Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0242172 (pelvic inflammatory disease)
 3,755 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Commentary is provided on the relationship between the use of the IUD and infertility from the development of pelvic inflammatory disease (PID), preventive behavior for those using an IUD, and recent reviews of the Dalkon Shield. Among IUD users who have never been pregnant, tubal infertility is increased 2-6 fold (200-600%), and most with tubal infertility will never bear a child. Tubal infertility develops in 11% of patients with PID, but most IUD users do not develop PID. The physicians responsibility is 1) to give formal and extensive recognition to the connection that IUD uses causes PID; 2) to inform patients of the potential risk of PID and sterility; 3) to develop proper patient selection for an IUD; 4) to identify and treat PID, which may appear initially as abnormal uterine bleeding and mild pain; 5) to recognize that the IUD facilitates the development of PID in patients with Neisseria gonorrhoea and Chlamydia trachomatis even though 25-50% of IUD patients have neither infection; 6) to recognize that the risk of PID is increased in the first 4-6 months of insertion and to research alternatives, e.g. the use of available antibiotics to treat selected patients to reduce infections, and 7) to realize that most PID occurs 6 months after insertion and indolent abscess formation is expected to increase among longterm copper IUD users. The reviews referred to in this article are ones claiming unfair removal of the Dalkon Shield in 1974 based on flawed study design and analysis of case control and the understanding that the Dalkon Shield is no worse than other IUDs and not related to PID. The author points out that neither review mentions that primary tubal infertility increased 6-fold among Dalkon Shield users who had used only 1 IUD in their life, and that infertility increased 3-fold among IUD users compared with the non-IUD using population. The case control studies provide enough evidence for the cause and effect relationship. The Kronmal et al. article did not present convincing new evidence even with reanalysis of the original Lee et al. data. In the Memford and Kessel review case controlled studies are excluded from consideration. Most PID goes unrecognized. The rate of PID cannot be determined. The goal is to protect patients and reduce population. The enemy is not physicians with opposing positions on this issue.
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PMID:Earth, motherhood, and the intrauterine device. 851 47

During the last twenty years the incidence of ectopic pregnancies has doubled or tripled. They constitute about 1.13% of all pregnancies in Norway, and remain an important cause of subsequent infertility. The main risk factors are sexually transmitted diseases, pelvic inflammatory disease, and use of intrauterine device. This paper reviews some of the recently published epidemiologic and non-epidemiologic reports that have shown a positive association between ectopic pregnancies and cigarette smoking. Some ectopic pregnancies would probably be prevented if pregnant women refrained from smoking.
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PMID:[Smoking and extrauterine pregnancy]. 163 28

Subfecundity is caused by disease and nutrition as well as by genetic, environmental, and psychological components. Sexually transmitted diseases (STDs) are caused by 21 different pathogens of which syphilis, gonorrhea, and chlamydia are the most important. Syphilis is caused by the bacterium Treponema pallidum with incidence of 10% in Thailand. 20% in Papua New Guinea, and 40% in Ethiopia. Stillbirths in infected mothers range from 66% to 80%. Gonorrhea is caused by the bacterium Neisseria gonorrhoea and its incidence was 18% in female patients in Ugandan clinic. 20% of women in Africa with cervical gonorrhea develop salpingitis. The risk of pelvic inflammatory disease is several times higher in IUD users. The bacterium Chlamydia trachomatis caused infertility in 15.4% of men in a 1991 study. Herpes simplex virus 2 infects 15-30% of sexually active adults, and the chance of fetal transmission is 40% when maternal lesions are present. Diseases other than STDs include tuberculosis (TB) whose development is aided by conditions such as malnutrition, malaria, leprosy, syphilis, and African sleeping sickness. Genital TB causes a 5-50% rate of menstrual disorders including amenorrhea and a 55-85% rate of sterility in women. Malaria is caused by Plasmodium protozoa, and the feverish state included by it can lead to oligospermia. Severe malarial anemia can lead to fetal and maternal mortality. The protozoa Trypanosoma causes African sleeping sickness that produces azoospermia and impairs the pituitary gland and ovaries. Schistosomiasis (bilharzia) and filariasis have less direct effect on fecundity but they negatively impact nutritional status. Maternal nutrition substantially impacts fetal and infant survival. During the Dutch famine of 1944-45 there was a 50% decrease in births 9 months subsequently. A 10-15% weight loss results in amenorrhea.
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PMID:Endemic disease, nutrition and fertility in developing countries. 163 64

In a retrospective cohort study of 252 patients with ectopic pregnancies the possible association between use of clomiphene citrate and the occurrence of an ectopic pregnancy was examined. Seventeen out of 252 patients had been treated with clomiphene. Epidemiologic data and animal experiments suggest, that there may be a role of clomiphene in the etiology of ectopic pregnancy. Marchbanks et al. [6] reported that patients who used clomiphene were found to have a relative risk of 10.0 for ectopic pregnancy. The analysis of our own data show an accumulation of classic risk factors as history of pelvic inflammatory disease or of microsurgery for treatment of tubal disease in the clomiphene group. The higher rate of ectopic pregnancies in patients who have been treated with clomiphene is more likely associated with the diagnosis of infertility than with the use of ovulatory-inducing agents. Clomiphene treatment is no independent risk factor in the etiology of ectopic pregnancy.
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PMID:[Ovarian stimulation with clomiphene is not a risk factor for extrauterine pregnancy]. 164 56

The Herero and Mbanderu of the northern Kalahari Desert of Botswana experienced population growth of -0.15%/year over the 1st 1/2 of the 20th century. Population growth for the population now stands near 3.5%/year. Over the last 3 decades, total fertility jumped from 2.65 to 7.02. This population has clearly become 1 of high fertility and rapid growth over a relatively short period. Population decline and a comparatively short 22-year cycle of birth waves were almost certainly due to widespread sterility in the population from diseases such as pelvic inflammatory disease. Antibiotics introduced into northwestern Botswana in the 1950s have greatly reduced earlier levels of infertility. Generation time has increased to 29 years, and more children are being born to older mothers. The present demographic pyramid of the population also reflects the large proportion of adolescent girls who have moved into their childbearing years. Population background, materials and methods, and graphs of population structure are included which show variation over the century.
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PMID:Effect of infertility on the population structure of the Herero and Mbanderu of southern Africa. 174 60

Salpingitis isthmica nodosa (SIN) is a condition of nodular thickening of the proximal Fallopian tube. The purpose of this study was to investigate the occurrence, distribution and frequency of SIN in Danish women salpingectomized because of tubal pregnancy or salpingitis and to correlate SIN with infertility, pregnancies, outcome of pregnancies, births, pelvic inflammatory disease and salpingitis. Sections from the isthmus were present in the specimens from 223 tubes from 193 patients and were analysed by the same pathologist. Originally, SIN was found in 12 patients but on re-examination, it was found in 24 patients. Ten women with SIN were bilaterally salpingectomized. Only one woman had SIN in both tubes. Women with SIN gave birth to as many children as women without SIN. After SIN had been diagnosed, no children were born, but this was not statistically different from the frequency of births in the non-SIN group after salpingectomy. Women with SIN had histological signs of salpingitis more often than women without SIN, but SIN complicated with salpingitis did not influence the number of children or tubal pregnancies. Women with SIN had a greater risk of two or more tubal pregnancies than women without SIN.
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PMID:Salpingitis isthmica nodosa in female infertility and tubal diseases. 175 22

This literature review compares the merits and disadvantages of the levonorgestrel-releasing IUD made by Leiras Pharmaceuticals, Turkey, Finland (LNG-IUD-20), with the Nova-T, Copper-T (TCu) and 220C, and Copper-T-38-Ag (TCu-380Ag). This IUD releases 20 mcg levonorgestrel daily from a Silastic sleeve on the vertical shaft containing 52 mg. The plasma level stabilized after a month at about 0.2 ng/ml, about half as high as that seen with Norplant implants. It is identical in size to the Nova-T. The Cu-T IUDs differ with respect to copper wire or sleeves, or silver-cored wire. The chief studies reviewed here were 2 multi-center trails primarily in European countries, and a 2 large multi-center trials in India. Cumulative pregnancy rates were 0.0 to 0.6 per 100 users for the LNG IUD, compared to slightly higher failures for inert or copper IUDs. While removal rates for bleeding, pain and pelvic inflammatory disease were lower for the LNG-IUD-20, removals for oligomenorrhea, amenorrhea and hormonal side effects were higher than for the other IUDS. In the Indian trials, removals for amenorrhea and irregular bleeding were much higher than rates reported in the European studies, resulting in significantly lower continuation rates overall. The results pointed to district benefits for the LNG-IUD-20, such as lower blood loss and anemia, relief of dysmenorrhea and menorrhagia, as well as possible lower risks of ectopic pregnancy in case of failure, less PID (pelvic inflammatory disease), and the claim by the maker that strictly correct placement is not necessary. Disadvantages of the LNG-IUD-20 are more difficult insertion due to the wider diameter; oligomenorrhea, amenorrhea and irregular bleeding; hormonal side effects such as acne, weight gain, nausea, headache and breast tension; and potential risk of functional ovarian cysts. The LNG-IUD-20 is considered comparable to copper IUDs in effectiveness, safety, longevity, and return to fertility after removal. Users should be counseled that the oligomenorrhea or amenorrhea is neither a medical problem or indicative of infertility, is common for the 1st 2 months, is reversible on removal, may signal an improved hemoglobin profile, relief of dysmenorrhea, and may be preferred to heavy bleeding from other IUDS. The program implications of this IUD are potential lower incidence of ectopic pregnancy and PID. The effect of its use on breast feeding, cost-effectiveness compared to Norplant, in-country manufacture, and cultural acceptance need to be determined in specific locales.
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PMID:An evaluation of the levonorgestrel-releasing IUD: its advantages and disadvantages when compared to the copper-releasing IUDs. 177 15

Pelvic inflammatory disease continues to be a major cause of morbidity in women of reproductive age. Findings of bilateral adnexal tenderness and signs of a lower genital tract infection (mucopus, or leukorrhea, or both) should prompt clinicians to consider the diagnosis of salpingitis in this group of women. Additional signs of infection, such as elevated temperature, palpable adnexal complex, leukocytosis, elevated erythrocyte sedimentation rate, or c-reactive protein, and positive tests for either Neisseria gonorrhoeae or Chlamydia trachomatis will improve the overall specificity of the clinical diagnosis. Endometrial biopsy offers an acceptable approach to documenting objectively inflammation of the upper genital tract. Diagnostic laparoscopy should be considered in all patients but may be especially helpful for those patients in whom a diagnosis is unclear. A laparoscopic grading system based primarily on tubal mobility and inflammation can be useful in predicting duration of in-hospital therapy and future tubal factor infertility.
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PMID:Diagnosis and laparoscopic grading of acute salpingitis. 182 4

In 1983, we reported on the role of laparoscopy in the Infertility Clinic at the Rotunda Hospital. We now present the current position and the effect of a laparoscopic investigation on subsequent patient management. At laparoscopy, 31% of patients had evidence of pelvic inflammatory disease and 5% had endometriosis. Management was altered in 39 (43%) patients. When reviewed, 14 (23%) patients had conceived, 5 patients without medical intervention and more patients with secondary infertility. The incidence of pelvic inflammatory disease is increased and of endometriosis is unchanged from the previous report.
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PMID:The influence of laparoscopy on infertility management. 183 58

In a study to evaluate the epidemiological status of Chlamydia trachomatis (C. trachomatis) infections in the OB/GYN field, we performed an indirect enzyme immune assay, measuring serum specific IgG and IgA. 1) Among 1,812 cases (0-68 years old), antibody positive rates for IgG and IgA were 29.7% and 11.2%, respectively. The first peak was observed in an age group under 1 year old, representing birth canal infections and the second one in a 20-24 age group showed a certain relation to STD. 2) The C. trachomatis IgG and IgA antibody positive rates in the antigen positive group (139 cases) were significantly higher (p less than 0.01) than in the antigen negative group (792 cases). 3) In the antigen positive group (139 cases), the positive IgG rate was high (78.8-90.9%) but it did not show any clear differences among the following groups: PID, cervicitis, pregnancy and infertility. However, the positive IgA rate in peritoneal antigen positive PID showed a significantly higher positive rate (100%) than other groups such as cervicitis (39.4%), pregnancy (37.8%) and infertility (45.5%). 4) Following oral administration of antibiotics, the C. trachomatis antigen became negative in almost all cases, while IgG decreased or became negative only in cases of initial infection. IgA decreased or became negative in the following cases: initial infection, low titer cases before treatment, cases treated many times and comparatively young patients with acute infections. Consequently, the immunoassay of C. trachomatis serum antibody appeared to be valuable for epidemiological surveys, for defermining the status of the infection and the effect of treatment.
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PMID:[Significance of the detection of serum specific IgA and IgG antibodies to Chlamydia trachomatis in the epidemiological survey, diagnosis and therapeutic effect on chlamydial infection in women]. 189 Mar 54


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