to conceive. Of these women, 209 (16.0%) of the patients and 12 (2.7%) of the control subjects failed to conceive. A total of 141 (10.8%) of the patients and 0 (0%) of the control subjects had confirmed tubal factor infertility, 21 (1.6%) of the patients and 3 (0.7%) control subjects had other causes of infertility, and 47 (3.6%) patients and 9 (2.0%) control subjects did not have a complete infertility evaluation. Additional information on tubal morphology (hysterosalpingography, laparoscopy, or laparotomy) in women from couples for whom evaluation was incomplete indicated that 165 (12.2%) patients and 4 (0.9%) of the control subjects had abnormal tubal function or morphology after index laparoscopy. Tubal factor infertility after PID was associated with number and severity of PID episodes. The ectopic pregnancy rate for first pregnancy after index laparoscopy was 9.1% among the patients and 1.4% among control subjects.
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PMID:Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. 141 32

The US Department of Health and Human Service reported that 25% of sexuality active teenagers have had a sexually transmitted disease (STD). In school, youth are reported to have a lower STD prevalence of 4% based on Centers for Disease Control high school surveys. The seriousness of the problem is approached through discussion of the prevalence and health impact, the determinants (behavioral, social, biological, institutional), control strategies, and educational strategies. STD educational strategies can be effective only when part of a larger health education program (human sexuality and family life education) rather than including HIV infection instruction in a biology class. Populations particularly affected are young women and low income, urban minority youth. The adolescent risk of STDs is higher than in other age groups. Unfortunately severe consequences may involve reproductive health, i.e., tubal infertility from pelvic inflammatory disease and ectopic pregnancies from, for instance, chlamydia and gonorrhea. Females suffer more damage than males, although more males die of AIDS. Behavioral factors are sexual behavior, drug use, and health care behavior. Psychological factors such as self-esteem and locus of control are associated with STD risk behavior. Sexual activity is possible earlier due to a decrease in the average age of menarche. Access to services is a critical factor in prevention. Effective intervention programs should take into account risk factors and adolescent development. Adolescent clinical services need to be improved through better diagnosis, treatment, and counseling; research and education are needed also. The goal of STD education is to provide adolescents with an increased self-sufficiency in practicing STD prevention and risk reduction. Programs must be sensitive to youth subcultures and include messages about HIV and AIDS. School and community programs are essential to reach all teenagers. The optimum conditions for controlling STDs are an improved social and economic environment, accessible and effective health clinics, and quality education.
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PMID:Adolescents and sexually transmitted diseases. 143 62

100 consecutive patients undergoing elective laparoscopic tubal ligation were enrolled in a study aimed at investigating the association between perihepatic adhesions and pelvic inflammatory disease (PID). Perihepatic adhesions were identified in 17 of these patients on the basis of evaluation of the liver capsule and anterior abdominal wall. 2 patients (12%) in the adhesions group and 12 (15%) in the no-adhesions group reported a history of sexually transmitted diseases (STDs). No patient with adhesions had a documented PID episode in her history compared with 2 (2%) in the no-adhesions group. 4 patients with adhesions (24%) and 5 (6%) of those with no adhesions had clinical evidence of old pelvic infection. 2 women with a history of STD and adhesions had evidence of chronic pelvic infection. All patients had a negative gonorrhea culture, and all were clinically asymptomatic. The finding that 13 of the 17 patients with perihepatic adhesions had no evidence of prior infection of the pelvis was unexpected and suggests a need for a larger study to define the causes of these adhesions. Also suggested by these findings is the lack of association between perihepatic adhesions and infertility, since all patients were fertile women undergoing interval sterilization.
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PMID:Perihepatic adhesions: not necessarily pathognomonic of pelvic infection. 836 60

Chlamydia trachomatis usually causes asymptomatic cervicitis, but it sometimes ascends into the uterine cavity, fallopian tubes, or peritoneal cavity, causing pelvic inflammatory disease and infertility. In this study, we examined endocervical chlamydial antigens and serum chlamydial antibodies in infertile women and laparoscopically evaluated pelvic lesions according to our pelvic scoring system. In patients testing positive for a chlamydial infection, the total pelvic score was significantly higher than in patients testing negative. When each area examined was assessed separately, however, only the tubal score was significantly higher in the chlamydia infected patients. These findings may indicate that tubal lesions are the major cause of infertility in women with chlamydial infections.
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PMID:Association between chlamydial infections and pelvic lesions. 144 24

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

Asymptomatic genital infection caused by Chlamydia trachomatis is common, and one or more test-of-cure consultations in such cases is routine. The economic implications of two post-treatment strategies, either no test-of-cure, or one test-of-cure consultation with a single test for C. trachomatis, renewed treatment, and another test-of-cure of those still chlamydia-positive, and so on, have been compared. The costs of the test-of-cure strategy are twice those of the no-test regimen. Without test-of-cure, 79 more cases of pelvic inflammatory disease, 8 cases of infertility requiring treatment, and 2 cases of ectopic pregnancy would occur for every 10,000 patients. It is concluded that routine test-of-cure of asymptomatic genital chlamydial infections after treatment is not cost beneficial.
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PMID:Test-of-cure for asymptomatic genital chlamydial infections in women. A cost-benefit analysis. 152 29

In order to explore possible etiologic differences between tubal infertility in women who had been physician-diagnosed as having pelvic inflammatory disease ("overt" PID) and in women who had not ("silent" pelvic inflammatory disease), we made use of self-reported data from a large, population-based, case-control study of infertility in King County, Washington. Responses from 33 infertile women with no history of physician-reported PID and 129 infertile women with such a history were compared to those of 501 fertile women. No cultures or blood for antibody titers were obtained. Logistic regression was used to compute the relative risks for silent and overt PID-related tubal dysfunction associated with various lifestyle and contraceptive habits in an effort to identify practices that potentially affect these outcomes. In general, practices associated with an increased risk of overt tubal disease, such as use of Dalkon Shield and other types of intrauterine devices, were also associated with an increased risk of silent tubal disease, but to a lesser extent. Women who used oral contraceptives for longer than three years had a decreased risk for silent disease (relative risk = 0.5, 95% confidence interval = 0.3-0.8), but their risk for overt disease did not decrease to the same extent (relative risk = 0.9, 95% confidence interval = 0.3-2.5). These results suggest that silent and overt tubal disease share many common lifestyle risk factors.
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PMID:Risk factors for tubal infertility. Influence of history of prior pelvic inflammatory disease. 156 85


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