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PubMed1998

Severity of pelvic inflammatory disease as a predictor of the probability of live birth.

OBJECTIVE: Our aim was to study the association between severity of pelvic inflammatory disease at laparoscopy and the probability of achieving a live birth, while accounting for subsequent episodes of pelvic inflammatory disease. STUDY DESIGN: Beginning in 1960 a cohort of 1288 women in Lund, Sweden, who had clinical symptoms of acute pelvic inflammatory disease and who desired pregnancy was followed for up to 24 years. All participants underwent laparoscopy and were categorized by degree of salpingitis: mild (n = 371), moderate (n = 580), or severe (n = 337) pelvic inflammatory disease. Cumulative live birth rates, obtained by life-table analysis, and proportional hazards ratios were compared among women by severity of pelvic inflammatory disease, while accounting for subsequent episodes. RESULTS: The cumulative proportion of women achieving a live birth after 12 years was 90% for women with mild, 82% for women with moderate, and 57% for women with severe pelvic inflammatory disease. The occurrence of subsequent episodes in women with mild pelvic inflammatory disease did not diminish their long-term probability of live birth, whereas it significantly lowered the probability of live birth in women with severe pelvic inflammatory disease. Women with severe disease and subsequent episodes were eight times more likely to fail to achieve live birth compared with women with a single pelvic inflammatory disease episode with mild disease (relative risk 8.1; 95% confidence interval 3.0 to 22.2). CONCLUSIONS: Increasing severity of pelvic inflammatory disease correlates with a lower long-term probability of live birth. Subsequent episodes have a greater impact on women with severe pelvic inflammatory disease at the index episode compared with those with milder disease.

Adult↗
PubMed1982

Etiological factors in tubal infertility.

An analysis was made of the history of 820 patients who underwent diagnostic laparoscopy for infertility reasons. Events in the patient's history related to abdominal surgery, infection of the genital tract, and endometriosis were compared with the incidence of tubal disease at laparoscopy. Salpingitis, puerperal endometritis, gynecologic operations such as ovarian cystectomy, wedge resection, and operative correction of uterine retroversion and appendicitis complicated by perforation of the appendix, inflammatory mass or appendiceal abscess, were all associated with a significantly higher incidence of tubal disease. In patients that had undergone an uncomplicated appendectomy, the occurrence of tubal abnormalities was not increased (42%), when they were compared with the group with a completely negative history (37%). Implications of these findings with relation to the prevention of tubal disease are discussed.

Adult↗
PubMed1984

Evidence of chlamydial infection in infertile women with and without fallopian tube obstruction.

This study investigates the prevalence of Chlamydia trachomatis antibodies in 164 infertile women who underwent diagnostic laparoscopy and dye insufflation as part of routine infertility investigations. C. trachomatis antibodies were found in 36 (22%) of 164 infertile women, which was significantly more than the prevalence of antibodies in a control group (22 of 200, 11%). C. trachomatis antibodies were found in 25 (35.7%) of 70 infertile women who had laparoscopically verified peripheral tubal disease. This was significantly more than the prevalence of C. trachomatis antibodies in infertile women with normal fallopian tubes (6 of 52, 11.5%). The prevalence of C. trachomatis antibodies in infertile patients with laparoscopically verified cornual disease was similar to those without cornual disease. C. trachomatis was not isolated from any of the patients studied. This study confirms that past chlamydial salpingitis is associated with the development of peripheral fallopian tube obstruction with resultant infertility.

Adult↗
PubMed1987

Microbiologic study of chronic inflammation associated with tubal factor infertility: role of Chlamydia trachomatis.

One hundred sixty-one women undergoing laparoscopy for infertility of obstructive origin (fallopian tube stenosis or obstruction and periadnexal adhesions) had thorough bacteriologic studies, including Chlamydia trachomatis cultures, of their lower and upper genital tracts. Peritoneal or tubal fluid cytologic features and biopsies of fallopian tubes or adhesions were also studied after each laparoscopy. The serum of each woman was titrated for evidence of C. trachomatis infection. The sera of a control group of 51 women with ovarian infertility but normal fallopian tubes according to laparoscopy and hysterosalpingogram were titrated in an identical manner. The current study confirms previous studies that showed a strong correlation between infertility due to fallopian tube factors and positive C. trachomatis cultures or serologic studies. The current study suggests that C. trachomatis infection does not correlate with a past history of salpingitis or pelvic pain, but that current C. trachomatis infection, as assessed by positive culture, does correlate with gross and histologic evidence of chronic inflammation.

Adult↗
PubMed1997

Endovaginal sonography for the diagnosis of upper genital tract infection.

OBJECTIVE: To determine the clinical utility of transvaginal sonography for the diagnosis of upper genital tract infection. METHODS: Fifty-five women who either met the Centers for Disease Control and Prevention's minimal criteria for acute pelvic inflammatory disease or were being seen for non-classic signs of upper genital tract infection were evaluated. During abdominal and endovaginal ultrasound testing, fluid in the cul-de-sac, discrete tubes with or without tubal fluid, multicystic ovaries, and adnexal masses were noted. Upper genital tract infection was confirmed by laparoscopic visualization or histologic or microbiologic evidence of salpingitis of endometritis. RESULTS: The specificity of identifying fallopian tubes with or without intraluminal fluid on ultrasound was 97% (35 of 36); the sensitivity, however, was only 32% (six of 19). Calculated using Bayes theorem and based on a prevalence rate of 50%, the positive predictive value of visualizing fallopian tubes was 91%. The sensitivities associated with the visualization of a multicystic ovary or tubo-ovarian abscess were 42% (eight of 19) and 32% (six of 19), with specificities of 86% (31 of 36) and 97%, (35 of 36), and positive predictive values of 75% and 91%, respectively. Cul-de-sac fluid was associated with low sensitivity (37%; seven of 19), low specificity (58%; 21 of 36), and the lowest positive predictive value (47%). CONCLUSION: Endovaginal sonography has limited clinical utility in the diagnosis of upper genital tract infection due to its low sensitivity.

Endometritis↗
PubMed1986

Scrum kidney: epidemic pyoderma caused by a nephritogenic Streptococcus pyogenes in a rugby team.

In December, 1984, an outbreak of pyoderma affected five scrum players in the St Thomas' Hospital rugby team. The causative organism, Streptococcus pyogenes, was acquired during a match against a team experiencing an outbreak of impetigo, and was transmitted to two front row players of another team a week later, and to two girlfriends of affected St Thomas' players a month later. The strain was M-type 49, tetracycline-resistant, and virulent. It caused salpingitis in a girlfriend and acute glomerulonephritis in one rugby player. No case of subclinical glomerulonephritis was detected in eight patients with pyoderma. Screening of the St Thomas' Hospital team revealed four further cases of non-streptococcal skin infection, with evidence for contemporaneous spread of Staphylococcus aureus. Teams should not field players with sepsis, and it may be advisable to apply a skin antiseptic to traumatised skin after the match.

Acute Disease↗
PubMed1998

Randomised controlled trial of prophylactic antibiotics before insertion of intrauterine devices. IUD Study Group.

BACKGROUND: The value of antibiotic prophylaxis before insertion of an intrauterine device (IUD) remains uncertain. We undertook a triple-masked, randomised, placebo-controlled trial to find out whether such prophylaxis reduces the rate of IUD removal within 90 days. METHODS: 11 clinic sites in southern California enrolled women who requested IUD insertion and were at low risk of sexually transmitted infection according to self-reported medical history. We randomly assigned 1985 participants either 500 mg azithromycin or placebo capsules of identical appearance taken about 1 h before insertion of a Copper T 380A IUD. 118 women did not have an IUD inserted. We followed up 1833 of the remaining 1867 (98%) participants for at least 90 days after insertion. FINDINGS: The rate of IUD removal for any reason other than partial expulsion was 3.8% (35/918) in the antibiotic group and 3.4% (31/915) in the placebo group (relative risk 1.1 [95% CI 0.7-1.8]). The two treatment groups sought medical attention with equal frequency (mean 38 visits per 100 women). During the 90 days after IUD insertion, only one woman from each assignment group had salpingitis, as defined by established criteria. INTERPRETATION: Prophylaxis with azithromycin did not affect the likelihood that a woman would retain her IUD at 90 days or the frequency of postinsertion medical attention. In appropriately screened women, the risk of upper-genital-tract infection is negligible after IUD insertion, with or without the administration of prophylactic antibiotics.

Adult↗
PubMed2003

DNA immunization with pgp3 gene of Chlamydia trachomatis inhibits the spread of chlamydial infection from the lower to the upper genital tract in C3H/HeN mice.

Chlamydia trachomatis pgp3 DNA immunized (no. 300) and non-immunized (no. 300) C3H/HeN mice were infected by vaginal inoculation with infectious C. trachomatis serotype D elementary bodies (EBs) and the spread of infection to the salpinges was assessed by cell culture isolation from tissue homogenates 7, 14, 21, 28, 35 and 42 days post-infection (p.i.). Overall, the pgp3-DNA immunization prevented salpinx infection in 94 (56%) mice, if compared with the 168 positive animals found among the non-immunized animals (P < 0.001). A group of negative control animals (i.e. mice immunized with plasmid DNA containing an irrelevant insert) was not protected, whereas all the mice of a positive immune control group (mice that had resolved a primary genital C. trachomatis infection) were resistant to re-infection. Pgp3 DNA immunization induced both humoral and mucosal anti-pgp3 antibodies.

Animals↗
PubMed1984

Fallopian tubal mucosal damage induced experimentally by Escherichia coli in the rabbit. A scanning electron microscopic study.

Pelvic inflammatory disease is the main cause of infertility due to a tubal factor. The importance of Gramnegative bacteria as major infecting organisms in pelvic inflammatory disease has been recently recognized. The predominant facultative pathogen found in tuboperitoneal fluid from women with salpingitis are coliform bacteria. This study describes an animal model for E. coli mediated tubal mucosa damage. E. coli (10(5)-10(9) bacteria 1 ml) was injected into the right Fallopian tube of sixty rabbits; the left tube injected with culture medium, served as a control. The luminal surface of the oviducts was examined by scanning electron microscope at various intervals after the injection. The degree of damage was found to be dose-dependent and maximal seven days after innoculation. The injury comprised of large areas of deciliation, severely shortened cilia, swollen and adherent throughout their entire length and disappearance of microvilli from the secretory cells. A process of regeneration began two weeks after the innoculation and was completed eight weeks later. Fertility studies carried out after completion of regeneration showed no difference in the ratio of corpora lutea/gestational sacs between the treated and control sides of individual pregnant animals. This model sheds light on the pathogenesis of tubal surface injury by E. coli and suggests that the major effects described are mediated through the endotoxin liberated from the cell wall of these bacteria and that, therefore, antibiotic treatment has no effect on the magnitude of injury. Endosalpingeal regeneration correlates well in this animal model with normal fertility suggesting that morphologic integrity of the surface epithelium may be a good criterion in assessing the reproductive capacity of the fallopian tube.

Animals↗
PubMed2002

Microbiology and management of polymicrobial female genital tract infections in adolescents.

This review describes the microbiology and management of female genital tract infections in adolescents. These infections include vulvovaginitis, vulvovaginal pyogenic infections (abscesses of Bartholin's and Skene's glands, infected labial inclusion cysts, labial abscesses, furunculosis, and hidradenitis), endometritis, pyometritis, salpingitis, pelvic inflammatory disease, and tubo-ovarian and pelvic abscess. Anaerobes can be cultured in 50% to 90% of females with a variety of genital infections and are the exclusive isolates in 20% to 50%. Obligate anaerobes are particularly common in closed-space infections, such as tubo-ovarian and vulvovaginal abscesses. The most common anaerobes found in these infections are gram-negative bacilli (especially P. bivia and P. disiens) and anaerobic cocci. Anaerobes generally are not the only pathogens found, but are usually mixed with aerobes. The most common aerobic pathogens are members of the Enterobacteriaceae family, especially E. coli, and aerobic or microaerophilic streptococci. Sexually acquired infections include Neisseria gonorrhoeae, Gardnerella vaginalis, Trichomonas vaginalis, Chlamydia trachomatis, herpes simplex, and Condyloma accuminata. Treatment regimens must provide antimicrobial coverage for N gonorrhoeae, C trachomatis, anaerobes, streptococci, and gram-negative facultative bacteria.

Adolescent↗
PubMed1998

Transvaginal sonographic markers of tubal inflammatory disease.

OBJECTIVES: Since the introduction of transvaginal sonography (TVS), clear pictures of the female reproductive tract have been obtained. These images enable the accurate description of Fallopian tube pathology. However, the current literature on the ultrasound diagnosis of pelvic inflammatory disease (PID) is confusing and contradictory. The goal of our study was to identify sonographic markers of inflammatory disease of the pelvis and to place these in a clinical context. PATIENTS AND METHODS: Seventy-seven patients were scanned by TVS. They were divided into two groups, according to their clinical picture, the first group with acute PID and the second with a history of chronic PID or no history at all. The sonographic markers studied were shape, wall structure and wall thickness of the Fallopian tube. Ovarian involvement and the presence of pelvic fluid were also evaluated. RESULTS: The best marker of tubal inflammatory disease, either acute or chronic, was the presence of an incomplete septum of the tubal wall, which was present in 92% of the total cases. A thick wall and the 'cogwheel' sign were sensitive markers of acute disease, whereas a thin wall and 'beads-on-a-string' sign were indicators of chronic disease. Palpable findings and surgical history were not discriminatory, but were present in three-quarters and one-third of the study population, respectively. Three false-positive cases are presented: an ovarian cystadenoma, an appendiceal mucocele and one case with periovarian fluid accumulation. CONCLUSIONS: The tubo-ovarian complex and the tubo-ovarian abscess should be considered separate entities that differ in their clinical implications. TVS allows one to distinguish between them. Distinguishing characteristics of acute and chronic salpingitis are presented.

Acute Disease↗
PubMed1994

[Tuberculous meningoencephalitis in post-embryo transfer status].

A 30-year old pregnant woman, who received an embryo transfer, suffered since the 12th week of pregnancy from therapy-resistant attacks of fever for several weeks. With progressive deterioration, the increasingly somnolent patient showed by now clear signs of meningism and acid-fast bacilli were found in the cerebrospinal fluid. NMR showed a finding consistent with bacterial meningoencephalitis. During therapy with INH, Rifa and EMB, the clinical course and the CSF findings showed rapid improvement. Nevertheless, spontaneous abortion occurred in the 23rd week of pregnancy. Previous history revealed, that granulomatous salpingitis had been diagnosed several years earlier as the reason for infertility.

Adult↗
PubMed1989

Abdominal pain. Chlamydia as culprit.

Chlamydia trachomatis infection in the lower part of the genital tract of young girls and women may ascend to produce endometritis, salpingitis, perihepatitis, and other localized or generalized abdominal diseases. The resultant pain syndromes mimic a number of other common conditions that must be differentiated. A careful history and physical examination, with attention to historical and physical evidence of sexually transmitted disease, will alert the clinician to the possibility of chlamydial infection. Laboratory tests for C trachomatis may be helpful. However, tests of specimens from the lower genitourinary tract may yield negative results in patients with disease of the upper part of the genital tract and abdomen. Prompt recognition and treatment not only alleviate pain but also may help prevent inflammatory sequelae such as chronic painful adhesions, small-bowel obstruction, and tubal infertility. Costly workups and unnecessary surgery may also be avoided.

Abdomen↗
PubMedDate not supplied

Overview of Chlamydia trachomatis infection and the requirements for a vaccine.

Chlamydia trachomatis is an important human pathogen. The development of vaccines designed to prevent C. trachomatis-associated morbidity would be highly desirable. In the developing world the major goal is the prevention of blindness due to trachoma; in industrialized societies and in some developing countries, the major goal is the prevention of chlamydial salpingitis and its consequences. In early trials of trachoma vaccine composed of a suspension of elementary bodies (the infectious particles), short-lived protective immunity was induced, but deleterious effects, i.e., hyperreactivity to infection, were also noted. Thus it is likely that separation of the protective from the sensitizing antigens and the development of a subunit vaccine will be necessary. Chlamydial virulence factors include the surface structures (presumably antigenic) that are responsible for specific attachment of the organism to a susceptible host cell, induction of phagocytosis by the host cell, or inhibition of phagolysosomal fusion. Serotype-specific neutralizing antigens might also be candidate antigens. Purification of such subunit antigens from chlamydial particles is probably impractical. It is likely that genetic engineering will be required for the production of cloned antigens after such antigens have been identified.

Bacterial Vaccines↗
PubMed1985

Detection of herpes simplex virus in women with acute pelvic inflammatory disease.

Four women are described with acute salpingitis confirmed by laparoscopy who had herpes simplex virus (HSV) isolated from the cervix or the upper genital tract (endometrium, fallopian tube, or cul-de-sac) or both. None of the patients had overt genital herpes, but one had typical HSV cervitis on a cervicovaginal smear stained with Papanicolaou's stain, one had a significant change in level of antibodies to HSV, and one had an endometrial biopsy specimen positive for HSV antigen. There are at least three potential explanations for these findings: chronic viral shedding, viral reactivation caused by acute pelvic inflammatory disease (PID), or that the PID was actually caused by HSV. Further prospective studies are needed to document the role of HSV in causing PID.

Adolescent↗
PubMed2001

Plumage condition and health of aviary-kept hens fed mash or crumbled pellets.

In the present experiment, we evaluated the effects on plumage condition and health of feeding a mash or a crumbled diet to two hybrids of laying hens in an aviary system. The two diets had the same composition and calculated nutrient content. A total of 3,204 birds was studied from 20 to 80 wk of age. Two hybrids, Lohmann Selected Leghorn and SLU-1329 (two line crosses of Leghorn and Rhode Island Red), were housed in six pens each of an aviary system with groups of 269 and 265 birds, respectively. There were three replicates per treatment (diet x hybrid). Diet generally had little effect on plumage condition, health, and tonic immobility. However, birds fed the crumbled diet had significantly fewer problems with bumble foot than those fed the mash diet. Hybrids reacted differently in most traits studied; SLU-1329 had better health scores but more problems with cannibalism and salpingitis than Lohmann Selected Leghorns, whereas the reverse was found in the proportion of cases with coccidiosis. The hybrid differences found underline the importance of genotype.

Animal Feed↗
PubMed1987

The etiology of ectopic pregnancy.

The cause of ectopic pregnancy is associated with two major categories: the integrity of the oviduct and the quality of the fertilized ovum. Several conditions that alter the tubal transport system include inflammatory insults, intrauterine devices, surgical manipulation, tubal ligations, salpingitis isthmica nodusa, DES exposure, and induced abortions. Risk factors that may theoretically alter ovum quality or the hormonal environment include ovulation induction, fertilization in vitro, delayed ovulation, and transperitoneal ovum migration. As we continue to investigate the fallopian tube and the fertilized ovum as unique entities, our knowledge will increase about the cause of ectopic gestations.

Abortion, Induced↗