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Nitta Y, Shibata T, Kato H, Nakago S. Pelvic inflammatory disease associated with cytomegalovirus infection in an immunocompetent adult: Case report and literature review. Clin Case Rep 2024; 12:e9323. [PMID: 39135768 PMCID: PMC11317621 DOI: 10.1002/ccr3.9323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 07/12/2024] [Accepted: 07/29/2024] [Indexed: 08/15/2024] Open
Abstract
Pelvic inflammatory disease associated with cytomegalovirus infection in immunocompetent adults might be difficult to diagnose because of the rarity and relatively inconspicuous symptoms of infectious mononucleosis. Even if the main complaint is lower abdominal pain, careful search for symptoms latent outside the abdomen could lead to the diagnosis.
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Affiliation(s)
- Yuto Nitta
- Department of Obstetrics and GynecologyTakatsuki General HospitalOsakaJapan
| | - Takashi Shibata
- Department of Obstetrics and GynecologyTakatsuki General HospitalOsakaJapan
| | - Hiroki Kato
- Department of Obstetrics and GynecologyTakatsuki General HospitalOsakaJapan
| | - Satoshi Nakago
- Department of Obstetrics and GynecologyTakatsuki General HospitalOsakaJapan
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2
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Jännebring J, Liv P, Knuts M, Idahl A. Impact of patient-reported salpingitis on the outcome of hysterectomy and adnexal surgery: A national register-based cohort study in Sweden. Acta Obstet Gynecol Scand 2024; 103:1153-1164. [PMID: 38358021 PMCID: PMC11103142 DOI: 10.1111/aogs.14797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Salpingitis is caused by ascending microbes from the lower reproductive tract and contributes to tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. The aim of this study was to analyze if the risk for complications and dissatisfaction after hysterectomy and adnexal surgery was increased in women reporting previous salpingitis. MATERIAL AND METHODS This is an observational cohort study including women undergoing gynecologic surgery from 1997 to 2020, registered in the Swedish National Quality Register of Gynecologic Surgery (GynOp). Patient-reported previous salpingitis was the exposure. Complications up to 8 weeks and satisfaction at 1 year postoperatively were the outcomes. Multivariable logistic regression and ordinal regression were performed. Results were adjusted for potential confounders including age, body mass index, smoking and year of procedure as well as endometriosis and previous abdominal surgery. Multiple imputation was used to handle missing data. RESULTS In this study, 61 222 women were included, of whom 5636 (9.2%) women reported a previous salpingitis. There was an increased risk for women reporting previous salpingitis in both the unadjusted and fully adjusted models to have complications within 8 weeks of surgery (adjusted odds ratio [aOR] 1.22, 95% confidence interval [CI] 1.14-1.32). The highest odds ratios were found for bowel injury (aOR 1.62, 95% CI 1.29-2.03), bladder injury (aOR 1.52, 95% CI 1.23-1.58), and postoperative pain (aOR 1.37, 95% CI 1.22-1.54). Women exposed to salpingitis were also more likely to report a lower level of satisfaction 1 year after surgery compared with unexposed women (aOR 0.87, 95% CI 0.81-0.92). CONCLUSIONS Self-reported salpingitis appears to be a risk factor for complications and dissatisfaction after gynecologic surgery. This implies that known previous salpingitis should be included in the risk assessment before gynecologic procedures.
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Affiliation(s)
- Josefin Jännebring
- Department of Clinical SciencesObstetrics and Gynecology, Umeå UniversityUmeåSweden
| | - Per Liv
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Malin Knuts
- Department of Clinical SciencesObstetrics and Gynecology, Umeå UniversityUmeåSweden
| | - Annika Idahl
- Department of Clinical SciencesObstetrics and Gynecology, Umeå UniversityUmeåSweden
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Cunningham VC, Hurdelbrink J, Smith HL, Sittig KR, Veach LA. Impact of education and clinic site champion on extragenital testing for sexually transmitted infections. Int J STD AIDS 2024:9564624241254875. [PMID: 38756016 DOI: 10.1177/09564624241254875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are on the rise in the United States. Infections at extragenital (EG) sites (throat or rectum) may serve as an overlooked reservoir for STIs. The aims of this project were to determine the proportion of patients receiving EG testing and to observe the impact of an educational intervention. METHODS Phase I included four urgent care clinics and baseline data for adults receiving STI testing (Chlamydia trachomatis and Neisseria gonorrhoeae). Clinics received access to an educational presentation regarding the importance of EG testing. Two of these clinics served as pilot sites for the implementation of self-collection kits. Phase II involved further expansion and utilization of clinic site champions. RESULTS Phase I baseline data indicated that less than 1% of samples from patients receiving STI testing were from EG sites. There was an increase in EG testing after the educational intervention and implementation of self-collection kits. A larger increase in EG testing was seen after utilization of a site champion in Phase II. CONCLUSION EG infections serve as a potential source for STI transmission which makes multi-site testing necessary. Our interventions to improve EG testing were most effective in Phase II after implementing a clinic site champion.
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Santana BDM, Armentano GM, Ferreira DAS, de Freitas CS, Carneiro-Ramos MS, Seabra AB, Christodoulides M. In Vitro Bactericidal Activity of Biogenic Copper Oxide Nanoparticles for Neisseria gonorrhoeae with Enhanced Compatibility for Human Cells. ACS APPLIED MATERIALS & INTERFACES 2024; 16:21633-21642. [PMID: 38632674 DOI: 10.1021/acsami.4c02357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Resistance to antibiotics and antimicrobial compounds is a significant problem for human and animal health globally. The development and introduction of new antimicrobial compounds are urgently needed, and copper oxide nanoparticles (CuO NPs) have found widespread application across various sectors including biomedicine, pharmacy, catalysis, cosmetics, and many others. What makes them particularly attractive is the possibility of their synthesis through biogenic routes. In this study, we synthesized biogenic green tea (GT, Camellia sinensis)-derived CuO NPs (GT CuO NPs) and examined their biophysical properties, in vitro toxicity for mammalian cells in culture, and then tested them against Neisseria gonorrhoeae, an exemplar Gram-negative bacterium from the World Health Organization's Priority Pathogen List. We compared our synthesized GT CuOP NPs with commercial CuO NPs (Com CuO NPs). Com CuO NPs were significantly more cytotoxic to mammalian cells (IC50 of 7.32 μg/mL) than GT CuO NPs (IC50 of 106.1 μg/mL). GT CuO NPs showed no significant increase in bax, bcl2, il6, and il1β mRNA expression from mammalian cells, whereas there were notable rises after treatment with Com CuO NPs. GT-CuO NPs required concentrations of 0.625 and 3.125 μg/mL to kill 50 and 100% of bacteria, respectively, whereas Com-CuO NPs needed concentrations of 15.625 and 30 μg/mL to kill 50 and 100% of bacteria, and the antibiotic ceftriaxone killed 50 and 100% with 3.125 and 30 μg/mL. Gonococci could be killed within 30 min of exposure to GT CuO NPs and the NPs could kill up to 107 within 1 h. In summary, this is the first report to our knowledge that describes the bioactivity of biogenic CuO NPs against N. gonorrhoeae. Our data suggest that biogenic nanoparticle synthesis has significant advantages over traditional chemical routes of synthesis and highlights the potential of GT-CuO NPs in addressing the challenges posed by multidrug-resistant Neisseria gonorrhoeae infections.
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Affiliation(s)
- Bianca de Melo Santana
- Center for Natural and Human Sciences (CCNH), Federal University of ABC (UFABC), Avenida dos Estados 5001, Santo André, São Paulo 09210-580, Brazil
- Neisseria Research Laboratory, Molecular Microbiology, School of Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, U.K
| | - Giovana Marchini Armentano
- Center for Natural and Human Sciences (CCNH), Federal University of ABC (UFABC), Avenida dos Estados 5001, Santo André, São Paulo 09210-580, Brazil
| | - Dayana Agnes Santos Ferreira
- Neisseria Research Laboratory, Molecular Microbiology, School of Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, U.K
- Laboratory of Pathophysiology, Butantan Institute, Av. Vital Brazil, 1500, São Paulo, SP 05503-900, Brazil
| | - Camila Simões de Freitas
- Neisseria Research Laboratory, Molecular Microbiology, School of Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, U.K
- Postgraduate Program in Health Sciences: Infectious Diseases and Tropical Medicine, Faculty of Medicine, Federal University of Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Marcela Sorelli Carneiro-Ramos
- Center for Natural and Human Sciences (CCNH), Federal University of ABC (UFABC), Avenida dos Estados 5001, Santo André, São Paulo 09210-580, Brazil
| | - Amedea Barozzi Seabra
- Center for Natural and Human Sciences (CCNH), Federal University of ABC (UFABC), Avenida dos Estados 5001, Santo André, São Paulo 09210-580, Brazil
| | - Myron Christodoulides
- Neisseria Research Laboratory, Molecular Microbiology, School of Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, U.K
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Allan-Blitz LT, Sanders G, Shah P, Adams G, Jarolimova J, Ard K, Branda JA, Klausner JD, Sabeti PC, Lemieux JE. Clinical Performance of Cas13a-based Point-of-Care Lateral Flow Assay for Detecting Neisseria gonorrhoeae. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.01.24303603. [PMID: 38496586 PMCID: PMC10942539 DOI: 10.1101/2024.03.01.24303603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background Diagnosis of Neisseria (N.) gonorrhoeae is dependent on nucleic acid amplification testing (NAAT), which is not available in resource-limited settings where the prevalence of infection is highest. Recent advances in molecular diagnostics leveraging the high specificity of CRISPR enzymes can permit field-deployable, point-of-care lateral flow assays. We previously reported on the development and in vitro performance of a lateral flow assay for detecting N. gonorrhoeae. Here we aimed to pair that assay with point-of-care DNA extraction techniques and assess the performance on clinical urine specimens. Methods We collected an additional urine specimen among individuals enrolling in an ongoing clinical trial at the Massachusetts General Hospital Sexual Health Clinic who presented with symptoms of urethritis or cervicitis (urethral or vaginal discharge, dysuria, or dyspareunia). We then assessed thermal, detergent, and combination DNA extraction conditions, varying the duration of heat at 95°C and concentration of Triton X. We assessed the efficacy of the various DNA extraction methods by quantitative polymerase chain reaction (qPCR). Once an extraction method was selected, we incubated samples for 90 minutes to permit isothermal recombinase polymerase amplification. We then assessed the performance of lateral flow Cas13a-based detection using our previously designed porA probe and primer system for N. gonorrhoeae detection, comparing lateral flow results with NAAT results from clinical care. Results We assessed DNA extraction conditions on 3 clinical urine specimens. There was no consistent significant difference in copies per microliter of DNA obtained using more or less heat. On average, we noted that 0.02% triton combined with 5 minutes of heating to 95°C resulted in the highest DNA yield, however, 0.02% triton alone resulted in a quantity of DNA that was above the previously determined analytic sensitivity of the assay. Given that detergent-based extraction is more easily deployable, we selected that as our method for extraction. We treated 23 clinical specimens with 0.02% triton, which we added to the Cas13a detection system. We ran all lateral flow detections in duplicate. The Cas13a-based assay detected 8 of 8 (100%) positive specimens, and 0 of 15 negative specimens. Conclusion Using point-of-care DNA extraction, isothermal amplification, and Cas13a-based detection, our point-of-care lateral flow N. gonorrhoeae assay correctly identified 23 clinical urine specimens as either positive or negative. Further evaluation of this assay among larger samples and more diverse sample types is warranted.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity: Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Gabriela Sanders
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Palak Shah
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Gordon Adams
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jana Jarolimova
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Kevin Ard
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - John A. Branda
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Jeffrey D. Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Pardis C. Sabeti
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
| | - Jacob E. Lemieux
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
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Amaya SI, Wolff SF, Ross M, French VA. Intrauterine devices are a safe form of contraception in users with solid organ transplantation: A single-center experience. Transpl Infect Dis 2023:e14220. [PMID: 38160328 DOI: 10.1111/tid.14220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Abstract
Patients who undergo organ transplantation are advised to use contraception for health optimization, yet limited data exists on safe contraceptive options for this population. This study investigates the infection risk of intrauterine devices (IUDs) in patients who have received a solid organ transplant by evaluating the incidence of pelvic inflammatory disease (PID). We performed a retrospective chart review of subjects with a solid organ transplant who used an IUD between the years of January 2007 to February 2021. We included subjects ages 22-55 years at the time of IUD placement. We abstracted demographic information, transplant type, IUD type, immunosuppressive medications, screening for sexually transmitted infections, and diagnosis of PID. We identified 29 subjects that met the inclusion criteria. Six subjects had a copper IUD (21%) and 23 had a levonorgestrel IUD (79%). The most common organ transplanted was a kidney (n = 10) and liver (n = 10) while five subjects had multiple organs transplanted. Twenty-five (86.2%) subjects took immunosuppressive medications at the time of IUD insertion. Twenty-four (82.8%) patients had their IUD placed after transplantation. The average time of IUD use was 2.5 years. . In our study of IUD use in patients with solid organ transplantation, no patients developed PID. IUDs are a safe contraceptive option for immunosuppressed transplant patients.
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Affiliation(s)
- Stephanie I Amaya
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
| | - Sharon F Wolff
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas, USA
| | - Meghan Ross
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas, USA
| | - Valerie A French
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas, USA
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Skarga E, Surcel HM, Kaaks R, Waterboer T, Fortner RT. Sexually Transmitted Infections and Risk of Epithelial Ovarian Cancer: Results From the Finnish Maternity Cohort. J Infect Dis 2023; 228:1621-1629. [PMID: 37196097 PMCID: PMC10681868 DOI: 10.1093/infdis/jiad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Sexually transmitted infections, specifically Chlamydia trachomatis (CT), may be associated with epithelial ovarian cancer (EOC) risk. The association between CT and EOC subtypes is unclear. Our aim was to investigate whether history of CT and other infections (Mycoplasma genitalium [MG], herpes simplex virus type 2 [HSV-2], and human papillomavirus [HPV]) are associated with EOC risk by histotype. METHODS We measured antibodies (Abs) to CT, MG, HSV-2, and HPV-16/18 in serum samples in a nested case-control study in the Finnish Maternity Cohort (N = 484 cases 1:1 matched to controls). Logistic regression was used to calculate relative risks (RRs) and 95% confidence intervals (CIs) in seropositive versus seronegative individuals in all cases, as well as serous (n = 249), clear cell and endometrioid (n = 91), and mucinous (n = 144) EOC. RESULTS CT seropositivity was not associated with EOC risk (eg, CT pGP3-Ab: RR, 0.92 [95% CI, .72-1.19]), regardless of disease subtype. We observed a positive association between MG seropositivity and mucinous EOC (RR, 1.66 [95% CI, 1.09-2.54]; P for heterogeneity by histotype ≤ .001), but not other subtypes. No associations were observed with seropositivity to multiple STIs. CONCLUSIONS CT infection was not associated with EOC risk, with associations observed only for MG and mucinous EOC. Mechanisms linking MG to mucinous EOC remain to be elucidated.
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Affiliation(s)
- Elizaveta Skarga
- Division of Cancer Epidemiology, German Cancer Research Center
- Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Heljä-Marja Surcel
- Faculty of Medicine, University of Oulu, Oulu, Finland
- Biobank Borealis of Northern Finland, Oulu, Finland
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center, Heidelberg, Germany
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center
- Department of Research, Cancer Registry of Norway, Oslo
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Allan-Blitz LT, Shah P, Adams G, Branda JA, Klausner JD, Goldstein R, Sabeti PC, Lemieux JE. Development of Cas13a-based assays for Neisseria gonorrhoeae detection and gyrase A determination. mSphere 2023; 8:e0041623. [PMID: 37732792 PMCID: PMC10597441 DOI: 10.1128/msphere.00416-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/22/2023] Open
Abstract
Neisseria gonorrhoeae is one of the most common bacterial sexually transmitted infections. The emergence of antimicrobial-resistant N. gonorrhoeae is an urgent public health threat. Currently, the diagnosis of N. gonorrhoeae infection requires expensive laboratory infrastructure, while antimicrobial susceptibility determination requires bacterial culture, both of which are infeasible in low-resource areas where the prevalence of infection is highest. Recent advances in molecular diagnostics, such as specific high-sensitivity enzymatic reporter unlocking (SHERLOCK) using CRISPR-Cas13a and isothermal amplification, have the potential to provide low-cost detection of pathogen and antimicrobial resistance. We designed and optimized RNA guides and primer sets for SHERLOCK assays capable of detecting N. gonorrhoeae via the porA gene and of predicting ciprofloxacin susceptibility via a single mutation in the gyrase A (gyrA) gene. We evaluated their performance using both synthetic DNA and purified N. gonorrhoeae isolates. For porA, we created both a fluorescence-based assay and lateral flow assay using a biotinylated fluorescein reporter. Both methods demonstrated sensitive detection of 14 N. gonorrhoeae isolates and no cross-reactivity with 3 non-gonococcal Neisseria isolates. For gyrA, we created a fluorescence-based assay that correctly distinguished between 20 purified N. gonorrhoeae isolates with phenotypic ciprofloxacin resistance and 3 with phenotypic susceptibility. We confirmed the gyrA genotype predictions from the fluorescence-based assay with DNA sequencing, which showed 100% concordance for the isolates studied. We report the development of Cas13a-based SHERLOCK assays that detect N. gonorrhoeae and differentiate ciprofloxacin-resistant isolates from ciprofloxacin-susceptible isolates. IMPORTANCE Neisseria gonorrhoeae, the cause of gonorrhea, disproportionately affects resource-limited settings. Such areas, however, lack the technical capabilities for diagnosing the infection. The consequences of poor or absent diagnostics include increased disease morbidity, which, for gonorrhea, includes an increased risk for HIV infection, infertility, and neonatal blindness, as well as an overuse of antibiotics that contributes to the emergence of antibiotic resistance. We used a novel CRISPR-based technology to develop a rapid test that does not require laboratory infrastructure for both diagnosing gonorrhea and predicting whether ciprofloxacin can be used in its treatment, a one-time oral pill. With further development, that diagnostic test may be of use in low-resource settings.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Palak Shah
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gordon Adams
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John A. Branda
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeffrey D. Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Robert Goldstein
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pardis C. Sabeti
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
| | - Jacob E. Lemieux
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Franco PN, García-Baizán A, Aymerich M, Maino C, Frade-Santos S, Ippolito D, Otero-García M. Gynaecological Causes of Acute Pelvic Pain: Common and Not-So-Common Imaging Findings. Life (Basel) 2023; 13:2025. [PMID: 37895407 PMCID: PMC10608316 DOI: 10.3390/life13102025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
In female patients, acute pelvic pain can be caused by gynaecological, gastrointestinal, and urinary tract pathologies. Due to the variety of diagnostic possibilities, the correct assessment of these patients may be challenging. The most frequent gynaecological causes of acute pelvic pain in non-pregnant women are pelvic inflammatory disease, ruptured ovarian cysts, ovarian torsion, and degeneration or torsion of uterine leiomyomas. On the other hand, spontaneous abortion, ectopic pregnancy, and placental disorders are the most frequent gynaecological entities to cause acute pelvic pain in pregnant patients. Ultrasound (US) is usually the first-line diagnostic technique because of its sensitivity across most common aetiologies and its lack of radiation exposure. Computed tomography (CT) may be performed if ultrasound findings are equivocal or if a gynaecologic disease is not initially suspected. Magnetic resonance imaging (MRI) is an extremely useful second-line technique for further characterisation after US or CT. This pictorial review aims to review the spectrum of gynaecological entities that may manifest as acute pelvic pain in the emergency department and to describe the imaging findings of these gynaecological conditions obtained with different imaging techniques.
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Affiliation(s)
- Paolo Niccolò Franco
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312 Vigo, Spain; (A.G.-B.); (S.F.-S.); (M.O.-G.)
- Department of Diagnostic Radiology, IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy; (C.M.); (D.I.)
| | - Alejandra García-Baizán
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312 Vigo, Spain; (A.G.-B.); (S.F.-S.); (M.O.-G.)
- Diagnostic Imaging Research Group, Radiology Department, Galicia Sur Health Research Institute (IIS Galicia Sur), Galician Health Service (SERGAS)-University of Vigo (UVIGO), 36213 Vigo, Spain;
| | - María Aymerich
- Diagnostic Imaging Research Group, Radiology Department, Galicia Sur Health Research Institute (IIS Galicia Sur), Galician Health Service (SERGAS)-University of Vigo (UVIGO), 36213 Vigo, Spain;
| | - Cesare Maino
- Department of Diagnostic Radiology, IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy; (C.M.); (D.I.)
| | - Sofia Frade-Santos
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312 Vigo, Spain; (A.G.-B.); (S.F.-S.); (M.O.-G.)
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Rua Prof. Lima Basto, 1099-023 Lisbon, Portugal
| | - Davide Ippolito
- Department of Diagnostic Radiology, IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy; (C.M.); (D.I.)
- School of Medicine, University of Milano Bicocca, Via Cadore 33, 20090 Monza, Italy
| | - Milagros Otero-García
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312 Vigo, Spain; (A.G.-B.); (S.F.-S.); (M.O.-G.)
- Diagnostic Imaging Research Group, Radiology Department, Galicia Sur Health Research Institute (IIS Galicia Sur), Galician Health Service (SERGAS)-University of Vigo (UVIGO), 36213 Vigo, Spain;
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Tian R, Apeseche S, Glass J, Wilks-Gallo L. Ascending Right-Sided Abdominal Pain in an Adolescent Woman. Pediatr Rev 2023; 44:S110-S112. [PMID: 37777215 DOI: 10.1542/pir.2021-005429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Rayna Tian
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Shantel Apeseche
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook Children's Hospital, Stony Brook, NY
| | - Joshua Glass
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook Children's Hospital, Stony Brook, NY
| | - Lisa Wilks-Gallo
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook Children's Hospital, Stony Brook, NY
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Allan-Blitz LT, Shah P, Adams G, Branda JA, Klausner JD, Goldstein R, Sabeti PC, Lemieux JE. Development of Cas13a-based Assays for Neisseria gonorrhoeae Detection and Gyrase A Determination. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.21.23290304. [PMID: 37293004 PMCID: PMC10246164 DOI: 10.1101/2023.05.21.23290304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Neisseria gonorrhoeae is one of the most common bacterial sexually transmitted infections. The emergence of antimicrobial-resistant N. gonorrhoeae is an urgent public health threat. Currently, diagnosis of N. gonorrhoeae infection requires expensive laboratory infrastructure, while antimicrobial susceptibility determination requires bacterial culture, both of which are infeasible in low-resource areas where prevalence is highest. Recent advances in molecular diagnostics, such as Specific High-sensitivity Enzymatic Reporter unLOCKing (SHERLOCK) using CRISPR-Cas13a and isothermal amplification, have the potential to provide low-cost detection of pathogen and antimicrobial resistance. Methods and Results We designed and optimized RNA guides and primer-sets for SHERLOCK assays capable of detecting N. gonorrhoeae via the por A gene and of predicting ciprofloxacin susceptibility via a single mutation in the gyrase A ( gyr A) gene. We evaluated their performance using both synthetic DNA and purified N. gonorrhoeae isolates. For por A, we created both a fluorescence-based assay and lateral flow assay using a biotinylated FAM reporter. Both methods demonstrated sensitive detection of 14 N. gonorrhoeae isolates and no cross-reactivity with 3 non-gonococcal Neisseria isolates. For gyr A, we created a fluorescence-based assay that correctly distinguished between 20 purified N. gonorrhoeae isolates with phenotypic ciprofloxacin resistance and 3 with phenotypic susceptibility. We confirmed the gyr A genotype predictions from the fluorescence-based assay with DNA sequencing, which showed 100% concordance for the isolates studied. Conclusion We report the development of Cas13a-based SHERLOCK assays that detect N. gonorrhoeae and differentiate ciprofloxacin-resistant isolates from ciprofloxacin-susceptible isolates.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity: Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Palak Shah
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Gordon Adams
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - John A. Branda
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Jeffrey D. Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Robert Goldstein
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Pardis C. Sabeti
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
| | - Jacob E. Lemieux
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
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12
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Wihlfahrt K, Günther V, Mendling W, Westermann A, Willer D, Gitas G, Ruchay Z, Maass N, Allahqoli L, Alkatout I. Sexually Transmitted Diseases-An Update and Overview of Current Research. Diagnostics (Basel) 2023; 13:diagnostics13091656. [PMID: 37175047 PMCID: PMC10178083 DOI: 10.3390/diagnostics13091656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/30/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
A rise in the rates of sexually transmitted diseases, both worldwide and in Germany, has been observed especially among persons between the ages of 15 and 24 years. Since many infections are devoid of symptoms or cause few symptoms, the diseases are detected late, may spread unchecked, and be transmitted unwittingly. In the event of persistent infection, the effects depend on the pathogen in question. Manifestations vary widely, ranging from pelvic inflammatory disease, most often caused by Chlamydia trachomatis (in Germany nearly 30% of PID) or Neisseria gonorrhoeae (in Germany <2% of PID), to the development of genital warts or cervical dysplasia in cases of infection with the HP virus. Causal treatment does exist in most cases and should always be administered to the sexual partner(s) as well. An infection during pregnancy calls for an individual treatment approach, depending on the pathogen and the week of pregnancy.
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Affiliation(s)
- Kristina Wihlfahrt
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3 (House C), 24105 Kiel, Germany
| | - Veronika Günther
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3 (House C), 24105 Kiel, Germany
| | - Werner Mendling
- German Center for Infections in Gynecology and Obstetrics, at Helios University Hospital Wuppertal, Heusnerstrasse 40, 42283 Wuppertal, Germany
| | - Anna Westermann
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3 (House C), 24105 Kiel, Germany
| | - Damaris Willer
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3 (House C), 24105 Kiel, Germany
| | - Georgios Gitas
- Department of Gynecology-Robotic Surgery at European Interbalkan Medical Center, 57001 Thessaloniki, Greece
| | - Zino Ruchay
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3 (House C), 24105 Kiel, Germany
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3 (House C), 24105 Kiel, Germany
| | - Leila Allahqoli
- School of Public Health, Iran University of Medical Sciences (IUMS), Tehran 14167-53955, Iran
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3 (House C), 24105 Kiel, Germany
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13
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Yusuf H, Trent M. Management of Pelvic Inflammatory Disease in Clinical Practice. Ther Clin Risk Manag 2023; 19:183-192. [PMID: 36814428 PMCID: PMC9939802 DOI: 10.2147/tcrm.s350750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/16/2022] [Indexed: 02/17/2023] Open
Abstract
Pelvic inflammatory disease (PID) is a common reproductive health disorder among women of reproductive age. The treatment of PID has slowly evolved, reflecting changing antibiotic susceptibility and advancements in therapeutics and research; however, it has been largely unchanged over the last several decades. The most recent treatment recommendations consider the severity of infection, clinical presentation, and the polymicrobial nature of the disease. In addition, the role of novel organisms like Mycoplasma genitalium in PID is of emerging significance. PID treatment guidance offers oral and parenteral treatment options based on the patient's clinical status; however, deviations from the published guidelines are a general concern. Point of care (POC) testing for precision care, provision of adherence support, optimizing self-management and prevention strategies, and other alternative or synergistic approaches that maximize treatment outcomes will be instrumental for addressing the current challenges in PID diagnosis and management.
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Affiliation(s)
- Hasiya Yusuf
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Maria Trent
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Correspondence: Maria Trent, Bloomberg Professor of American Health and Pediatrics, Departments of Population, Family, and Reproductive Health Sciences and Pediatrics, Johns Hopkins University, 200 N. Wolfe Street #2056, Baltimore, MD, 21287, USA, Tel +1 443-287-8945, Fax +1 410-502-5440, Email
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14
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Acupuncture for Female Infertility: Discussion on Action Mechanism and Application. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3854117. [PMID: 35832528 PMCID: PMC9273356 DOI: 10.1155/2022/3854117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/11/2022] [Indexed: 11/18/2022]
Abstract
A higher incidence of female infertility has been reported with an unexpectedly early appearance in recent years. The female infertility treatment and application of assisted reproductive technology have recently gained immense interest from scientists. Many studies have discussed the beneficial effects of acupuncture on female infertility. With advancements in science and medical technology, acupuncture-related research has increased in investigating its effectiveness in treating female infertility. This review focuses on a compilation of research in recent years on acupuncture for female infertility treatment and the exploration of the underlying mechanism. For this purpose, literature was searched using various search engines like PubMed, Web of Science, and Google Scholar. The search was refined by only focusing on recent studies on acupuncture effectiveness and mechanism in female infertility and evaluating pregnancy outcomes.
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15
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Houdre D, Chapron C, Pirot F. [How I do… an ultrasound guided drainage of a complicated pelvic inflammatory disease?]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:272-275. [PMID: 34800738 DOI: 10.1016/j.gofs.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 06/13/2023]
Affiliation(s)
- D Houdre
- Department of gynecology obstetrics and reproductive medicine, hôpital universitaire Paris Centre (HUPC), CHU de Cochin, AP-HP, Paris, France
| | - C Chapron
- Department of gynecology obstetrics and reproductive medicine, hôpital universitaire Paris Centre (HUPC), CHU de Cochin, AP-HP, Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - F Pirot
- Department of gynecology obstetrics and reproductive medicine, hôpital universitaire Paris Centre (HUPC), CHU de Cochin, AP-HP, Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, Paris, France.
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16
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Tan KL, Chen YM, Zeng W, Meng Y, Jiang L. Local Methotrexate Injection Followed by Dilation and Curettage for Cesarean Scar Pregnancy: A Prospective Non-randomized Study. Front Med (Lausanne) 2022; 8:800610. [PMID: 35127758 PMCID: PMC8815728 DOI: 10.3389/fmed.2021.800610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
PurposeTo evaluate the clinical effects and outcomes of local intra-gestational sac methotrexate injection followed by dilation and curettage for treatment of cesarean scar pregnancies (CSP).MethodThis prospective non-randomized study was conducted on patients diagnosed with CSP between 2018 and 2020 at the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. Patients were categorized into two groups according to the treatments, i.e., local intra-gestational sac methotrexate injection followed by dilation and curettage (group A), and uterine artery embolization in combination with dilation and curettage (group B). The choices of treatment reflect the patients' decision after they thoroughly understood the benefits and risks of the two therapies. Clinical data were then collected and compared between these two alternatives.ResultsSeventy-seven patients with CSP were enrolled in the study. Of this total, 41 vs. 36 were respectively categorized into group A and group B. Similar success rates were observed between these two groups (92.7 vs. 97.2%; RR = 27.362, 95% CI: 0.496–1.51E3, p = 0.106). However, the overall occurrence of complications in group A was significant lower when compared with group B (17.1 vs. 52.8%; RR = 0.236, 95% CI: 0.077–0.728, p = 0.012). Lower abdominal pain (unrelated to infection) and intrauterine adhesions were the two primary complications exhibited in group B of the present study, with rates of 38.9 and 22.2% respectively.ConclusionsLocal intra-gestational sac methotrexate injection followed by dilation and curettage is an effective and safe treatment for CSP that also drastically reduces the risks of complications. Further multiple center randomized trials with large series are warranted to confirm these findings.
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17
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Kalas MA, Alhariri S, Ortega AJ, Galura GM, Al Bayati I, Al Obaidi S. Colorectal Carcinoma in the Background of Pelvic Inflammatory Disease. J Investig Med High Impact Case Rep 2022; 10:23247096221106755. [PMID: 35748423 PMCID: PMC9235299 DOI: 10.1177/23247096221106755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Colorectal carcinoma (CRC) is a common malignancy with steadily declining incidence rates
and mortality, secondary to improved screening and lifestyle changes (eg, decreased
smoking rates). The association between pelvic inflammatory disease (PID) and CRC has been
unclear in the past. However, multiple studies showed a positive association between PID
and underlying malignancy (gynecologic and pelvic primarily). Several studies evaluated
the relation between PID and CRC, but the results were conflicting. We describe a case of
a 33-year-old female patient, with a history of PID and recurrent pelvic abscesses, who
was found to have CRC. Of note, the patient’s diagnosis was based on abnormal computed
tomography findings, which were further investigated (by colonoscopy and biopsy), rather
than on symptoms suggestive of CRC, such as rectal bleeding, constipation, symptomatic
anemia, or abdominal pain.
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Affiliation(s)
- M Ammar Kalas
- Texas Tech University Health Sciences Center El Paso, TX, USA
| | - Sara Alhariri
- Texas Tech University Health Sciences Center El Paso, TX, USA
| | | | | | - Ihsan Al Bayati
- Texas Tech University Health Sciences Center El Paso, TX, USA
| | - Sarah Al Obaidi
- Texas Tech University Health Sciences Center El Paso, TX, USA
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18
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Fan L, Liu Z, Zhang Z, Li T, Li H, Chen J, Zong X, Zhang X, Chen X, Bai H, Wang F, Shang C. Identifying the clinical presentations, progression, and sequela of pelvic inflammatory disease through physiological, histological and ultrastructural evaluation of a rat animal model. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1710. [PMID: 35071404 PMCID: PMC8743706 DOI: 10.21037/atm-21-3345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/02/2021] [Indexed: 01/03/2023]
Abstract
Background Patients with pelvic inflammatory disease (PID) are at an increased risk of ectopic pregnancy, infertility, and varying degrees of chronic pelvic pain. The aims of this study were to establish a rat model of PID and characterize its progression in order to assist in the study of pathophysiological mechanisms and to provide animal model for future studies of PID treatments. Methods Fifty Sprague-Dawley rats (female, 6-weeks-old) were divided into a model group (n=28) and a control group (n=22). The rat endometrium was mechanically injured by a needle which moved back and forth 3 times on the endometrial tissue, and a mixed bacterial solution (6×108 CFU) of equal concentrations of Escherichiacoli and Staphylococcus aureus was injected into both horns of the rat uterus. Physiological characteristics including weight, temperature, blood, and inflammatory factors were compared, and immunohistochemistry and transmission electron microscopy were used to evaluate the progress and sequela of PID. Results The model rats experienced acute PID in the first 14 days and exhibited higher body temperatures and decreased body weight. Infection-related factors in the blood were also significantly changed compared with the normal group, with obviously increased serum levels of C-reactive protein (CRP), interferon gamma (IFN-γ), and interleukin-4 (IL-4). Congestion and edema were observed in the uteri of the model rats, followed by infiltration of numerous inflammatory cells and ultrastructural morphology changes. Histological examination of the uterus showed that adhesion initially appeared at approximately 21 days. In addition to the increased collagen fibers biomass, the expression of transforming growth factor-beta 1 (TGF-β1) was elevated, which might have contributed to pelvic tissue adhesion formation in the PID sequela. Conclusions This study clearly described the characteristics and progression of PID in a rat model. The detailed evidence increased our understanding of the pathogenesis and progression of PID and may be useful for future studies of PID treatments.
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Affiliation(s)
- Linyuan Fan
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Zhaohui Liu
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Zhan Zhang
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Ting Li
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Hua Li
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Jing Chen
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xiaonan Zong
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xu Zhang
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China
| | - Xi Chen
- Department of Gynecology, Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Huihui Bai
- Department of Microecological Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Fengjuan Wang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Chenguang Shang
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
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19
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Maina AN, Mureithi MW, Ndemi JK, Revathi G. Diagnostic accuracy of the syndromic management of four STIs among individuals seeking treatment at a health centre in Nairobi, Kenya: a cross-sectional study. Pan Afr Med J 2021; 40:138. [PMID: 34909106 PMCID: PMC8641642 DOI: 10.11604/pamj.2021.40.138.25166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/22/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION the syndromic approach to the management of sexually transmitted diseases (STIs) is recommended in areas without adequate laboratory support. We assessed the diagnostic accuracy of this approach in diagnosing Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG) among 18 to 49 year-old individuals seeking treatment for STIs in a health centre in Nairobi, Kenya. METHODS participants were recruited between April and June 2019. After providing written informed consent, an interviewer-administered questionnaire was completed. Endocervical swabs from women and urethral swabs from men were collected for STI testing using polymerase chain reaction (PCR). Diagnostic accuracy of reported symptoms was calculated using PCR as the gold standard. RESULTS a total of 297 individuals (148 men and 149 women) were recruited. Majority of the participants had at least one reported symptom (130/148; 87.8% men and 145/148; 97.3% women). The most commonly diagnosed STI was NG (85/297; 28.6% 95%CI 23.5%-34.1%). Vaginal discharge syndrome had moderate (44.4%) to high (92.9%) sensitivity, low specificity, low positive predictive value (PPV) (2.4 % to 31.5%) and high negative predictive value (NPV) (68.2% to 95.2%). The lower abdominal pain syndrome had moderate to high sensitivity (40% to 71.4%), low specificity (30.9% to 35.6%), low PPV (9.9% to 15.8%) and high NPV (79.2% to 93.8%). The urethral discharge syndrome had high sensitivity (71.4% to 84.8%); moderate specificity (37.6% to 51.7%); low to moderate PPV (5.4% to 53.8%) and high NPV (83.6% to 96.4%). The kappa scores for the three syndromes were generally poor. CONCLUSION these findings support the need for the review of the syndromic management of STIs.
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Affiliation(s)
- Anne Njeri Maina
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
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20
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Greydanus DE, Cabral MD, Patel DR. Pelvic inflammatory disease in the adolescent and young adult: An update. Dis Mon 2021; 68:101287. [PMID: 34521505 DOI: 10.1016/j.disamonth.2021.101287] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
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).
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
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21
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Podlacha M, Grabowski Ł, Kosznik-Kawśnicka K, Zdrojewska K, Stasiłojć M, Węgrzyn G, Węgrzyn A. Interactions of Bacteriophages with Animal and Human Organisms-Safety Issues in the Light of Phage Therapy. Int J Mol Sci 2021; 22:8937. [PMID: 34445641 PMCID: PMC8396182 DOI: 10.3390/ijms22168937] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 12/13/2022] Open
Abstract
Bacteriophages are viruses infecting bacterial cells. Since there is a lack of specific receptors for bacteriophages on eukaryotic cells, these viruses were for a long time considered to be neutral to animals and humans. However, studies of recent years provided clear evidence that bacteriophages can interact with eukaryotic cells, significantly influencing the functions of tissues, organs, and systems of mammals, including humans. In this review article, we summarize and discuss recent discoveries in the field of interactions of phages with animal and human organisms. Possibilities of penetration of bacteriophages into eukaryotic cells, tissues, and organs are discussed, and evidence of the effects of phages on functions of the immune system, respiratory system, central nervous system, gastrointestinal system, urinary tract, and reproductive system are presented and discussed. Modulations of cancer cells by bacteriophages are indicated. Direct and indirect effects of virulent and temperate phages are discussed. We conclude that interactions of bacteriophages with animal and human organisms are robust, and they must be taken under consideration when using these viruses in medicine, especially in phage therapy, and in biotechnological applications.
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Affiliation(s)
- Magdalena Podlacha
- Department of Molecular Biology, University of Gdansk, Wita Stwosza 59, 80-308 Gdansk, Poland; (M.P.); (K.Z.); (M.S.); (G.W.)
| | - Łukasz Grabowski
- Laboratory of Phage Therapy, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Kładki 24, 80-822 Gdansk, Poland; (Ł.G.); (K.K.-K.)
| | - Katarzyna Kosznik-Kawśnicka
- Laboratory of Phage Therapy, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Kładki 24, 80-822 Gdansk, Poland; (Ł.G.); (K.K.-K.)
| | - Karolina Zdrojewska
- Department of Molecular Biology, University of Gdansk, Wita Stwosza 59, 80-308 Gdansk, Poland; (M.P.); (K.Z.); (M.S.); (G.W.)
| | - Małgorzata Stasiłojć
- Department of Molecular Biology, University of Gdansk, Wita Stwosza 59, 80-308 Gdansk, Poland; (M.P.); (K.Z.); (M.S.); (G.W.)
| | - Grzegorz Węgrzyn
- Department of Molecular Biology, University of Gdansk, Wita Stwosza 59, 80-308 Gdansk, Poland; (M.P.); (K.Z.); (M.S.); (G.W.)
| | - Alicja Węgrzyn
- Laboratory of Phage Therapy, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Kładki 24, 80-822 Gdansk, Poland; (Ł.G.); (K.K.-K.)
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Xu SX, Gray-Owen SD. Gonococcal Pelvic Inflammatory Disease: Placing Mechanistic Insights Into the Context of Clinical and Epidemiological Observations. J Infect Dis 2021; 224:S56-S63. [PMID: 34396410 DOI: 10.1093/infdis/jiab227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
While infection by Neisseria gonorrhoeae is often asymptomatic in women, undetected infections can ascend into the upper genital tract to elicit an inflammatory response that manifests as pelvic inflammatory disease, with the outcomes depending on the intensity and duration of inflammation and whether it is localized to the endometrial, fallopian tube, ovarian, and/or other tissues. This review examines the contribution of N. gonorrhoeae versus other potential causes of pelvic inflammatory disease by considering new insights gained through molecular, immunological, and microbiome-based analyses, and the current epidemiological burden of infection, with an aim to highlighting key areas for future study.
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Affiliation(s)
- Stacey X Xu
- Department of Molecular Genetics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Scott D Gray-Owen
- Department of Molecular Genetics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Hosseininasab-Nodoushan SA, Ghazvini K, Jamialahmadi T, Keikha M, Sahebkar A. Association of Chlamydia and Mycoplasma infections with susceptibility to ovarian cancer: A systematic review and meta-analysis. Semin Cancer Biol 2021; 86:923-928. [PMID: 34333041 DOI: 10.1016/j.semcancer.2021.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/01/2021] [Accepted: 07/14/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ovarian cancer is one of the most prevalent cancers with a high mortality rate in women. Published studies indicate that inflammation, DNA damage, and pelvic inflammatory disease (PID) are the most important risk factors for ovarian cancer and this could be induced and exacerbated by infectious agents such as Chlamydia trachomatis and Mycoplasma genitalium. The aim of this study was to determine the association between Chlamydia and Mycoplasma infections and the risk of ovarian cancer. METHODS We carried out a comprehensive search of PubMed, Scopus, Web of Science, Embase, and Google Scholar without limitation on publication date. All relevant studies which investigatived probable potential connection between Chlamydia and Mycoplasma infection and development of ovarian cancer were included. RESULTS Eighteen studies comprising a total of 8207 patients were evaluated in the study and this showed that the frequency of infection with Chlamydia and Mycoplasma among ovarian cancer patients was 32.6 % and 23 %, respectively. The results suggested that Chlamydia trachomatis infection increased the overall risk for ovarian cancer by 1.344 fold (OR: 1.344; 95 %CI: 1.19-1.50). Moreover, infection with Mycoplasma infections showed a week but not significant increased risk of ovarian cancer (OR: 1.12; 95 %CI: 0.86-1.44). However, the test for heterogeneity was significant among these studies. CONCLUSION This study confirmed the clinical relevance of Chlamydia and Mycoplasma infection and development of the ovarian cancer risk, although the significance was marginal and study heterogeneity was significant. This highlights the need for further studies in this area.
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Affiliation(s)
| | - Kiarash Ghazvini
- Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tannaz Jamialahmadi
- Department of Food Science and Technology, Quchan Branch, Islamic Azad University, Quchan, Iran; Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Keikha
- Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; School of Medicine, The University of Western Australia, Perth, Australia; School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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24
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Wahid M, Dar SA, Jawed A, Mandal RK, Akhter N, Khan S, Khan F, Jogiah S, Rai AK, Rattan R. Microbes in gynecologic cancers: Causes or consequences and therapeutic potential. Semin Cancer Biol 2021; 86:1179-1189. [PMID: 34302959 DOI: 10.1016/j.semcancer.2021.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/24/2022]
Abstract
Gynecologic cancers, starting in the reproductive organs of females, include cancer of cervix, endometrium, ovary commonly and vagina and vulva rarely. The changes in the composition of microbiome in gut and vagina affect immune and metabolic signaling of the host cells resulting in chronic inflammation, angiogenesis, cellular proliferation, genome instability, epithelial barrier breach and metabolic dysregulation that may lead to the onset or aggravated progression of gynecologic cancers. While microbiome in gynecologic cancers is just at horizon, certain significant microbiome signature associations have been found. Cervical cancer is accompanied with high loads of human papillomavirus, Fusobacteria and Sneathia species; endometrial cancer is reported to have presence of Atopobium vaginae and Porphyromonas species and significantly elevated levels of Proteobacteria and Firmicutes phylum bacteria, with Chlamydia trachomatis, Lactobacillus and Mycobacterium reported in ovarian cancer. Balancing microbiome composition in gynecologic cancers has the potential to be used as a therapeutic target. For example, the Lactobacillus species may play an important role in blocking adhesions of incursive pathogens to vaginal epithelium by lowering the pH, producing bacteriocins and employing competitive exclusions. The optimum or personalized balance of the microbiota can be maintained using pre- and probiotics, and fecal microbiota transplantations loaded with specific bacteria. Current evidence strongly suggest that a healthy microbiome can train and trigger the body's immune response to attack various gynecologic cancers. Furthermore, microbiome modulations can potentially contribute to improvements in immuno-oncology therapies.
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Affiliation(s)
- Mohd Wahid
- Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, Jazan University, Jazan, Saudi Arabia
| | - Sajad A Dar
- Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, Jazan University, Jazan, Saudi Arabia
| | - Arshad Jawed
- Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, Jazan University, Jazan, Saudi Arabia
| | - Raju Kumar Mandal
- Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, Jazan University, Jazan, Saudi Arabia
| | - Naseem Akhter
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Albaha University, Albaha, Saudi Arabia
| | - Saif Khan
- Department of Basic Dental and Medical Sciences, College of Dentistry, University of Ha'il, Ha'il, Saudi Arabia
| | - Farah Khan
- Department of Biochemistry, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Sudhisa Jogiah
- Department of Biotechnology and Microbiology, Karnatak University, Dharwad, Karnataka, India
| | - Ashutosh Kumar Rai
- Department of Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ramandeep Rattan
- Division of Gynecology Oncology, Women's Health Services, Henry Ford Hospital, Detroit, MI, USA; Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA.
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25
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Menezes MLB, Giraldo PC, Linhares IM, Boldrini NAT, Aragon MG. Brazilian Protocol for Sexually Transmitted infections, 2020: pelvic inflammatory disease. Rev Soc Bras Med Trop 2021; 54:e2020602. [PMID: 34008722 PMCID: PMC8210479 DOI: 10.1590/0037-8682-602-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/25/2022] Open
Abstract
Pelvic Inflammatory Disease is a topic included in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Pelvic inflammatory disease is an upper female genital tract acute infection due to canalicular spread of endogenous cervicovaginal microorganisms and especially the sexually transmitted microorganisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The main sequelae are chronic pelvic pain, infertility, and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment must start immediately after the clinical suspicion. Guidelines for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling sexual partners and special populations are described. Given the increased availability of the molecular biology techniques in Brazil, C. trachomatis and N. gonorrhoeae screening are recommended as a disease prevention strategy. Pelvic inflammatory disease is one of the most significant sexually transmitted infections, and in most cases, it is a main consequence of cervicitis.
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Affiliation(s)
| | - Paulo Cesar Giraldo
- Universidade Estadual de Campinas, Departamento de Tocoginecologia, Campinas, SP, Brasil
| | - Iara Moreno Linhares
- Universidade de São Paulo, Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, São Paulo, SP, Brasil
| | | | - Mayra Gonçalves Aragon
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasilia, DF, Brasil
- Universidade Federal do Espírito Santo, Programa de Pós-Graduação em Doenças Infecciosas, Vitória, ES, Brasil
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26
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Zhang Y, Zhao Z, Chen H, Fu Y, Wang W, Li Q, Li X, Wang X, Fan G, Zhang Y. The Underlying Molecular Mechanisms Involved in Traditional Chinese Medicine Smilax china L. for the Treatment of Pelvic Inflammatory Disease. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:5552532. [PMID: 33927774 PMCID: PMC8052137 DOI: 10.1155/2021/5552532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/04/2021] [Accepted: 03/21/2021] [Indexed: 02/07/2023]
Abstract
Smilax china L. (SCL) is extensively used in the treatment of pelvic inflammatory disease (PID). This study aimed to clarify the potential active ingredients of SCL and mechanisms on PID. SCL was widely distributed in Japan, South Korea, and China, which was traditionally considered heat-clearing, detoxicating, and dampness-eliminating medicine. Systems pharmacology revealed that 32 compounds in SCL may interact with 19 targets for immunoenhancement, antiapoptosis, anti-inflammation, and antioxidant activity of the PID model. Molecular docking revealed that isorhamnetin, moracin M, rutin, and oxyresveratrol may have higher binding potential with prostaglandin-endoperoxide synthase 2 (PTGS2), mitogen-activated protein kinase 1 (MAPK1), siderocalin (LCN2), tumor necrosis factor (TNF), and matrix metalloprotein-9 (MMP9), respectively. Molecular dynamics simulation showed that the binding modes of moracin M-MAPK1, rutin-TNF, and oxyresveratrol-MMP9 complexes were more stable, evidenced by relatively smaller fluctuations in root mean square deviation values. Conclusively, SCL may treat PID by inhibiting inflammatory factors, antitissue fibrosis, and microbial growth.
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Affiliation(s)
- Yunsen Zhang
- School of Ethnic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zikuang Zhao
- School of Ethnic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huimin Chen
- School of Ethnic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yutong Fu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Wenxiang Wang
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qi Li
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xuanhao Li
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaobo Wang
- Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Ethnic Medicine Academic Heritage Innovation Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Gang Fan
- School of Ethnic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yi Zhang
- School of Ethnic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Ethnic Medicine Academic Heritage Innovation Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- NMPA Key Laboratory for Quality Evaluation of Traditional Chinese Medicine (Traditional Chinese Patent Medicine), Chengdu University of Traditional Chinese Medicine, Chengdu, China
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27
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Kumar S, Chesson H, Spicknall IH, Kreisel K, Gift TL. The Estimated Lifetime Medical Cost of Chlamydia, Gonorrhea, and Trichomoniasis in the United States, 2018. Sex Transm Dis 2021; 48:238-246. [PMID: 33492090 PMCID: PMC10440745 DOI: 10.1097/olq.0000000000001357] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to provide updated estimates of the average lifetime medical cost per infection for chlamydia, gonorrhea, and trichomoniasis. METHODS We adapted a published decision tree model that allowed for 7 possible outcomes of infection: (1) symptomatic infection, treated, no sequelae; (2) symptomatic infection, not treated, sequelae; (3) symptomatic infection, not treated, no sequelae; (4) asymptomatic infection, treated, sequelae; (5) asymptomatic infection, treated, no sequelae; (6) asymptomatic infection, not treated, sequelae; and (7) asymptomatic infection, not treated, no sequelae. The base case values and ranges we applied for the model inputs (i.e., the probability and cost assumptions) were based on published studies. RESULTS The estimated lifetime medical costs per infection for men and women, respectively, were $46 (95% credibility interval, $32-$62) and $262 ($127-$483) for chlamydia, $78 ($36-$145) and $254 ($96-$518) for gonorrhea, and $5 ($1-$14) and $36 ($17-$58) for trichomoniasis. Cost estimates for men were most sensitive to assumptions regarding the probability that the infection is symptomatic, the probability of treatment if asymptomatic, and the cost of treatment of infection. Cost estimates for chlamydia and gonorrhea in women were most sensitive to assumptions regarding the probability and cost of subsequent pelvic inflammatory disease. CONCLUSIONS These estimates of the lifetime medical cost per infection can inform updated estimates of the total annual cost of sexually transmitted infections in the United States, as well as analyses of the value and cost-effectiveness of sexually transmitted infection prevention interventions.
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Affiliation(s)
- Sagar Kumar
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia
- Oak Ridge Institute of Science and Education, Oak Ridge, Tennessee
| | - Harrell Chesson
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia
| | - Ian H. Spicknall
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia
| | - Kristen Kreisel
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia
| | - Thomas L. Gift
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia
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28
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Edinoff AN, Silverblatt NS, Vervaeke HE, Horton CC, Girma E, Kaye AD, Kaye A, Kaye JS, Garcia AJ, Neuchat EE, Eubanks TN, Varrassi G, Viswanath O, Urits I. Hyperprolactinemia, Clinical Considerations, and Infertility in Women on Antipsychotic Medications. PSYCHOPHARMACOLOGY BULLETIN 2021; 51:131-148. [PMID: 34092827 PMCID: PMC8146565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Infertility, the inability to establish a clinical pregnancy after 12 months of regular unprotected sexual intercourse, is caused by a wide variety of both male and female factors. Infertility is estimated to affect between 8-12% of couples trying to conceive globally. Female factor infertility can be subdivided into the following broad categories: ovulatory dysfunction, fallopian tubal disease, uterine causes, and oocyte quality. Hyperprolactinemia causes ovulary dysfunction along with other hormonal abnormalities, such as decreased estrogen, which can lead to infertility. In this regard, antipsychotics are commonly used for both schizophrenia and bipolar disorder. The use of these medications can be associated with hyperprolactinemia and hyperprolactinemia associated infertility. Antipsychotic-induced hyperprolactinemia occurs through blockade of D2 receptors on lactotroph cells of the anterior pituitary gland. Discontinuation of the hyperprolactinemia-inducing antipsychotic is an option, but this may worsen the patient's psychosis or mood. If antipsychotics are determined to be the culprit of infertility, the degree of hyperprolactinemia symptoms, length of treatment with the antipsychotic, and risk of relapse should be assessed prior to discontinuation, reduction, or switching of antipsychotic medications. The treatment of a women's mental health and her desire to have children should always be considered as treatment may influence fertility while on the medication.
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Affiliation(s)
- Amber N Edinoff
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Nancy S Silverblatt
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Hayley E Vervaeke
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Cassidy C Horton
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Eden Girma
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Alan D Kaye
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Adam Kaye
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Jessica S Kaye
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Andrew J Garcia
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Elisa E Neuchat
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Treniece N Eubanks
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Giustino Varrassi
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Omar Viswanath
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Ivan Urits
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
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29
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Menezes MLB, Giraldo PC, Linhares IM, Boldrini NAT, Aragón MG. [Brazilian Protocol for Sexually Transmitted Infections 2020: pelvic inflammatory disease]. ACTA ACUST UNITED AC 2021; 30:e2020602. [PMID: 33729405 DOI: 10.1590/s1679-4974202100011.esp1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022]
Abstract
Pelvic Inflammatory Disease is a topic included in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Pelvic inflammatory disease is an acute infection of the upper female genital tract due to canalicular spread of endogenous cervicovaginal microorganisms, in particular sexually transmitted organisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The most important sequels are chronic pelvic pain, infertility and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment should start immediately upon clinical suspicion. The article contains guidance for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling of sexual partnerships and special populations. In view of increased availability of the molecular biology technique in Brazil, C. trachomatis and N. gonorrhoeae screening is recommended as a disease prevention strategy.
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Affiliation(s)
| | - Paulo Cesar Giraldo
- Universidade Estadual de Campinas, Departamento de Tocoginecologia, Campinas, SP, Brasil
| | - Iara Moreno Linhares
- Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, São Paulo, SP, Brasil
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30
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Zhang F, Feng Q, Yang L, Liu X, Su L, Wang C, Yao H, Sun D, Feng Y. Analysis of the etiologies of female infertility in Yunnan minority areas. BMC WOMENS HEALTH 2021; 21:88. [PMID: 33648484 PMCID: PMC7923498 DOI: 10.1186/s12905-021-01216-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/09/2021] [Indexed: 11/24/2022]
Abstract
Background The present study aims to provide a comparative analysis of the etiologies of female infertility between Dehong, on the Yunnan Frontier, and Kunming. Methods A retrospective study, which included 941 infertile females in Kunming who were treated in the First People’s Hospital of Yunnan Province and infertile females who were treated in the local hospital in Dehong from January 2016 to November 2018, was conducted. A comparative analysis of the etiologies of infertility in the two regions was then carried out. Results In patients with primary infertility, ovulation disorder (15.03%) was the main cause of infertility in Kunming, and pelvic inflammatory disease (25.59%) was the main cause in Dehong. With regard to secondary infertility, although pelvic inflammatory disease was the main cause of infertility in both regions, the incidence of intrauterine adhesions in Kunming was significantly higher than in Dehong. Conclusions The etiology of infertility showed different epidemiological characteristics depending on the region, hence individualized treatment should be given accordingly
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Affiliation(s)
- Fen Zhang
- Department of Obstetrics and Gynecology, The First People's Hospital of Yunnan Province, No. 157 of Jinbi Road, Xishan District, Kunming, 650032, China.,Medical School of Kunming University of Science and Technology, Kunming, 650500, China
| | - Qing Feng
- Kunming Dianchi Lake Evironmental Protection Collaborative Research Center, Kunming University, Kunming, 650214, China
| | - Linna Yang
- Department of Obstetrics and Gynecology, The First People's Hospital of Yunnan Province, No. 157 of Jinbi Road, Xishan District, Kunming, 650032, China.,Medical School of Kunming University of Science and Technology, Kunming, 650500, China
| | - Xuelian Liu
- Department of Gynecology, Dehong Hospital of Traditional Chinese Medicine, Mangshi, 678400, China
| | - Lingyun Su
- Department of Obstetrics and Gynecology, The First People's Hospital of Yunnan Province, No. 157 of Jinbi Road, Xishan District, Kunming, 650032, China.,Medical School of Kunming University of Science and Technology, Kunming, 650500, China
| | - Chunyan Wang
- Department of Gynecology, The Second People's Hospital of Baoshan City, Baoshan, 678000, China
| | - Huimei Yao
- Department of Obstetrics and Gynecology, Cangyuan Wa Autonomous County People's Hospital, Cangyuan, 677400, China
| | - Dawei Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital (Dongdan Campus), No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, China.
| | - Yun Feng
- Department of Obstetrics and Gynecology, The First People's Hospital of Yunnan Province, No. 157 of Jinbi Road, Xishan District, Kunming, 650032, China. .,Medical School of Kunming University of Science and Technology, Kunming, 650500, China.
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31
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Zhang F, Dai J, Chen T. Role of Lactobacillus in Female Infertility Via Modulating Sperm Agglutination and Immobilization. Front Cell Infect Microbiol 2021; 10:620529. [PMID: 33569356 PMCID: PMC7868545 DOI: 10.3389/fcimb.2020.620529] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022] Open
Abstract
Infertility has become a common problem in recent decades. The pathogenesis of infertility is variable, but microbiological factors account for a large proportion of it. Dysbiosis of vaginal microbiota is reportedly associated with female infertility, but the influence of normal vaginal microbiota on infertility is unclear. In this review, we summarize the physiological characteristics of the vaginal tract and vaginal microbiota communities. We mainly focus on the bacterial adherence of vaginal Lactobacillus species. Given that the adherent effect plays a crucial role in the colonization of bacteria, we hypothesize that the adherent effect of vaginal Lactobacillus may also influence the fertility of the host. We also analyze the agglutination and immobilization effects of other bacteria, especially Escherichia coli, on ejaculated spermatozoa, and speculate on the possible effects of normal vaginal microbiota on female fertility.
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Affiliation(s)
- Fenghao Zhang
- Institute of Translational Medicine & School of Life Sciences, Nanchang University, Nanchang, China
| | - Jie Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Tingtao Chen
- Institute of Translational Medicine & School of Life Sciences, Nanchang University, Nanchang, China
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32
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Barinov SV, Tirskaya YI, Borisova AV, Pyanova LG, Di Renzo GC. The effectiveness of using a molded sorbent: Modified polyvinylpyrrolidone for the combined treatment of chronic endometritis. Int J Gynaecol Obstet 2021; 154:277-284. [PMID: 33471361 DOI: 10.1002/ijgo.13609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/23/2020] [Accepted: 01/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To improve the management of patients with chronic endometritis (CE) by using a molded sorbent-modified by polyvinylpyrrolidone (FSMP). METHODS This prospective study included 70 patients with CE divided into two groups: group 1 (n = 23) received traditional antibiotic therapy (from days 3 to 10 of the menstrual cycle); group 2 (n = 47), received antibiotics and FSMP was inserted from days 5 to 10. RESULTS At the end of therapy, group 1 had massive growth of pathogenic microflora in 21.7%, moderate growth in 69.6%, and no growth in 8.7% of cases. In group 2, after combined therapy, massive growth was observed in 4.3%, moderate growth in 44.7%, and no growth in 51.0%. In group 2 after 5 days, serum levels of interleukin-1β (IL-1β) were 1.9 times, of IL-6 were 7.0 times, and of IL-8 and IL-1 receptor antagonist were 1.3 times lower than in group 1. In uterine cavity aspirates, IL-1β decreased around 4.8 times, IL-6 by 11.8 times, IL-8 by 3.2 times, tumor necrosis factor-α by 3.9 times, and IL-1 receptor antagonist by 2.1 times in comparison to group 1. CONCLUSION Combined therapy of FSMP with antibiotics is more effective in treating CE, because it contributes to the almost complete elimination of pathogens and toxins from the uterine cavity, blocking the local pro-inflammatory cascade.
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Affiliation(s)
- Sergey V Barinov
- Department of Gynecology and Obstetrics No. 2, Federal State Funded Educational Institution for Higher Education Omsk State Medical University, Ministry of Public Health, Russian Federation, Omsk, Russia
| | - Yuliya I Tirskaya
- Department of Gynecology and Obstetrics No. 2, Federal State Funded Educational Institution for Higher Education Omsk State Medical University, Ministry of Public Health, Russian Federation, Omsk, Russia
| | - Anna V Borisova
- Peoples Friendship University of Russia (RUDN, Moscow, Russia
| | - Lidiya G Pyanova
- Laboratory of Synthesis of Functional Carbon Materials, Institute of Hydrocarbons Processing of the Siberian Branch of the Russian Academy of Sciences, Omsk, Russia
| | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology and Centre for Reproductive and Perinatal Medicine, University of Perugia, Perugia, Italy
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33
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Wang A, Hajmurad S, Khan M, Villarreal S. Development of Pelvic Inflammatory Disease after Ectopic Removal. Infect Dis Obstet Gynecol 2021; 2021:6668299. [PMID: 33531793 PMCID: PMC7837769 DOI: 10.1155/2021/6668299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/17/2022] Open
Abstract
Although ectopic pregnancy and pelvic inflammatory disease (PID) are separately commonly seen in practice, development of PID after surgical removal is rare. Here, we present the case of a 41-year-old female who was admitted for pelvic inflammatory disease diagnosed after laparoscopic salpingectomy for a ruptured ectopic pregnancy. Treatment required drainage of TOAs with interventional radiology and antibiotic treatment. This case report demonstrates how treatment of PID following ectopic pregnancy is complex and may require surgical- or radiology-guided drainage of infection in addition to common antibiotic treatment. Follow-up and duration of treatment are highlighted.
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Affiliation(s)
- Amanda Wang
- Department of OBGYN, University of Texas Medical Branch, Galveston, TX, USA
| | - Sema Hajmurad
- Department of OBGYN, University of Texas Medical Branch, Galveston, TX, USA
| | - Maryam Khan
- Department of OBGYN, University of Texas Medical Branch, Galveston, TX, USA
| | - Sarah Villarreal
- Department of OBGYN, University of Texas Medical Branch, Galveston, TX, USA
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34
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Alshammari SM, Alrajhi NN, Al-Rumayh SS, Alosaimi MA, Alsharyuf RM, Bukhari YS, Aldhrye SA, Kasem GH, Aljohani RMJ. An Overview on Pelvic Inflammatory Disease Diagnosis and Management Approach. ARCHIVES OF PHARMACY PRACTICE 2021. [DOI: 10.51847/1jlwkjj2kw] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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35
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Glassford M, Davis M, Rivas S. Sexually Transmitted Infections in Pregnancy: An Update for Primary Care Providers. Nurs Clin North Am 2020; 55:403-416. [PMID: 32762859 DOI: 10.1016/j.cnur.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article provides an overview of the incidence and prevalence of sexually transmitted infections in pregnant women in the United States. It discusses screening guidelines and best practices related to treatments. Safety, pharmacology, and monitoring of both the woman and her fetus are detailed.
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Affiliation(s)
- Melissa Glassford
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA.
| | - Melissa Davis
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA
| | - Shelza Rivas
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA
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36
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Wang C, La L, Feng H, Yang Q, Wu F, Wang C, Wu J, Hou L, Hou C, Liu W. Aldose Reductase Inhibitor Engeletin Suppresses Pelvic Inflammatory Disease by Blocking the Phospholipase C/Protein Kinase C-Dependent/NF-κB and MAPK Cascades. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2020; 68:11747-11757. [PMID: 33047600 DOI: 10.1021/acs.jafc.0c05102] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pelvic inflammatory disease (PID) is a common inflammation in the upper reproductive tract in women and may cause serious and costly consequences without effective treatment. Engeletin is a flavanonol glycoside and a naturally derived aldose reductase (AR) inhibitor that is widely distributed in vegetables, fruits, and plant-based foods. The present study investigated the anti-PID activity of engeletin in a mucilage-induced rat model of PID and LPS-stimulated RAW 264.7 macrophages. Engeletin significantly reduced inflammation and ameliorated the typical uterine pathological changes in PID rats. Engeletin also inhibited AR-dependent PLC/PKC/NF-κB and MAPK inflammatory pathways, as indicated by the suppression of the phosphorylation levels of PLC, PKC, p38, ERK, and JNK and the nuclear translocation of NF-κB p65. In vitro studies demonstrated that engeletin significantly inhibited inflammatory mediator expression and enhanced the phagocytic ability of LPS-induced RAW 264.7 macrophages. RNA interference of AR prevented the engeletin-induced inhibition of inflammatory mediators. Engeletin also inhibited AR-dependent PLC/PKC/NF-κB and MAPK inflammatory pathways, which was consistent with the in vivo results. These findings support engeletin as a potential agent for prevention or treatment of PID.
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Affiliation(s)
- Canmao Wang
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Lei La
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Haixing Feng
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Qin Yang
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Fuling Wu
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Chunxia Wang
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jiangjie Wu
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Lianbing Hou
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Chuqi Hou
- Biopharmaceutics, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Wenqin Liu
- Biopharmaceutics, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
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37
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Idahl A, Le Cornet C, González Maldonado S, Waterboer T, Bender N, Tjønneland A, Hansen L, Boutron-Ruault MC, Fournier A, Kvaskoff M, Boeing H, Trichopoulou A, Valanou E, Peppa E, Palli D, Agnoli C, Mattiello A, Tumino R, Sacerdote C, Onland-Moret NC, Gram IT, Weiderpass E, Quirós JR, Duell EJ, Sánchez MJ, Chirlaque MD, Barricarte A, Gil L, Brändstedt J, Riesbeck K, Lundin E, Khaw KT, Perez-Cornago A, Gunter MJ, Dossus L, Kaaks R, Fortner RT. Serologic markers of Chlamydia trachomatis and other sexually transmitted infections and subsequent ovarian cancer risk: Results from the EPIC cohort. Int J Cancer 2020; 147:2042-2052. [PMID: 32243586 DOI: 10.1002/ijc.32999] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/23/2020] [Accepted: 02/19/2020] [Indexed: 12/19/2022]
Abstract
A substantial proportion of epithelial ovarian cancer (EOC) arises in the fallopian tube and other epithelia of the upper genital tract; these epithelia may incur damage and neoplastic transformation after sexually transmitted infections (STI) and pelvic inflammatory disease. We investigated the hypothesis that past STI infection, particularly Chlamydia trachomatis, is associated with higher EOC risk in a nested case-control study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort including 791 cases and 1669 matched controls. Serum antibodies against C. trachomatis, Mycoplasma genitalium, herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) 16, 18 and 45 were assessed using multiplex fluorescent bead-based serology. Conditional logistic regression was used to estimate relative risks (RR) and 95% confidence intervals (CI) comparing women with positive vs. negative serology. A total of 40% of the study population was seropositive to at least one STI. Positive serology to C. trachomatis Pgp3 antibodies was not associated with EOC risk overall, but with higher risk of the mucinous histotype (RR = 2.30 [95% CI = 1.22-4.32]). Positive serology for chlamydia heat shock protein 60 (cHSP60-1) was associated with higher risk of EOC overall (1.36 [1.13-1.64]) and with the serous subtype (1.44 [1.12-1.85]). None of the other evaluated STIs were associated with EOC risk overall; however, HSV-2 was associated with higher risk of endometrioid EOC (2.35 [1.24-4.43]). The findings of our study suggest a potential role of C. trachomatis in the carcinogenesis of serous and mucinous EOC, while HSV-2 might promote the development of endometrioid disease.
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Affiliation(s)
- Annika Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Charlotte Le Cornet
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Tim Waterboer
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Noemi Bender
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Genes and Environment (DGE), Copenhagen, Germany
| | - Louise Hansen
- Danish Cancer Society Research Center, Diet, Genes and Environment (DGE), Copenhagen, Germany
| | - Marie-Christine Boutron-Ruault
- CESP, Faculté de Médecine, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Agnès Fournier
- CESP, Faculté de Médecine, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Marina Kvaskoff
- CESP, Faculté de Médecine, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE) Potsdam-Rehbrücke, Nuthetal, Germany
| | | | | | | | - Domenico Palli
- Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Cancer Risk Factors and Life-Style Epidemiology Unit, Florence, Italy
| | - Claudia Agnoli
- Istituto Nazionale dei Tumori di Milano Via Venezian, Epidemiology and Prevention Unit Fondazione IRCCS, Milan, Italy
| | - Amalia Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, Federico II university, Naples, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, "Civic - M.P. Arezzo" Hospital, ASP, Ragusa, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città Della Salute e Della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, YOUth onderzoek - Universiteit Utrecht, Utrecht, The Netherlands
| | - Inger T Gram
- Faculty of Health Sciences, Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | | | - Jose R Quirós
- J.S. Información Sanitaria, Dirección General de Salud Pública, Consejería de Sanidad, Oviedo, Spain
| | - Eric J Duell
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Maria-Dolores Chirlaque
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Aurelio Barricarte
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA) Pamplona, Spain
| | - Leire Gil
- Public Health Division of Gipuzkoa, Research institute of BioDonostia, San Sebastian, Spain
| | - Jenny Brändstedt
- Department of Clinical Sciences, Lund University, Division of Surgery, Skåne University Hospital, Lund, Sweden
- Division of Surgery, Skåne University Hospital, Lund, Sweden
| | - Kristian Riesbeck
- Clinical Microbiology, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Eva Lundin
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marc J Gunter
- International Agency for Research on Cancer, Lyon, France
| | - Laure Dossus
- International Agency for Research on Cancer, Lyon, France
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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38
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Lemly D, Gupta N. Sexually Transmitted Infections Part 2: Discharge Syndromes and Pelvic Inflammatory Disease. Pediatr Rev 2020; 41:522-537. [PMID: 33004664 DOI: 10.1542/pir.2019-0078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Sexually transmitted infections (STIs) disproportionately affect young people, with more than half of the infections occurring in youth aged 15 to 25 years. (1)(2) This review, the second in a 2-part series on STIs, focuses on infections that may cause abnormal vaginal or penile discharge, including trichomonas, chlamydia, gonorrhea, and pelvic inflammatory disease (PID). Most infected persons, however, are asymptomatic. Nucleic acid amplification tests are the most sensitive and specific for the detection of chlamydia, gonorrhea, and trichomoniasis, and they can be performed on provider- or patient-collected swabs. Providers should have a low threshold for diagnosing and treating PID because untreated PID can have serious long-term complications for young women. Indications for hospitalization for PID include the presence of a tubo-ovarian abscess, severe illness with systemic symptoms, pregnancy, human immunodeficiency virus infection, and failure to respond to outpatient oral treatment (within 48-72 hours) or inability to tolerate the oral treatment.
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Affiliation(s)
- Diana Lemly
- Division of Adolescent and Young Adult Medicine and.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Nupur Gupta
- Division of Adolescent and Young Adult Medicine and.,Division of Global Health, MassGeneral Hospital for Children, Boston, MA.,Harvard Medical School, Boston, MA
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39
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Elliott SR, Betts S, Hobbs K, Wand H, Rumbold AR, Ward J, Johnson DR. Analysis of diagnostic data for sexually transmissible infections in South Australian Aboriginal Community Controlled Health Services (2008-16). Sex Health 2020; 16:566-573. [PMID: 31623703 DOI: 10.1071/sh18189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/22/2019] [Indexed: 11/23/2022]
Abstract
Australian Aboriginal communities experience a high burden of sexually transmissible infections (STIs). Since 2009, a comprehensive sexual health program has been implemented at nine Aboriginal Community Controlled Health Services in South Australia. This study assessed trends in STI testing and positivity using deidentified diagnostic data from this period (2008-16). METHODS Testing data for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) from one urban, three regional and five remote Aboriginal health services were analysed using logistic regression. RESULTS From 2008 to 2016, testing increased for CT (twofold), NG (threefold) and TV (sixfold). On average, 30% of testing occurred during an annual 6-week screen. Fewer males were tested (range 27-38% annually). Mean annual STI testing coverage was 28% for 16- to 30-year-old clients attending regional or remote services (2013-16). Positivity at first testing episode for all three infections declined during the study period. From 2013 to 2016, when testing was stable and changes in positivity were more likely to indicate changes in prevalence, there were significant reductions in CT positivity (adjusted odds ratio (aOR) 0.4; 95% confidence interval (CI) 0.2-0.5) and TV positivity (aOR 0.6, 95% CI 0.4-0.9), although declines were statistically significant for females only. There was no significant decrease in NG positivity (aOR 0.9; 95% CI 0.5-1.5). CONCLUSIONS Since the sexual health program began, STI testing increased and STI positivity declined, but significant reductions observed in CT and TV positivity were confined to females. These findings suggest evidence of benefit from sustained, comprehensive sexual health programs in Aboriginal communities with a high STI prevalence, but highlight the need to increase STI testing among men in these communities.
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Affiliation(s)
- Salenna R Elliott
- Aboriginal Health Council of South Australia, Adelaide, SA 5000, Australia; and South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; and Flinders University, Bedford Park, SA 5042, Australia; and SA Health, Adelaide, SA 5000, Australia; and Corresponding author.
| | - Sarah Betts
- Aboriginal Health Council of South Australia, Adelaide, SA 5000, Australia
| | - Katie Hobbs
- Aboriginal Health Council of South Australia, Adelaide, SA 5000, Australia; and SA Health, Adelaide, SA 5000, Australia
| | - Handan Wand
- The Kirby Institute, UNSW, Sydney, NSW 2052, Australia
| | - Alice R Rumbold
- The Robinson Research Institute, University of Adelaide, North Adelaide, SA 5006, Australia
| | - James Ward
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; and Flinders University, Bedford Park, SA 5042, Australia
| | - David R Johnson
- Aboriginal Health Council of South Australia, Adelaide, SA 5000, Australia
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Duncan SA, Sahu R, Dixit S, Singh SR, Dennis VA. Suppressors of Cytokine Signaling (SOCS)1 and SOCS3 Proteins Are Mediators of Interleukin-10 Modulation of Inflammatory Responses Induced by Chlamydia muridarum and Its Major Outer Membrane Protein (MOMP) in Mouse J774 Macrophages. Mediators Inflamm 2020; 2020:7461742. [PMID: 32684836 PMCID: PMC7333066 DOI: 10.1155/2020/7461742] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/10/2020] [Indexed: 12/26/2022] Open
Abstract
The immunopathology of chlamydial diseases is exacerbated by a broad-spectrum of inflammatory mediators, which we reported are inhibited by IL-10 in macrophages. However, the chlamydial protein moiety that induces the inflammatory mediators and the mechanisms by which IL-10 inhibits them are unknown. We hypothesized that Chlamydia major outer membrane protein (MOMP) mediates its disease pathogenesis, and the suppressor of cytokine signaling (SOCS)1 and SOCS3 proteins are mediators of the IL-10 inhibitory actions. Our hypothesis was tested by exposing mouse J774 macrophages to chlamydial stimulants (live Chlamydia muridarum and MOMP) with and without IL-10. MOMP significantly induced several inflammatory mediators (IL-6, IL-12p40, CCL5, CXCL10), which were dose-dependently inhibited by IL-10. Chlamydial stimulants induced the mRNA gene transcripts and protein expression of SOCS1 and SOCS3, with more SOCS3 expression. Notably, IL-10 reciprocally regulated their expression by reducing SOCS1 and increasing SOCS3. Specific inhibitions of MAPK pathways revealed that p38, JNK, and MEK1/2 are required for inducing inflammatory mediators as well as SOCS1 and SOCS3. Chlamydial stimulants triggered an M1 pro-inflammatory phenotype evidently by an enhanced nos2 (M1 marker) expression, which was skewed by IL-10 towards a more M2 anti-inflammatory phenotype by the increased expression of mrc1 and arg1 (M2 markers) and the reduced SOCS1/SOCS3 ratios. Neutralization of endogenously produced IL-10 augmented the secretion of inflammatory mediators, reduced SOCS3 expression, and skewed the chlamydial M1 to an M2 phenotype. Inhibition of proteasome degradation increased TNF but decreased IL-10, CCL5, and CXCL10 secretion by suppressing SOCS1 and SOCS3 expressions and dysregulating their STAT1 and STAT3 transcription factors. Our data show that SOCS1 and SOCS3 are regulators of IL-10 inhibitory actions, and underscore SOCS proteins as therapeutic targets for IL-10 control of inflammation for Chlamydia and other bacterial inflammatory diseases.
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Affiliation(s)
- Skyla A. Duncan
- Center for NanoBiotechnology Research (CNBR), Department of Biological Sciences, Alabama State University, 1627 Harris Way, Montgomery, AL 36104, USA
| | - Rajnish Sahu
- Center for NanoBiotechnology Research (CNBR), Department of Biological Sciences, Alabama State University, 1627 Harris Way, Montgomery, AL 36104, USA
| | - Saurabh Dixit
- Center for NanoBiotechnology Research (CNBR), Department of Biological Sciences, Alabama State University, 1627 Harris Way, Montgomery, AL 36104, USA
| | - Shree R. Singh
- Center for NanoBiotechnology Research (CNBR), Department of Biological Sciences, Alabama State University, 1627 Harris Way, Montgomery, AL 36104, USA
| | - Vida A. Dennis
- Center for NanoBiotechnology Research (CNBR), Department of Biological Sciences, Alabama State University, 1627 Harris Way, Montgomery, AL 36104, USA
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Lucío MI, Kyriazi ME, Hamilton J, Batista D, Sheppard A, Sams-Dodd E, Humbert MV, Hussain I, Christodoulides M, Kanaras AG. Bactericidal Effect of 5-Mercapto-2-nitrobenzoic Acid-Coated Silver Nanoclusters against Multidrug-Resistant Neisseria gonorrhoeae. ACS APPLIED MATERIALS & INTERFACES 2020; 12:27994-28003. [PMID: 32530591 DOI: 10.1021/acsami.0c06163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Neisseria gonorrhoeae is among the most multidrug-resistant bacteria in circulation today, and new treatments are urgently needed. In this work, we demonstrate the ability of 5-mercapto-2-nitrobenzoic acid-coated silver nanoclusters (MNBA-AgNCs) to kill strains of Neisseria gonorrhoeae. Using an in vitro bactericidal assay, MNBA-AgNCs had been found to show significantly higher anti-gonococcal bioactivity than the antibiotics ceftriaxone and azithromycin and silver nitrate. These nanoclusters were effective against both planktonic bacteria and a gonococcal infection of human cell cultures in vitro. Treatment of human cells in vitro with MNBA-AgNCs did not induce significant release of lactate dehydrogenase, suggesting minimal cytotoxicity to eukaryotic cells. Our results suggest that MNBA-AgNCs hold great potential for topical treatment of localized gonorrhoeae.
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Affiliation(s)
- María Isabel Lucío
- Physics and Astronomy, Faculty of Physical Sciences and Engineering, University of Southampton, Southampton SO17 1BJ, U.K
| | - Maria-Eleni Kyriazi
- Physics and Astronomy, Faculty of Physical Sciences and Engineering, University of Southampton, Southampton SO17 1BJ, U.K
| | - Joshua Hamilton
- Neisseria Research Laboratory, Molecular Microbiology, School of Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, U.K
| | - Diego Batista
- Neisseria Research Laboratory, Molecular Microbiology, School of Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, U.K
| | - Alexander Sheppard
- Neisseria Research Laboratory, Molecular Microbiology, School of Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, U.K
| | - Elisabeth Sams-Dodd
- Neisseria Research Laboratory, Molecular Microbiology, School of Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, U.K
| | - Maria Victoria Humbert
- Neisseria Research Laboratory, Molecular Microbiology, School of Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, U.K
| | - Irshad Hussain
- Department of Chemistry & Chemical Engineering, Syed Babar Ali School of Science and Engineering, Lahore University of Management Sciences (LUMS), DHA, Lahore Cantt 54792, Pakistan
| | - Myron Christodoulides
- Neisseria Research Laboratory, Molecular Microbiology, School of Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, U.K
- Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, U.K
| | - Antonios G Kanaras
- Physics and Astronomy, Faculty of Physical Sciences and Engineering, University of Southampton, Southampton SO17 1BJ, U.K
- Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, U.K
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Cueva F, Caicedo A, Hidalgo P. A Need for Standardization of the Diagnosis and Treatment of Pelvic Inflammatory Disease: Pilot Study in an Outpatient Clinic in Quito, Ecuador. Infect Dis Obstet Gynecol 2020; 2020:5423080. [PMID: 32454581 PMCID: PMC7232719 DOI: 10.1155/2020/5423080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/04/2020] [Accepted: 04/11/2020] [Indexed: 11/23/2022] Open
Abstract
Background Pelvic inflammatory disease (PID) diagnosis is often challenging as well as its treatment. This study sought to characterize the diagnostic and therapeutic trend among physicians at the outpatient level, in Quito, Ecuador, where currently no nationwide screening or specific clinical guideline has been implemented on PID or its main microbiological agents. Methods A retrospective analysis of medical records with pelvic inflammatory disease diagnosis in an outpatient clinic was performed. Electronic medical records from 2013 to 2018 with any pelvic inflammatory disease-related diagnoses were retrieved. Information with regard to age, sexually related risk factors, symptoms and physical exam findings, ancillary tests, method of diagnosis, and antibiotic regimens was extracted. Results A total of 186 records were included. The most frequent clinical manifestations were vaginal discharge (47%) and pelvic pain (39%). In the physical examination, leucorrhea was the most frequent finding (47%), followed by lower abdominal tenderness (35%) and cervical motion tenderness in 51 patients (27%). A clinical diagnosis was established in 60% of patients, while 37% had a transvaginal sonography-guided diagnosis. Antibiotic treatment was prescribed with standard regimens in 3% of cases, while other regimens were used in 93% of patients. Additionally, an average of 1.9 drugs were prescribed per patient, with a range from 1 to 5, all in different combinations and dosages. Conclusions No standardized methods of diagnosis or treatment were identifiable. These findings highlight the need for standardization of the diagnosis and treatment of PID attributed to chlamydial and gonococcal infections.
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Affiliation(s)
- Francisco Cueva
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, 17-12-841 Quito, Ecuador
| | - Andrés Caicedo
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, 17-12-841 Quito, Ecuador
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, 17-12-841 Quito, Ecuador
- Sistemas Médicos, SIME, Universidad San Francisco de Quito, 17-12-841 Quito, Ecuador
| | - Paula Hidalgo
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, 17-12-841 Quito, Ecuador
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, 17-12-841 Quito, Ecuador
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Kaufman JS, Banack HR, Adams JW, Marshall BDL, Stovitz SD. Risk Factor Reversal in Studies of Infectious Disease: Making Counterintuitive Results Intuitive Again. Sex Transm Dis 2020; 46:e5-e7. [PMID: 30234795 DOI: 10.1097/olq.0000000000000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A previously published study reported the seemingly paradoxical finding that men who have sex with men status was strongly protective and recent sexual abstinence strongly deleterious in relation to mortality prognosis. We explain why these results are entirely logical and that the counterintuitive direction of the effects derives from the comparison group implied by the study design.
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Affiliation(s)
- Jay S Kaufman
- From the Department of Epidemiology, Biostatistics, and Occupational Health McGill University, Montreal, QC, Canada
| | - Hailey R Banack
- Department of Epidemiology and Environmental Health School of Public Health and Health Professions University at Buffalo, The State University of New York, Buffalo, NY
| | - Joëlla W Adams
- Department of Epidemiology Brown University School of Public Health, Providence, RI, and
| | - Brandon D L Marshall
- Department of Epidemiology Brown University School of Public Health, Providence, RI, and
| | - Steven D Stovitz
- Department of Family Medicine and Community Health University of Minnesota, Minneapolis, MN
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Trabert B, Waterboer T, Idahl A, Brenner N, Brinton LA, Butt J, Coburn SB, Hartge P, Hufnagel K, Inturrisi F, Lissowska J, Mentzer A, Peplonska B, Sherman ME, Wills GS, Woodhall SC, Pawlita M, Wentzensen N. Antibodies Against Chlamydia trachomatis and Ovarian Cancer Risk in Two Independent Populations. J Natl Cancer Inst 2020; 111:129-136. [PMID: 29790947 DOI: 10.1093/jnci/djy084] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/20/2018] [Accepted: 04/03/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Pelvic inflammatory disease (PID) has been associated with ovarian cancer risk. To clarify the role of Chlamydia trachomatis and other infectious agents in the development of ovarian cancer, we evaluated the association of serologic markers with incident ovarian cancer using a staged approach in two independent populations. METHODS Studies included: 1) a case-control study in Poland (244 ovarian cancers/556 control subjects) and 2) a prospective nested case-control study in the PLCO Cancer Screening Trial (160 ovarian cancers/159 control subjects). Associations of serologic marker levels with ovarian cancer risk at diagnostic as well as higher thresholds, identified in Poland and independently evaluated in PLCO, were estimated using multivariable adjusted logistic regression. RESULTS In the Polish study, antibodies (based on laboratory cut-point) against the chlamydia plasmid-encoded Pgp3 protein (serological gold standard) were associated with increased ovarian cancer risk (adjusted odds ratio [OR] = 1.63, 95% confidence interval [CI] = 1.20 to 2.22); when a positive result was redefined at higher levels, ovarian cancer risk was increased (cut-point 2: OR = 2.00, 95% CI = 1.38 to 2.89; cut-point 3 [max OR]: OR = 2.19, 95% CI = 1.29 to 3.73). In the prospective PLCO study, Pgp3 antibodies were associated with elevated risk at the laboratory cut-point (OR = 1.43, 95% CI = 0.78 to 2.63) and more stringent cut-points (cut-point 2: OR = 2.25, 95% CI = 1.07 to 4.71); cut-point 3: OR = 2.53, 95% CI = 0.63 to 10.08). In both studies, antibodies against other infectious agents measured were not associated with risk. CONCLUSIONS In two independent populations, antibodies against prior/current C. trachomatis (Pgp3) were associated with a doubling in ovarian cancer risk, whereas markers of other infectious agents were unrelated. These findings lend support for an association between PID and ovarian cancer.
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Affiliation(s)
- Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annika Idahl
- Department of Clinical Science, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Nicole Brenner
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Julia Butt
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sally B Coburn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Patricia Hartge
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Katrin Hufnagel
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Federica Inturrisi
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jolanta Lissowska
- Department of Epidemiology and Cancer Prevention, Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland
| | | | - Beata Peplonska
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Mark E Sherman
- Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL
| | - Gillian S Wills
- Jefferiss Research Trust Laboratories, Imperial College London, St Mary's Campus, London, UK
| | - Sarah C Woodhall
- National Infection Service, Public Health England, London, UK.,Research Department of Infection and Population Health, UCL, London, UK.,Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Michael Pawlita
- Molecular Diagnostics of Oncogenic Infections Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Pape J, Gnehm F, Bajka M, Fink D, Samartzis EP. [Pelvic Inflammatory Disease - Synergies between Family Practices and Gynaecological Specialised Assessment]. PRAXIS 2020; 109:1251-1259. [PMID: 33292013 DOI: 10.1024/1661-8157/a003582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Pelvic Inflammatory Disease - Synergies between Family Practices and Gynaecological Specialised Assessment Abstract. The 'pelvic inflammatory disease' (PID) describes an ascending inflammation of the upper female genital tract, beginning with a local cervicitis and proceeding to endometritis and adnexitis. It is a common clinical picture with rising numbers in recent years, and it occurs both in gynaecological and general practice. The symptoms are often unspecific, discrete or althogehter lacking. In order to reduce long-term risks of chronic pelvic pain, sterility and/or ectopic pregnancies, rapid diagnosis followed by immediate therapy and a good interdisciplinary cooperation are necessary. Screening programs for chlamydia and gonococcus as the most common pathogens of PID have not yet been implemented in Switzerland so far.
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Affiliation(s)
- Janna Pape
- 1 Klinik für Gynäkologie, Universitätsspital Zürich
| | - Florian Gnehm
- Departement für Innere Medizin, Universitätsspital Zürich
| | | | - Daniel Fink
- 1 Klinik für Gynäkologie, Universitätsspital Zürich
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Abstract
The emergency medicine provider sees a broad range of pathology involving the female genitourinary system on a daily basis. Must-not-miss diagnoses include pelvic inflammatory disease and ovarian torsion, because these diagnoses can have severe complications and affect future fertility. Although most patients with abnormal uterine bleeding are hemodynamically stable, it can present as a life-threatening emergency and providers should be adept managing severe hemorrhage. Bartholin gland cysts are common complaints that often require procedural intervention. This article discusses these diagnoses and appropriate evaluation and management in the emergency department.
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Affiliation(s)
- Sarah Mahonski
- Heritage Valley Health System, 1000 Dutch Ridge Road, Beaver, PA 15009, USA
| | - Kami M Hu
- Emergency/Internal/Critical Care Medicine, University of Maryland, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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Body Parts Matter: Social, Behavioral, and Biological Considerations for Urethral, Pharyngeal, and Rectal Gonorrhea and Chlamydia Screening Among MSM in Lima, Peru. Sex Transm Dis 2019; 45:607-614. [PMID: 30102262 DOI: 10.1097/olq.0000000000000816] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gonorrhea (Neisseria gonorrhoeae [GC]) and chlamydia (Chlamydia trachomatis [CT]) disproportionately affect men who have sex with men (MSM), and public health implications vary by anatomic site and bacterial agent. Urethral and rectal GC and CT can increase risk of HIV transmission, whereas pharyngeal GC may be a reservoir for antimicrobial resistance. To define screening priorities in Latin America, we compare differences in the prevalence and correlates of urethral, pharyngeal, and rectal GC and CT among MSM in Peru. METHODS A cross-sectional sample of 787 MSM from Lima was screened between 2012 and 2014. We described prevalence of urethral, pharyngeal, and rectal GC and CT infection and conducted bivariate analyses of associations with social, behavioral, and biological characteristics. Poisson regression analyses assessed the correlates of each infection at each anatomic site. RESULTS The most commonly symptomatic infection (urethral GC; 42.1%) was the least prevalent (2.4%). The most prevalent infections were rectal CT (15.8%) and pharyngeal GC (9.9%). Rectal CT was the least commonly symptomatic (2.4%) infection, and was associated with younger age (adjusted prevalence ratio [95% confidence interval], 0.96 [0.94-0.98]), HIV infection (1.46 [1.06-2.02]), and pasivo (receptive; 3.59 [1.62-7.95]) and moderno (versatile; 2.63 [1.23-5.60]) sexual roles. CONCLUSIONS Results highlight limitations of current syndromic screening strategies for sexually transmitted diseases in Peru, wherein urethral CT and rectal GC and CT may be missed due to their frequently asymptomatic presentations. Successful management of GC and CT infections among MSM in low-resource settings requires differentiating between bacterial agent, symptomatic presentation, associated risk factors, and public health implications of untreated infection at different anatomic sites.
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Bautista CT, Hollingsworth BP, Sanchez JL. Repeat Chlamydia Diagnoses Increase the Hazard of Pelvic Inflammatory Disease among US Army Women: A Retrospective Cohort Analysis. Sex Transm Dis 2019; 45:770-773. [PMID: 29870505 DOI: 10.1097/olq.0000000000000878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the US military, chlamydia is the mostly commonly diagnosed bacterial sexually transmitted infection and the rates of pelvic inflammatory disease (PID) have remained high since the early 2000s. METHODS The relationship between the number of chlamydia diagnoses and hazard of PID was investigated in a retrospective cohort analysis among US Army women from 2006 to 2012. Cox regression model was used to estimate hazard ratios for associations between the number of repeat chlamydia diagnoses and PID. RESULTS The study population comprised 33,176 women with chlamydia diagnosis. Of these, 25,098 (75%) were diagnosed only once ("nonrepeaters"). By comparison, 6282 (19%), 1435 (4%), and 361 (1%) women had one, two and three repeat chlamydia diagnoses, respectively. Among these 4 groups, 1111, 325, 72, and 25 PID diagnoses were noted. According to the Cox regression analysis, for every additional diagnosis of chlamydia, the hazard of PID increased by 28% (95% confidence interval, 19%-38%) compared with women with a single diagnosis or nonrepeaters. Moreover, the corresponding adjusted hazard ratio of 1.28, 1.35, and 1.97 represented a significantly greater risk for PID among the three "repeater" groups compared with nonrepeaters. CONCLUSIONS We found an increased hazard of PID among US Army women with repeat chlamydia diagnoses and the characterization of a dose-response relationship. These findings reinforce the notion that early diagnosis and treatment of chlamydia is necessary to avoid subsequent PID and associated morbidity.
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Affiliation(s)
| | | | - Jose L Sanchez
- Armed Forces Health Surveillance Branch, Public Health Division, Defense Health Agency, Silver Spring, MD
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Koninckx PR, Ussia A, Tahlak M, Adamyan L, Wattiez A, Martin DC, Gomel V. Infection as a potential cofactor in the genetic-epigenetic pathophysiology of endometriosis: a systematic review. Facts Views Vis Obgyn 2019; 11:209-216. [PMID: 32082526 PMCID: PMC7020943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The genetic-epigenetic theory postulates that endometriosis is triggered by a cumulative set of genetic-epigenetic (GE) incidents. Pelvic and upper genital tract infection might induce GE incidents and thus play a role in the pathogenesis of endometriosis. Thus, this article aims to review the association of endometriosis with upper genital tract and pelvic infections. METHODS Pubmed, Scopus and Google Scholar were searched for 'endometriosis AND (infection OR PID OR bacteria OR viruses OR microbiome OR microbiota)', for 'reproductive microbiome' and for 'reproductive microbiome AND endometriosis', respectively. All 384 articles, the first 120 'best match' articles in PubMed for 'reproductive microbiome' and the first 160 hits in Google Scholar for 'reproductive microbiome AND endomytriosis' were hand searched for data describing an association between endometriosis and bacterial, viral or other infections. All 31 articles found were included in this manuscript. RESULTS Women with endometriosis have a significantly increased risk of lower genital tract infection, chronic endometritis, severe PID and surgical site infections after hysterectomy. They have more colony forming units of Gardnerella, Streptococcus, Enterococci and Escherichia coli in the endometrium. In the cervix Atopobium is absent, but Gardnerella, Streptococcus, Escherichia, Shigella, and Ureoplasma are increased. They have higher concentrations of Escherichia Coli and higher concentrations of bacterial endotoxins in menstrual blood. A Shigella/Escherichia dominant stool microbiome is more frequent. The peritoneal fluid of women with endometriosis contains higher concentrations of bacterial endotoxins and an increased incidence of mollicutes and of HPV viruses. Endometriosis lesions have a specific bacterial colonisation with more frequently mollicutes (54%) and both high and medium-risk HPV infections (11%). They contain DNA with 96% homology with Shigella. In mice transplanted endometrium changes the gut microbiome while the gut microbiome influences the growth of these endometriosis lesions. CONCLUSIONS Endometriosis is associated with more upper genital tract and peritoneal infections. These infections might be co-factors causing GE incidents and influencing endometriosis growth.
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Affiliation(s)
- P R Koninckx
- Latifa Hospital, Dubai, United Arab Emirates
- KU, Leuven, Belgium
- Gruppo Italo-Belga, Villa Del Rosario, Rome, Italy
- University of Oxford-Hon Consultant, Oxford,UK
| | - A Ussia
- Gruppo Italo-Belga, Villa Del Rosario, Rome, Italy
- Università Cattolica, Roma Italy
| | - M Tahlak
- Latifa Hospital, Dubai, United Arab Emirates
| | - L Adamyan
- Department of Operative Gynecology, V. I. Kulakov Research Centre for Obstetrics, Gynecology, and Perinatology, Russian Federation
- Department of Reproductive Medicine and Surgery, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A Wattiez
- Latifa Hospital, Dubai, United Arab Emirates
- Department of Obstetrics and Gynaecology, University of Strasbourg, France
| | - D C Martin
- School of Medicine, University of Tennessee Health Science Centre, Memphis Tennessee, USA
- Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Obstetrics and Gynecology, University of British Columbia and Women's Hospital, Vancouver, BC, Canada
| | - V Gomel
- Department of Obstetrics and Gynecology, University of British Columbia and Women's Hospital, Vancouver, BC, Canada
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Association of pelvic inflammatory disease (PID) with ectopic pregnancy and preterm labor in Taiwan: A nationwide population-based retrospective cohort study. PLoS One 2019; 14:e0219351. [PMID: 31408465 PMCID: PMC6692029 DOI: 10.1371/journal.pone.0219351] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/23/2019] [Indexed: 12/18/2022] Open
Abstract
Background Pelvic inflammatory disease (PID) is an infectious disease that causes tubal occlusion and other pelvic and abdominal adhesions. The incidence of pelvic inflammatory disease (PID) has increased due to the sexually active status of the young population. This leads to a more serious problem and a larger effect than previously observed. However, there have been few studies on this topic in Asian populations. Aim We aimed to evaluate the risk of preterm labor and/or ectopic pregnancy in Taiwanese women following PID. Design Using the Taiwan National Health Insurance Database, we designed a retrospective cohort study that included 12- to 55-year-old pregnant women between 2000 and 2010. We selected a 1:3 age-matched control group of non-PID women. The endpoint was any episode of preterm labor or ectopic pregnancy; otherwise, the patients were tracked until 31 December 2010. Methods The risk factors for preterm labor or ectopic pregnancy were explored. For cases included from the index date until the end of 2010, we analyzed the risk of incident preterm labor or ectopic pregnancy. With the use of a multivariate Cox proportional hazard regression analysis, we calculated the hazard ratio (HR) with a 95% CI and compared it with that of the control group. Results This study examined 30,450 patients with PID and 91,350 controls. During the follow-up period, patients in the PID group were more likely to develop preterm labor or ectopic pregnancy than patients in the control group. The cumulative incidence rates for developing preterm labor were 1.84% (561/30,450 individuals) in patients with PID and 1.63% (1492/91,350 individuals) in patients without PID. On the other hand, the cumulative incidence rate for developing ectopic pregnancy in patients with PID was 0.05% (14/30,450 individuals) but was only 0.04% (33/91,350 individuals) in patients without PID. Compared with those without PID, the patients with PID had a 1.864 times (P<0.001) higher risk of developing preterm labor and a 2.121 times (P = 0.003) higher risk of developing ectopic pregnancy. Conclusion Our study provided evidence of an increased risk of preterm labor or ectopic pregnancy in PID patients.
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