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)

From 1983 to 1987, seventy-five subfertile women of non demonstrable causes in the Infertility Unit, Department of Obstetrics & Gynaecology at the Siriraj Hospital, Mahidol University had diagnostic laparoscopy. Thirty-five of seventy-five subfertile women (46.66%) had pelvic pathologies which were not suspected by clinical examination. The two common pathologies of subfertile women of non demonstrable causes were pelvic inflammatory diseases (18.6%: pelvic and peritubal adhesion) and mild endometriosis (16%). Pathophysiology of subfertile women with chronic pelvic inflammatory disease was mainly due to disturbances of tubal ovarian anatomy and function. The possible mechanism of mild endometriosis which may interfere with pregnancy was discussed in the text. The results of this study indicated that diagnostic laparoscopy should be performed in all subfertile women of non demonstrable causes to find out the pelvic pathology in order to correct the causes of infertility.
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PMID:Diagnostic laparoscopy of subfertile women of non demonstrable causes. 214 13

One thousand and five women, and 354 of their partners, attending an infertility clinic have been assessed for the presence of Chlamydia trachomatis antibodies in their serum. The overall prevalence in women was 12.4% (125/1,005) but appeared to have increased over a 2-year period. A similar trend was not apparent for men and the prevalence was only 4.2% (15/354). Of the 125 seropositive women 81 had their pelvis examined for the first time by laparoscopy. Fifty seven had tubal disease of varying severity, but only 16 had had an ectopic pregnancy or admitted to a previous history of pelvic inflammatory disease or nonspecific urethritis. These findings suggest that laboratory testing for chlamydial antibodies should be routine in the initial investigation of an infertile couple and that early laparoscopy is indicated in seropositive women.
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PMID:Chlamydia trachomatis: the prevalence, trend and importance in initial infertility management. 214 48

A review of the clinical features, diagnosis and management of primary and secondary dysmenorrhea updates some old views. Dysmenorrhea is painful menstruation, either cramps with no visible cause, primary dysmenorrhea, or secondary to specific pelvic pathology. Primary dysmenorrhea occurs in as many as 50% of young women, only in ovulatory cycles, and usually limited to the first 48 or 72 hours of menstruation. Secondary dysmenorrhea can be caused by any of a dozen or so disorders such as endometriosis, pelvic inflammatory disease, IUDs, irregular cycles or infertility problems, ovarian cysts, adenomyosis, uterine myomas or polyps, intrauterine adhesions or cervical stenosis. Psychological factors are now known not to cause dysmenorrhea, only to add to the reactive component of the pain. The pain is due to uterine cramps, hypoxia or ischemia, due to overproduction of prostaglandins, leukotrienes or vasopressin. Thus, primary dysmenorrhea can be treated with oral contraceptives if the women wishes to take pills for contraception and they are not contraindicated, or with non-steroidal antiinflammatory agents for the full 72 hours after pain begins. Calcium channel-blockers are also used on a research basis; transcutaneous electrical nerve stimulation is sometimes effective. If these treatments are not effective, investigation for causes of secondary dysmenorrhea is indicated, preferably for laparoscopy.
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PMID:Dysmenorrhea. 217 34

The sequelae of sexually transmitted diseases most seriously affect women and their infants. Pelvic inflammatory disease with associated ectopic pregnancy and infertility leads the list. Male infertility as a result of sexually transmitted diseases appears uncommon.
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PMID:Sequelae of sexually transmitted diseases. 218 8

Risk factors for ectopic pregnancy include previous ectopic pregnancy, current intrauterine device use, prior fallopian tube surgery, previous pelvic inflammatory disease and a prior history of infertility. Abdominal pain is the most common symptom, followed by amenorrhea or vaginal bleeding, nausea, vomiting, syncope and dizziness. Referred shoulder pain following the onset of abdominal pain is characteristic of intraperitoneal bleeding and, in the appropriate clinical setting, strongly suggests a ruptured ectopic pregnancy. A coordinated evaluation includes measurement of serum human chorionic gonadotropin concentration and transabdominal or, preferably, transvaginal ultrasonography. Treatment is primarily by one of a variety of surgical techniques. Medical therapy with methotrexate or other drugs is currently under investigation.
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PMID:Management of ectopic pregnancy. 218 38

The pathogenesis, risk factors, microbiology, sequelae, diagnosis, and treatment of pelvic inflammatory disease (PID) are reviewed, and factors associated with the selection of effective, safe, and economical drug therapy are discussed. PID is an acute clinical syndrome not related to surgery or pregnancy that is caused by the spread of microorganisms from the vagina and cervix to the endometrium, fallopian tubes, and other adnexal structures. Primary PID, the most common form of the disease, is the result of the ascent of sexually acquired or endogenous lower genital tract microorganisms to the upper genital tract. Presence of a sexually transmitted disease is the most common risk factor for PID, but a previous episode of PID, multiple sexual partners, intrauterine device use, and young age are also risk factors. PID is classified as gonococcal or nongonococcal (i.e., caused by anaerobic and aerobic pelvic organisms). The long-term consequences of PID are the most devastating aspects of the disease; infertility remains the most common sequela. Therapy of PID is aimed at preserving fertility, preventing long-term consequences, and relieving acute clinical symptoms. In areas in which penicillinase-producing Neisseria gonorrhoeae is endemic, therapy that is effective against penicillinase-producing N. gonorrhoeae is necessary. Gonococcal PID that is not penicillin resistant may be treated with a single intramuscular or oral dose of a penicillin; penicillin-resistant infection may be treated with a cephalosporin or ciprofloxacin. If chlamydia is a diagnostic consideration, a one- to two-week course of oral tetracycline or doxycycline (injectable-drug therapy is an alternative) should be added to the regimen. Single-agent therapy is a cost-effective alternative to combination regimens. Ampicillin-sulbactam is a cost-effective alternative to the more costly injectable cephalosporins or the combination regimens of an aminoglycoside plus clindamycin or metronidazole. With the increasing prevalence of PID in the United States, the selection of cost-effective antimicrobial therapy has important implications for the hospital pharmacist and the pharmacy and therapeutics committee.
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PMID:Treatment of pelvic inflammatory disease. 212 40

Aspects of sexually transmitted diseases (STDS) peculiar to the developing countries in South America and sub-Saharan Africa are discussed. The most common STD infections are N. Gonorrhoeae, Chlamydia trachomatis, T. pallidum and T. vaginalis. Vertical transmission, particularly of syphilis among prostitutes, and of Chlamydia and gonorrhea after ophthalmia neonatorum, are common. Chlamydia is also a common respiratory tract infection in African neonates. Late complications of STDs, infertility and ectopic pregnancy, and particularly pelvic inflammatory disease, are responsible for a high proportion of hospitalizations. Antibiotic resistant gonorrhea strains are common, a result of poorly managed antibiotic treatment. Genital ulcer diseases (GUD), which predispose to HIV infections, are more common in Africa than in developed countries, not only herpes but chancroid, donovanosis and lymphogranuloma venereum. Chancroid, caused by Haemophilus ducreyi, causes 36-49% of ulcers in 2 reports. The L1-L3 strains of Chlamydia trachomatis cause lymphogranuloma venereum, the agent responsible for ulcers in 3.6-6.1% of 2 clinic populations. HIV infections have an equal sex ratio in Africa, with a younger age incidence in women and a high vertical transmission rate, while in Latin America, bisexual men, and increasingly, heterosexual transmission by intravenous drug users is reported. There is also an HIV-2 virus, whose virulence is in question, common in West Africa.
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PMID:The epidemiology of sexually transmitted diseases in Africa and Latin America. 220 6

Pelvic inflammatory disease (PID) and PID-related sequelae have risen to alarming proportions and are a major public health problem. During the last two decades, an epidemic of sexually transmitted diseases has led to an epidemic of PID that has now led to a secondary epidemic of tubal infertility and ectopic pregnancies. The direct and indirect economic consequences caused by PID to the community are enormous. The spectrum of clinical manifestations of PID is extremely broad, leading to major diagnostic problems in clinical practice. Although PID is the most preventable cause of tubal damage, PID and PID-related sequelae remain one of the most neglected areas in modern medicine. Prevention of PID should be the main goal of the appropriate diagnosis and treatment of lower genital tract infections. Only better understanding of the risk factors, microbial etiology, pathophysiology, immunopathology, and manifestation of PID can ultimately lead to improved therapeutic results and decrease in the current epidemic of acute, chronic, and late complications of PID.
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PMID:Pelvic inflammatory disease. 220 8

Chlamydia trachomatis causes sexually transmitted diseases and is associated with serious long-term sequelae such as tubal infertility and ectopic pregnancy. There have been suggestions that chlamydial antigens of approximately 57,000-60,000 Mr may be involved in the immunopathology. Two important chlamydial antigens of 57,000-60,000 Mr are a Triton X-100-soluble antigen, which induces hypersensitivity in ocular models, and a sarcosyl-insoluble cysteine-rich structural protein, omp2. In this study, a 57,000 Mr Triton X-100-soluble protein was characterized as the chlamydial homolog of groEL, a heat shock protein. Using protein fractions, antibody responses of pelvic inflammatory disease (PID) and ectopic pregnancy patients to chlamydial groEL and omp2 were differentiated. Nearly all patients in both groups were reactive to omp2. Of those with titers greater than or equal to 1:512, 31% of PID sera and 81% of ectopic pregnancy sera were positive for chlamydial groEL (P = .004). This selectivity suggests that women with PID who develop chronic sequelae are those with antibody to groEL.
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PMID:Differential human serologic response to two 60,000 molecular weight Chlamydia trachomatis antigens. 220 52

This is a comprehensive review of the risk of infertility or adverse effects on pregnancy outcome, such as chromosomal or congenital birth defects, amenorrhea, pelvic inflammatory disease (PID), or spontaneous abortion, after use of oral contraceptives, IUDs, induced abortion or spermicides. The sequelae reported for orals are chromosomal abnormalities, the VACTERL anomalies, masculinization of female fetus, Down's syndrome and post-pill amenorrhea. Several large studies found no increased risks for birth defects, although the risk of malformations when pregnant women inadvertently take the pill in early pregnancy was high in 1 of 2 such studies. Masculinization was reported with high dose combined hormone treatment and in 2 infants of a woman who took Enovid. the bulk of recent studies on secondary amenorrhea indicate that it is rare, but just as likely to occur in women with prior normal or abnormal menstrual patterns. One study found that amenorrhea is 7.7 times more likely to develop in women who took the pill to regulate menses. It is recommended that women with amenorrhea be screened for pituitary tumors and counseled before prescribing pills, and that those who fail to ovulate after stopping the pill be treated at least 6 months with clomiphene. A massing of all studies on the impact of 1st trimester induced abortion on subsequent fertility, premature delivery and spontaneous abortion, shows all relative risks around 1.0. After multiple abortions, the results are conflicting. In contrast, prior series analyzing illegal abortion have an unquestioned adverse effect on fertility and pregnancy outcome. Asherman's syndrome, a rare disorder of intrauterine adhesions, menstrual abnormalities, infertility and habitual abortion, has been associated with D & C abortion concurrent with pelvic sepsis, or traumatic pregnancy with D & C. This condition can be treated with moderate success. The bulk of IUD studies conclude that there is no overall decrement in fertility, while some disaggregated studies point the Dalkon shield as a higher risk and copper IUDs as a lower risk. PID and its consequences are now considered related to the immediate post-insertion time frame, or specifically to women who are at risk of contracting sexually transmitted disease, i.e., those with multiple partners, those with prior PID and nulliparas. Comprehensive review of current large series on spermicides shows no relationship between their use and spontaneous abortion or congenital malformation.
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PMID:Fertility after contraception or abortion. 220 74


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