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)

Pelvic inflammatory disease (PID) is defined as the acute clinical syndrome associated with ascending spread of micro-organisms from the lower to the upper female genital tract. The causative organisms can be divided into exogenous (mostly sexually transmittable) and endogenous agents. During the past three decades' epidemic of sexually transmitted diseases (STDs), STD agents have accounted for 60-80% of PIDs in women below the age of 25. After PID a total of 17.4% of the women become infertile because of post-PID tubal damage. Multiple infections, increasing age at the first infection, and severe infections are followed by a more unfavourable fertility prognosis. The risk of an ectopic pregnancy increases 7-10-fold after PID. In areas with high prevalence of STDs, use of IUDs among women in the high risk age group for PID (15-24 years) seems to increase the risk of acquiring the disease but has no influence on the clinical course of the infection. Use of combined oral contraceptive pills decreases both the risk of acquiring PID and the risk of infertility after the infection.
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PMID:Pelvic inflammatory disease: bacteriology and sequelae. 331 21

A review of existing case-control and cohort studies on the association between IUD use and ectopic pregnancy suggests 3 conclusions: 1) neither current nor past use of an IUD is associated with any increased risk of ectopic pregnancy; 2) the incidence of ectopic pregnancy seems to be similar for current users of all types of IUDs, except for the Progestasert; and 3) the duration of IUD use does not increase the risk of ectopic pregnancy. Pooled data from clinical studies of various types of IUDs indicate that the lowest risk for ectopic pregnancy is found in users of copper-bearing IUDs, while the highest risk occurs in users of progesterone-releasing devices. Although the incidence of ectopic pregnancy increased throughout the 1970s, when IUD use was also on the rise, there is no basis for assuming a cause and effect relationship. It is more plausible that the increase in ectopic pregnancy is related to the increase in various sexually transmitted diseases and the effects they have on the female genital tract. However, there is a need for further evaluation of the interrelationships between contraceptive use and predisposing factors such as pelvic inflammatory disease to tubal infertility and ectopic pregnancy.
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PMID:The intrauterine device and ectopic pregnancy. 331 27

An immunological technique for detecting Chlamydia trachomatis and Chlamydia psittaci inclusions in infected McCoy cell cultures was developed by using a genus-specific monoclonal antibody to Chlamydia spp., rabbit anti-mouse immunoglobulin G bridging antibody, alkaline phosphatase-anti-alkaline phosphatase (APAAP) monoclonal antibody conjugate, and naphthol AS-phosphate/fast red substrate. Chlamydial inclusions stained red and were easily detected against a background of blue hematoxylin-stained nuclei. After 18 h, inclusions of C. trachomatis serovar L2 LGV434/Bu and C. psittaci strain 6BC were stained by APAAP but not by iodine or Giemsa. At 48 h inclusion counts were significantly higher in the APAAP cultures. Both the APAAP procedure and conventional staining detected 35 of 239 (15%) cultures 48 h after inoculation with urethral or endocervical specimens. However, at 24 h after inoculation 22 of 35 (63%) were positive by APAAP staining while negative by iodine. This immunostain also allowed identification of chlamydial inclusions in endometrial biopsies from patients with tubal factor infertility or pelvic inflammatory disease.
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PMID:Detection of chlamydial inclusions in cell culture or biopsy tissue by alkaline phosphatase-anti-alkaline phosphatase staining. 331 86

PID is a major medical, economic, and public health problem in the United States. It is the most common serious complication of sexually transmitted diseases among young women. Of great concern is the increasing incidence of adverse reproductive consequences that are thought to be directly related to PID. The most common and important sequelae are tubal factor infertility and ectopic pregnancy. Retrospective serologic evidence has been generated by many studies implicating previous chlamydial infection as a major cause of tubal factor infertility and probably of ectopic pregnancy. Treatment of PID must include regimens effective against a broad range of pathogens, including N. gonorrhoeae and C. trachomatis.
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PMID:Sexually transmitted diseases. Pelvic inflammatory disease and infertility in women. 333 83

Four patients with heterotopic (combined) pregnancies were treated at one institution during the period of a year. The use of fertility agents, infertility surgery, and pelvic inflammatory disease may be risk factors predisposing to an increasing incidence of such pregnancies. Combined pregnancy may reasonably belong in the differential diagnosis in certain clinical settings.
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PMID:Heterotopic pregnancy: report of four cases. 334 18

In 265 Canadian women, with and without tubal factor infertility (TFI), we compared Chlamydia trachomatis cultures of endocervical swabs, endotubal swabs and biopsies, serology, and past history. A history of pelvic inflammatory disease (PID) was absent in 69.2% of TFI women, despite visual evidence of tubal damage. C. trachomatis was not isolated in any of 52 patients with TFI (TFI group), 114 having tubal ligation (STER group), or 99 patients having hysterectomy (HYST group). However, chlamydial antigen was detected with an immunochemical method in 1 of 16 tubal biopsy specimens from TFI women. The prevalence of chlamydial IgM or IgG antibody in serum was significantly higher (P less than 0.0001) in the TFI group (79.1%) than in the other two groups (relative odds, 6.3; 95% confidence interval: 2.5, 16.8). In seropositive (IgG or IgM) subjects, there was a significant (P = 0.003) and strong (relative odds, 5.1; 95% confidence interval: 1.5, 18.1) association between chlamydial IgA antibody and TFI. In women with TFI, there was no significant association between IgM or IgG seropositivity (P = 0.56). or IgA seropositivity (P = 0.53), and a negative history for PID. These findings are consistent with the hypothesis that C. trachomatis is a major cause of TFI following PID, which may or may not be asymptomatic.
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PMID:Tubal factor infertility: an association with prior chlamydial infection and asymptomatic salpingitis. 334 98

The complications of sexually transmitted diseases -- epididymitis in men and pelvic inflammatory disease in women -- result in 12,000 cases of infertility a year in France. It is therefore necessary to implement a program for the prevention of sexually transmitted diseases in France. The 1st step in such a program must be a feasibility study to determine the level of participation of general practitioners and the suitability of the questionnaires. The feasibility study was carried out in 2 steps, one in 1984 and a similar one in 1985. In each year, during a 4-week period, 57 participating doctors filled out questionnaires for each patient consulting for leucorrhea or urethral discharge. During the year between the studies, information brochures on sexually transmitted diseases were produced for doctors and the public. In 1984, the physicians noted 154 cases of leucorrhea and urethral discharge; in 1985, they noted 121 cases, an average of 6 cases/1000 patients. Of the 275 cases, 141 were in men, 134 in women. Only 4% of the men and 9% of the women were under 20, indicating that young patients go to a free health clinic rather than to private practitioners. Over 1/2 of the men, but only 1/5 of the women had multiple sexual partners, and 1/2 the patients were consulting for a recurrence. Bacteriological screening showed that the commonest organisms in the male infections were Gonococcus and Chlamydia trachomatis, while in women mycoses were more prevalent. The feasibility study showed that general practitioners cooperated and that the quality of the data was good. The 2nd phase of the study, a community randomized trial, is currently being conducted in 6 French administrative departments, 3 for treatment and 3 to act as controls. In each department 50 physicians are participating. All available information will be disseminated in the 3 treatment departments for 3 months after beginning the experiment.
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PMID:The prevention of sexually transmitted diseases which affect fertility: methodological problems and initial results. 334 19

To evaluate the association between ectopic pregnancy and 22 potential risk factors, we conducted a population-based case-control study. The investigation included 274 cases diagnosed from 1935 through 1982 in residents of Rochester, Minn, and 548 matched controls selected from live-birth deliveries. Risk factor information documented prior to the last index menstrual period was obtained via medical record abstract. Univariate matched analyses revealed nine variables associated with a significantly elevated relative risk of ectopic pregnancy. Following conditional logistic regression, four variables remained as strong and independent risk factors for ectopic pregnancy: current intrauterine device use (relative risk, 13.7; 95% confidence interval, 1.6 to 120.6), a history of infertility (relative risk, 2.6; 95% confidence interval, 1.6 to 4.2), a history of pelvic inflammatory disease (relative risk, 3.3; 95% confidence interval, 1.6 to 6.6), and prior tubal surgery (relative risk, 4.5; 95% confidence interval, 1.5 to 13.9). Theoretically, any condition that prevents or retards migration of the fertilized ovum to the uterus could predispose a woman to ectopic gestation. Further research is needed to clarify the impact of other potential risk factors in the etiology of ectopic pregnancy.
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PMID:Risk factors for ectopic pregnancy. A population-based study. 334 90

Pelvic inflammatory disease (PID) from the perspective of African practitioners is reviewed: diagnosis, staging and treatment. PID is the most common disorder treated in the gynecological department, and is a major public health problem because of the large number of patients, prolonged hospital stays, high mortality rate, and serious late sequelae of chronic pain, infertility and ectopic pregnancy. Diagnosis is difficult without confirmation by laparoscopy. PID is probable in complaints of acute abdominal pain, arising just after menses, with cervical excitation tenderness upon vaginal examination. The most reliable laboratory finding is accelerated sedimentation rate. State I is acute PID without peritoneal irritation; Stage II involves peritonitis and bilateral lower quadrant rebound tenderness; State III is a mass or abscess; Stage IV is rupture of the tubo-ovarian abscess. Culdocentesis producing gross pus suggests polymicrobial infection. The goals of treatment are to cure the patient and reach all of her partners, and to prevent late sequelae. Stage I patients can be treated with oral antibiotics as outpatients. Stage II can be effectively treated with penicillin and chloramphenicol in 80% in Zimbabwe. Stage III can sometimes be treated with antibiotics, but usually requires early surgery, by colpotomy if possible. Aggressive use of 3 antibiotics e.g., penicillin, clindamycin and gentamicin, will cover enteric organisms. Stage IV is life-threatening, with a mortality rate of 30-50% from septic shock. Total abdominal hysterectomy and bilateral adnexectomy are advised. A table depicting management of PID is included.
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PMID:Pelvic inflammatory disease in Zimbabwe. Guidelines for diagnosis and treatment. 336 58

Consultant genitourinary physicians were asked about facilities for chlamydial diagnosis and their perception of the need for this service. A wide range of facilities was available, but eight respondents had no access to a chlamydial diagnostic service (CDS). Epidemiological treatment was widely practised as a substitute for chlamydial diagnosis; some clinicians used a CDS as an adjunct to epidemiological treatment, but few clinicians based their treatment of female contacts of men with non-gonococcal urethritis on the results of a test for chlamydial infection. All respondents felt that a CDS was essential in some situations, although there was a difference of opinion about the extent of the CDS. Most clinicians believed that all or most women should be tested, but the need for testing men routinely was more controversial. Although a CDS is costly, many clinicians believed that early diagnosis was a cost effective procedure if it prevented the long term sequelae of pelvic inflammatory disease--ectopic pregnancy, chronic pelvic pain, and probably infertility.
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PMID:Chlamydial diagnostic services in the United Kingdom and Eire: current facilities and perceived needs. Royal College of Physicians Committee on Genitourinary Medicine. 342 93


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