Pelvic inflammatory disease

Pelvic inflammatory disease is a polymicrobial infection of the upper genital tract. It primarily affects young, sexually active women. The diagnosis is made clinically; no single test or study is sensitive or specific enough for a definitive diagnosis. Pelvic inflammatory disease should be suspected in at-risk patients who present with pelvic or lower abdominal pain with no identified etiology, and who have cervical motion, uterine, or adnexal tenderness. Chlamydia trachomatis and Neisseria gonorrhoeae are the most commonly implicated microorganisms; however, other microorganisms may be involved. The spectrum of disease ranges from asymptomatic to life-threatening tubo-ovarian abscess. Patients should be treated empirically, even if they present with few symptoms. Most women can be treated successfully as outpatients with a single dose of a parenteral cephalosporin plus oral doxycycline, with or without oral metronidazole. Delay in treatment may lead to major sequelae, including chronic pelvic pain, ectopic pregnancy, and infertility. Hospitalization and parenteral treatment are recommended if the patient is pregnant, has human immunodeficiency virus infection, does not respond to oral medication, or is severely ill. Strategies for preventing pelvic inflammatory disease include routine screening for chlamydia and patient education.     

Fitz-Hugh-Curtis syndrome

The Fitz-Hugh-Curtis syndrome consists of right upper quadrant abdominal pain, perihepatitis and genital tract infection. Neisseria gonorrhoeae and Chlamydia trachomatis have been identified as causative agents. This syndrome frequently mimics other diseases and typically occurs in sexually active young women. A high index of suspicion is essential for early diagnosis. Laparoscopy may be indicated for diagnosis and for lysis of adhesions.     

2018－2019年浙江省生殖道沙眼衣原体感染重复报告情况调查

目的了解浙江省2018 — 2019年生殖道沙眼衣原体感染重复报告情况,为掌握疫情数据制定相应管理措施提供参考。方法收集中国疾病预防控制信息系统传染病监测信息系统2018 — 2019年浙江省上报的报告病例,进行个案查重,计算重复报告率,并进行统计学分析。结果2018年1月1日至2019年12月31日报告生殖道沙眼衣原体感染病例59 826例,重复报告率为1.29%。 地区重复率为0.28%～5.68%,差异有统计学意义（χ2＝300.970,P＜0.001）;各年龄组的重复报告率为0.67%～1.65%（χ2＝50.060,P＜0.001）;妇产（科）医院及妇幼保健院（所、站）重复报告率（1.54%）高于其他的医疗机构（1.19%）χ2＝10.790,P＜0.05）。结论浙江省生殖道沙眼衣原体感染存在重复报告的情况,应加强医疗机构和疾病预防控制机构查重工作。     

Recommendations and rationale for the treatment of pelvic inflammatory disease

Pelvic inflammatory disease (PID) is one of the most common serious infections of nonpregnant women of reproductive age. Management of PID is directed at containment of infection. Goals of therapy include the resolution of clinical symptoms and signs, the eradication of pathogens from the genital tract and the prevention of sequelae including infertility, ectopic pregnancy and chronic pelvic pain. The choice of an antibiotic regimen used to treat PID relies upon the appreciation of the polymicrobial etiology of this ascending infection including Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and other lower genital tract endogenous anaerobic and facultative bacteria, many of which are associated with bacterial vaginosis. Currently available evidence and the CDC treatment recommendations support the use of broad-spectrum antibiotic regimens that adequately cover the above named microorganisms. The outpatient treatment of mild-to-moderate PID should include tolerated antibiotic regimens consisting of an extended-spectrum cephalosporin in conjunction with either azithromycin or doxycycline. Clinically severe PID should prompt hospitalization and imaging to rule out a tubo-ovarian abscess. Parenteral broad-spectrum antibiotic therapy with activity against a polymicrobial flora, particularly Gram-negative aerobes and anaerobes, should be implemented.     

Effects of cationic liposome-encapsulated doxycycline on experimental Chlamydia trachomatis genital infection in mice

In a previous study, we demonstrated that cationic liposome-encapsulated doxycycline (CaL-Dox) was two-fold more effective than free doxycycline against Chlamydia trachomatis in vitro. Here, we evaluated the effects of two CaL-Dox regimens in comparison with unencapsulated doxycycline on the course of chlamydial genital infection in mice. Progesterone-treated, female CF-1 mice were challenged intravaginally with 1.2 x 10(5) inclusion-forming units (ifu) of C. trachomatis. Two days post-infection, the animals were divided into four treatment groups for im injection of doxycycline at 10 mg/kg body weight bd for 3 (3 Dox) or 7 days (7 Dox), or of CaL-Dox at the same dose level for 3 (3 CaL-Dox) or 7 days (7 CaL-Dox) consecutively. An infected fifth group served as a control and was given an empty CaL preparation. C. trachomatis were isolated after five blind passages from 82% of infected control mice, 61.4% of 3 Dox, 52.2% of 3 CaL-Dox, 29% of 7 Dox and 20% of 7 CaL-Dox animals. Histopathological reactions were found in various tissues of the genital tract in 79.5% of infected control mice, 80.9% of 3 Dox, 65.2% of 3 CaL-Dox, 47.1% of 7 Dox and 25.7% of 7 CaL-Dox animals. Total antichlamydial antibody titres were lower in 7 CaL-Dox mice than in all the other groups (P < 0.005). The results showed that progesterone-treated CF-1 mice are suitable for investigation of both lower and upper genital tract infection with a lymphogranuloma venereum biovar strain of C. trachomatis. Neither 7 CaL-Dox nor 3 CaL-Dox treatment was more effective than unencapsulated 7 Dox doses in the bacteriological cure of chlamydial genital infection in mice. However, 7 CaL-Dox prevented tissue damage in the genital tract significantly more than all the other regimens (P < 0.05). These results suggest that liposome-encapsulated doxycycline, particularly CaL-Dox, may have potential for the clinical treatment of chlamydial infections.     

不育男性生殖道沙眼衣原体感染对精子核DNA碎片化指数的影响

目的探讨不育男性生殖道沙眼衣原体感染对精子核DNA碎片化指数的影响。方法选择2017年1月至2017年5月在成都市锦江区妇幼保健院生殖医学中心(成都西囡妇科医院)门诊初诊的117例生殖道沙眼衣原体感染的不育男性(感染组)和92例体检正常的男性(对照组),对两组的精液常规参数及精子核DNA完整性(以精子核DNA碎片化指数DFI表示)检测结果进行回顾性分析。结果⑴感染组的精子浓度低于对照组,但差异无统计学意义(P>0.50);感染组的前向运动精子百分比低于对照组,但差异无统计学意义(P>0.20);⑵与对照组相比,感染组的精子DFI值显著升高,差异有统计学意义(P<0.05)。结论生殖道感染沙眼衣原体的男性不育患者的精子核DNA损伤程度明显高于未感染者。精子核DNA碎片化指数可能是评估男性精液质量的独立指标。     

The challenge of pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infection of the upper genital tract in women that can include endometritis, parametritis, salpingitis, oophoritis, tubo-ovarian abscess, and peritonitis. The spectrum of disease ranges from subclinical, asymptomatic infection to severe, life-threatening illness; sequelae include chronic pelvic pain, ectopic pregnancy, and infertility. PID is diagnosed clinically, with laboratory and imaging studies reserved for patients who have an uncertain diagnosis, are severely ill, or do not respond to initial therapy. The Centers for Disease Control and Prevention diagnostic criteria include uterine, adnexal, or cervical motion tenderness with no other obvious cause in women at risk of PID. Empiric treatment should be initiated promptly and must cover Chlamydia trachomatis and Neisseria gonorrhoeae; the possibility of fluoroquinolone-resistant N. gonorrhoeae also should be considered. Hospitalization for initial parenteral therapy is necessary for patients with tubo-ovarian abscess and for those who are pregnant, severely ill, unable to follow a prescribed treatment plan, or unable to tolerate oral antibiotics. Patients also should be hospitalized if a surgical emergency cannot be excluded or if no clinical improvement occurs after three days. Routine screening for asymptomatic chlamydial infection can help prevent PID and its sequelae.     

Chlamydia and other sexually transmitted bacterial infections

Chlamydia trachomatis is the most common sexually transmitted bacterium worldwide. In Western Europe, the prevalence of gonorrhoea has decreased by more than 95% since the 1970ies; "tripper" and syphilis are essentially confined to high-risk groups while genital chlamydial infections affect people of all social classes, but information about chlamydia is still scarce in many European countries. Clinically genital chlamydial infections resemble gonorrhoea (dysuria, discharge, irregular bleeding, dyspareunia, perihepatitis) and may be mistaken for appendicitis. However, Chlamydia trachomatis persists longer and more often asymptomatic than Neisseria gonorrhoeae in the urogenital tract of men and women. About 20% of all chlamydia infected women suffer from partial or complete tubal occlusion. Chlamydia trachomatis is the leading cause of female infertility, but most of these women never experienced any clinical sign of pelvic inflammatory disease. Since particle concentrations are often very low in urine and cervical secretions only DNA-amplification tests, e.g. PCR or LCR, exhibit sufficient sensitivity for direct detection Chlamydia trachomatis. While Neisseria gonorrhoeae is eradicated by single-shot treatment with commonly used antibiotics like penicillins or cephalosporins Chlamydia trachomatis affords treatment for at least 10 days with doxycyline or macrolides. Partner treatment is essential to avoid reinfections. Condoms not only protect against HIV, but also against chlamydia, gonorrhoea and syphilis.     

下生殖道性传播病原体分布特点及其与高级别宫颈鳞状上皮内病变的关系

目的 探讨女性下生殖道性传播病原体的分布特点及其与高级别宫颈鳞状上皮内病变(HSIL)的关系.方法 选取246名进行宫颈癌筛查的女性作为研究对象,对其进行下生殖道涂片病理学检查.筛查出82例下生殖道性传播病原体阳性患者,并对其进行宫颈组织细胞学检查.共有38例患者被诊断为HSIL阳性,将此部分双阳性患者设为阳性组,HS...     

Pelvic inflammatory disease in the adolescent and young adult: An update

Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic routes are also noted. A variety of risk factors have been identified including adolescence, young adulthood, adolescent cervical ectropion, multiple sexual partners, immature immune system, history of previous PID, risky contraceptive practices and others. An early diagnosis and prompt treatment are necessary to reduce risks of PID complications such as chronic pelvic pain, ectopic pregnancy and infertility. Current management principles of PID are also reviewed. It is important for clinicians to screen sexually active females for common sexually transmitted infections such as Chlamydia trachomatis and provide safer sex education to their adolescent and young adult patients. Clinicians should provide comprehensive management to persons with PID and utilize established guidelines such as those from the US Centers for Disease Control and Prevention (CDC).     

Intra-articular chlamydial antigen and inflammatory arthritis

Joint material from 133 patients with well-characterized inflammatory arthritis, including individuals likely to have suffered reactive arthritis, was studied. The majority of patients were also examined for the presence of genital tract infection with Chlamydia trachomatis. Fluorescein-conjugated monoclonal antibodies demonstrated the presence of C. trachomatis antigen in synovial fluid cell deposits or synovial sections from inflamed knee joints of seven patients with reactive arthritis. The significance of these findings is discussed, as is the low rate of detection of chlamydial antigen in either the genital tract or the joint from patients in this study. We emphasize the need for further work aimed at identifying the relevant immunogenic chlamydial antigens responsible for the initiation of reactive arthritis.     

重庆市綦江区人民医院2009～2012年7种性病检出率分析

目的了解淋病、艾滋病、梅毒、生殖器疱疹、生殖器疣类病变、沙眼衣原体感染、解脲支原体感染等7种性病近4年在重庆市綦江区人民医院皮肤性病门诊的检出率及检出率的变化。方法统计和分析2009年4月至2012年9月在该院皮肤性病门诊部就诊的4 764例皮肤性病患者,11 571人次的泌尿生殖道分泌物或血液进行病原生物培养、抗原检测和血清抗体检测。结果近4年来,7种性病的检出率分别为:淋病14.1%,艾滋病0.8%,梅毒31.1%,生殖器疱疹23.1%,生殖器疣类病变13.4%,沙眼衣原体感染25.8%,解脲支原体感染9.9%。结论近4年来梅毒的检出率最高达31.1%,艾滋病的检出率最低为0.8%;性病的总检出率在下降,其中生殖器疱疹的检出率下降最明显,而梅毒的检出率在逐年上升。     

Clinical aspects of pelvic inflammatory disease.

Pelvic inflammatory disease is caused by spread of organisms from the vagina and cervix to the upper genital tract. The patient may have a life-threatening illness or may remain asymptomatic. The disease may be caused by sexually or nonsexually transmitted organisms. Polymicrobial infections are the rule. Therapy requires antibiotic agents with broad coverage of aerobic and anaerobic organisms, including Chlamydia trachomatis and Neisseria gonorrhoeae.     

某市不同行业女性生殖道环境及常见性传播疾病混合感染状况的研究

目的 通过分析某市不同行业女性生殖道环境及常见性传播疾病混合感染状况,从而为这些女性不同人群制定有效保护生殖道环境及防治性传播疾病流行提供依据.方法 所有病例选自2011年1~12月该院妇产科门诊,年龄17~35岁女性,对其从业情况和性行为采取问卷调查,根据其从业情况分为白领行业组(Wci)、特殊服务行业组(Ssi)、普通服务行业组(Osi)、工人行业组(Twi);每例患者用4支无菌专用拭子采样,分别进行白带常规、BV、细菌和支原体培养、沙眼衣原体检查.结果 Wci与Ssi、Osi和Twi三组分别比较:Wci发生混合感染情况基本低于其他三组(P＜0.05),其中Wci发生Ng+CT和Ng+CT混合感染情况与Ssi相比差异无统计学意义(P>0.05),四组中Wci生殖道环境最好、细菌性阴道病的发病也最低;Ssi与Osi和Twi两组分别比较:Ssi发生Ng+CT和Ng+CT混合感染情况低于其他两组(P＜0.05),Ssi发生Uu+Mh和Uu+CT混合感染情况显著高于其他两组(P＜0.01),三组生殖道环境都差,但Ssi细菌性阴道病的发病率最高;四组发生Ng+Uu+CT混合感染相互比差异无统计学意义(P>0.05).结论 某市女性的生殖道环境及发生常见性传播疾病混合感染情况与其从事的行业紧密相关.     

Use of vaginal pH in diagnosis of infections and its association with reproductive manifestations

Increase in vaginal secretion pH is an indicator of bacterial vaginosis (BV), but is yet to be in use as a diagnostic tool by clinicians. Similarly, no reports are available on the effect of cervical chlamydia infection and different reproductive manifestations on vaginal secretion pH. This study evaluated the use of vaginal pH for screening of BV, the effect of Chlamydia trachomatis (C. trachomatis) infection, and different reproductive manifestations on vaginal pH of women attending the gynecology outpatient department of a general hospital. Vaginal pH was recorded while diagnosing infections in 358 women, among which 45 were with repeated spontaneous abortion, 79 with infertility, 185 had sign and symptoms of lower genital tract infection, and 49 had no history or symptom of any complications or infections. Normal vaginal pH, BV, and C. trachomatis infection were observed in 72.6, 21.5, and 10.1% of women, respectively. BV and C. trachomatis were observed in 78.6 and 4.1% of women, respectively, with high vaginal pH; 12.3% of women with normal vaginal pH had C. trachomatis infection. C. trachomatis infection or different reproductive manifestations do not lead to change in vaginal pH but high vaginal pH correlated with BV and should be used as a simple tool for its diagnosis.     

329例宫颈分泌物衣原体、支原体检测及药敏结果分析

目的 探讨女性生殖道炎症支原体、衣原体感染情况及药敏结果分析。方法应用培养和衣原体抗原快速免疫测定法对女性生殖道炎症患者阴道(宫颈)分泌物进行检测，同时测定支原体对抗生索的敏感程度。结果329例生殖道炎症感染患者检测出129例支原体、衣原体阳性，其中Uu76例(23．1％)，Mh8例(2．4％)，Uu Mh20例(6．1％)，C1 9例(2．7％)，Uu C1 16例(4．9％)，支原体、农原体总感染牢为39．2％，10种药敏试验结果显示有7种抗生素敏感率为80％以上，3种在80％以下，其中敏感率最低的是四环素和氧氟沙星。结论 研究表明女性生殖道炎症Uu感染率在明显上升，耐药菌株在不断增加。进行衣原体、支原体及药敏试验。以明确病因及敏感药物，为临床医生提供治疗依据。     

Polymorphisms in Chlamydia trachomatis tryptophan synthase genes differentiate between genital and ocular isolates

We previously reported that laboratory reference strains of Chlamydia trachomatis differing in infection organotropism correlated with inactivating mutations in the pathogen's tryptophan synthase (trpBA) genes. Here, we have applied functional genomics to extend this work and find that the paradigm established for reference serovars also applies to clinical isolates - specifically, all ocular trachoma isolates tested have inactivating mutations in the synthase, whereas all genital isolates encode a functional enzyme. Moreover, functional enzyme activity was directly correlated to IFN-gamma resistance through an indole rescue mechanism. Hence, a strong selective pressure exists for genital strains to maintain a functional synthase capable of using indole for tryptophan biosynthesis. The fact that ocular serovars (serovar B) isolated from the genital tract were found to possess a functional synthase provided further persuasive evidence of this association. These results argue that there is an important host-parasite relationship between chlamydial genital strains and the human host that determines organotropism of infection and the pathophysiology of disease. We speculate that this relationship involves the production of indole by components of the vaginal microbial flora, allowing chlamydiae to escape IFN-gamma-mediated eradication and thus establish persistent infection.     

Epidemiology, pathogenesis and treatment of pelvic inflammatory disease

Pelvic inflammatory disease, the infection and inflammation of the female upper genital tract, is a common cause of infertility, chronic pain and ectopic pregnancy. Diagnosis and management are challenging, due largely to a polymicrobial etiology which is not fully delineated. Signs and symptoms of this syndrome vary widely, further complicating diagnosis and treatment. Due to the potential for serious sequelae, a low threshold for diagnosis and treatment is recommended. Since pelvic inflammatory disease has a multimicrobial etiology including Neisseria gonorrhoeae, Chlamydia trachomatis and anaerobic and mycoplasmal bacteria, treatment of pelvic inflammatory disease should be broad spectrum. Recent treatment trials have focused on shorter duration regimens such as azithromycin and monotherapies including ofloxacin, although data are sparse. Research comparing sequelae development by differing antimicrobial regimens is extremely limited, but will ultimately shape future treatment guidelines. Several promising short-duration and monotherapy antibiotic regimens should be evaluated in pelvic inflammatory disease treatment trials for compliance, microbiological and clinical cure, and reduction of subsequent adverse reproductive and gynecological morbidity.     

女性生殖道感染病原学检查及结果分析

目的 了解女性生殖道感染病原体感染状况,探讨HIV感染与相关病原体的关系。方法 采用高超倍镜检测阴道/宫颈分泌物及抽取静脉血分别进行相关病原体实验室检查。结果 门诊患者生殖道炎症为82.63%（6939/8398）,霉菌感染18.83%、滴虫感染3.57%、淋球菌感染1.45%、衣原体/支原体感染21.89%、细菌性感染28.6%、梅毒感染2.26%、HIV0.08%,38.51%的人有两种或两种以上病原体感染,其中合并HIV感染7例;健康体检组生殖道炎症19.93%（1656/8309）,霉菌感染7.7%、滴虫感染0.3%、淋球菌感染0.05%、衣原体/支原体感染2.0%、细菌性感染9.3%,4.28%的人有两种或两种以上病原体感染。结论 阴道炎患者以细菌性感染为主,宫颈炎者以衣原体/支原体感染为主,细菌性阴道炎患者是HIV感染的重要危险因子;超高倍镜能快速、准确检测多种病原体,是筛查生殖道常见病原体感染较理想的方法。     

Evaluation of dysuria in men.

Men with pain or a burning sensation on urination should be evaluated with a thorough history, a focused physical examination and urinalysis (both urine dipstick and microscopic examination of the urine specimen). Although dysuria may be caused by anything that leads to inflammation of the urethal mucosa, it is most often the result of urinary tract infection. In younger patients, the infectious agent is usually a sexually transmitted organism such as Chlamydia trachomatis. In patients over 35 years of age, coliform bacteria predominate. Infection in older men most often occurs as a result of urinary stasis secondary to benign prostatic hyperplasia. Other conditions that may cause dysuria include renal calculus, genitourinary malignancy, spondyloarthropathy and medications. Successful treatment of dysuria depends on correct identification of its cause.