Physician Specialty Influences Care of Pelvic Inflammatory Disease

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

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

Ozone therapy ameliorates inflammation and endometrial injury in rats with pelvic inflammatory disease

As a common cause of infertility, pelvic inflammatory disease (PID) is characterized by chronic pain, ectopic pregnancy as well as inflammation and infection of the female upper genital tract. Ozone water, also known as O_3, has been previously reported to be a distinctly effective agent in treating inflammation. During the present study, we asserted the hypothesis that O₃ could be applied by pelvic inflammation and works to regulate the expression of inflammatory factors including interleukin-6 (IL-6), IL-2 and tumor necrosis factor-α (TNF-α). In an attempt to evaluate the effect of O₃ on PID, an acute PID rat model was subsequently established. O₃ at concentrations of 45 μg/mL and 60 μg/mL in addition to levofloxacin (LVLX) was injected respectively into the PID rats in a bid to alter the contents of inflammatory factors and immunologic markers. Hematoxylin-eosin (HE) staining was applied to analyze endometrial inflammation. Reductions to the contents of IL-6 and TNF-α were recorded, while that of IL-2, IgA, IgG, IgM, C3 and C4, and E rosette formation rate and transformation rate of T lymphocytes exhibited notably elevated levels after the PID rats had been injected with 45 μg/mL O₃, 60 μg/mL O₃ or LVLX. The pathological condition of the endometrium in rats with PID was alleviated among the PID rats after injected with the 45 μg/mL O₃, 60 μg/mL O₃ or LVLX. Taken together, the key findings of the current study present evidence demonstrating that the administration of O₃ to the pelvic cavity ameliorated the PID conditions among rat models via inhibition of the necrosis of the endometrial epithelial cells as well as alleviated the inflammatory reactions, highlighting a potential novel PID treatment target.

HIV and Syphilis Screening Among Adolescents Diagnosed With Pelvic Inflammatory Disease

BACKGROUND AND OBJECTIVES

Women with pelvic inflammatory disease (PID) are at an increased risk for syphilis and HIV, but screening rates among adolescents have been understudied. Our objective is to measure the frequency of HIV and syphilis screening among adolescents who are diagnosed with PID and identify patient- and hospital-level characteristics associated with screening.

METHODS

We performed a retrospective cohort study using the Pediatric Health Information System from 2010 to 2015. We included visits to the emergency department by female adolescents who were diagnosed with PID and determined the frequency of HIV and syphilis screening. We performed separate multivariable logistic regression analyses to identify factors associated with screening.

RESULTS

Of the 10 698 patients who were diagnosed with PID, 22.0% (95% confidence interval [CI] 21.2%-22.8%) underwent HIV screening, and 27.7% (95% CI 26.9%-28.6%) underwent syphilis screening. Screening rates varied by hospital (HIV: 2.6%-60.4%; syphilis: 2.9%-62.2%). HIV screening was more likely to occur in younger (adjusted odds ratio [aOR] 1.2; 95% CI 1.0-1.3), non-Hispanic African American (aOR 1.4; 95% CI 1.2-1.7), non-privately insured (publicly insured [aOR 1.3; 95% CI 1.1-1.5], uninsured [aOR 1.6; 95% CI 1.2-2.0]), and admitted patients (aOR 7.0; 95% CI 5.1-9.4) at smaller hospitals (aOR 1.4; 95% CI 1.0-1.8). Syphilis screening was more likely to occur in younger (aOR 1.1; 95% CI 1.0-1.3), non-Hispanic African American (aOR 1.8; 95% CI 1.2-2.8), non-privately insured (publicly insured [aOR 1.4; 95% CI 1.2-1.6], uninsured [aOR 1.6; 95% CI 1.2-1.9]), and admitted patients (aOR 4.6; 95% CI 3.3-6.4).

CONCLUSIONS

We found low rates of HIV and syphilis screening among adolescents who were diagnosed with PID, with wide variability across hospitals.