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Prokopev IV, Abdrakhmanov AR. Capabilities of combined peptide drugs in the correction of male infertility (literature review). CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.12.201295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acute and chronic urogenital infections are associated with male infertility. Besides "traditional" sexually transmitted infections, there is a significant increase in inflammatory diseases of reproductive system caused by opportunistic pathogens. Studies show that sperm fertility is influenced by direct exposure to sexually transmitted infections, as well as dysfunction of the blood-testicular barrier, leading to autoimmune infertility. In a number of clinical trials, Prostatilen AC was shown to have benefitial effects on the ejaculate.
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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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Savaris RF, Fuhrich DG, Maissiat J, Duarte RV, Ross J. Antibiotic therapy for pelvic inflammatory disease. Cochrane Database Syst Rev 2020; 8:CD010285. [PMID: 32820536 PMCID: PMC8094882 DOI: 10.1002/14651858.cd010285.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pelvic inflammatory disease (PID) affects 4% to 12% of women of reproductive age. The main intervention for acute PID is broad-spectrum antibiotics administered intravenously, intramuscularly or orally. We assessed the optimal treatment regimen for PID. OBJECTIVES: To assess the effectiveness and safety of antibiotic regimens to treat PID. SEARCH METHODS In January 2020, we searched the Cochrane Sexually Transmitted Infections Review Group's Specialized Register, which included randomized controlled trials (RCTs) from 1944 to 2020, located through hand and electronic searching; CENTRAL; MEDLINE; Embase; four other databases; and abstracts in selected publications. SELECTION CRITERIA We included RCTs comparing antibiotics with placebo or other antibiotics for the treatment of PID in women of reproductive age, either as inpatient or outpatient treatment. We limited our review to a comparison of drugs in current use that are recommended by the 2015 US Centers for Disease Control and Prevention guidelines for treatment of PID. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two authors independently extracted data, assessed risk of bias and conducted GRADE assessments of the quality of evidence. MAIN RESULTS We included 39 RCTs (6894 women) in this review, adding two new RCTs at this update. The quality of the evidence ranged from very low to high, the main limitations being serious risk of bias (due to poor reporting of study methods and lack of blinding), serious inconsistency, and serious imprecision. None of the studies reported quinolones and cephalosporins, or the outcomes laparoscopic evidence of resolution of PID based on physician opinion or fertility outcomes. Length of stay results were insufficiently reported for analysis. Regimens containing azithromycin versus regimens containing doxycycline We are uncertain whether there was a clinically relevant difference between azithromycin and doxycycline in rates of cure for mild-moderate PID (RR 1.18, 95% CI 0.89 to 1.55; 2 RCTs, 243 women; I2 = 72%; very low-quality evidence). The analyses may result in little or no difference between azithromycin and doxycycline in rates of severe PID (RR 1.00, 95% CI 0.96 to 1.05; 1 RCT, 309 women; low-quality evidence), or adverse effects leading to discontinuation of treatment (RR 0.71, 95% CI 0.38 to 1.34; 3 RCTs, 552 women; I2 = 0%; low-quality evidence). In a sensitivity analysis limited to a single study at low risk of bias, azithromycin probably improves the rates of cure in mild-moderate PID (RR 1.35, 95% CI 1.10 to 1.67; 133 women; moderate-quality evidence), compared to doxycycline. Regimens containing quinolone versus regimens containing cephalosporin The analysis shows there may be little or no clinically relevant difference between quinolones and cephalosporins in rates of cure for mild-moderate PID (RR 1.05, 95% CI 0.98 to 1.14; 4 RCTs, 772 women; I2 = 15%; low-quality evidence), or severe PID (RR 1.06, 95% CI 0.91 to 1.23; 2 RCTs, 313 women; I2 = 7%; low-quality evidence). We are uncertain whether there was a difference between quinolones and cephalosporins in adverse effects leading to discontinuation of treatment (RR 2.24, 95% CI 0.52 to 9.72; 6 RCTs, 1085 women; I2 = 0%; very low-quality evidence). Regimens with nitroimidazole versus regimens without nitroimidazole There was probably little or no difference between regimens with or without nitroimidazoles (metronidazole) in rates of cure for mild-moderate PID (RR 1.02, 95% CI 0.95 to 1.09; 6 RCTs, 2660 women; I2 = 50%; moderate-quality evidence), or severe PID (RR 0.96, 95% CI 0.92 to 1.01; 11 RCTs, 1383 women; I2 = 0%; moderate-quality evidence). The evidence suggests that there was little to no difference in in adverse effects leading to discontinuation of treatment (RR 1.05, 95% CI 0.69 to 1.61; 17 studies, 4021 women; I2 = 0%; low-quality evidence). . In a sensitivity analysis limited to studies at low risk of bias, there was little or no difference for rates of cure in mild-moderate PID (RR 1.05, 95% CI 1.00 to 1.12; 3 RCTs, 1434 women; I2 = 0%; high-quality evidence). Regimens containing clindamycin plus aminoglycoside versus quinolone We are uncertain whether quinolone have little to no effect in rates of cure for mild-moderate PID compared to clindamycin plus aminoglycoside (RR 0.88, 95% CI 0.69 to 1.13; 1 RCT, 25 women; very low-quality evidence). The analysis may result in little or no difference between quinolone vs. clindamycin plus aminoglycoside in severe PID (RR 1.02, 95% CI 0.87 to 1.19; 2 studies, 151 women; I2 = 0%; low-quality evidence). We are uncertain whether quinolone reduces adverse effects leading to discontinuation of treatment (RR 0.21, 95% CI 0.02 to 1.72; 3 RCTs, 163 women; I2 = 0%; very low-quality evidence). Regimens containing clindamycin plus aminoglycoside versus regimens containing cephalosporin We are uncertain whether clindamycin plus aminoglycoside improves the rates of cure for mild-moderate PID compared to cephalosporin (RR 1.02, 95% CI 0.95 to 1.09; 2 RCTs, 150 women; I2 = 0%; low-quality evidence). There was probably little or no difference in rates of cure in severe PID with clindamycin plus aminoglycoside compared to cephalosporin (RR 1.00, 95% CI 0.95 to 1.06; 10 RCTs, 959 women; I2= 21%; moderate-quality evidence). We are uncertain whether clindamycin plus aminoglycoside reduces adverse effects leading to discontinuation of treatment compared to cephalosporin (RR 0.78, 95% CI 0.18 to 3.42; 10 RCTs, 1172 women; I2 = 0%; very low-quality evidence). AUTHORS' CONCLUSIONS We are uncertain whether one treatment was safer or more effective than any other for the cure of mild-moderate or severe PID Based on a single study at a low risk of bias, a macrolide (azithromycin) probably improves the rates of cure of mild-moderate PID, compared to tetracycline (doxycycline).
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Affiliation(s)
| | | | - Jackson Maissiat
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rui V Duarte
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Jonathan Ross
- Department of G U Medicine, The Whittall Street Clinic, Birmingham, UK
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Castro J, Jefferson KK, Cerca N. Genetic Heterogeneity and Taxonomic Diversity among Gardnerella Species. Trends Microbiol 2020; 28:202-211. [DOI: 10.1016/j.tim.2019.10.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/27/2019] [Accepted: 10/08/2019] [Indexed: 12/17/2022]
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Cazanave C, de Barbeyrac B. [Pelvic inflammatory diseases: Microbiologic diagnosis - CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]. ACTA ACUST UNITED AC 2019; 47:409-417. [PMID: 30878688 DOI: 10.1016/j.gofs.2019.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the microorganisms potentially involved in pelvic inflammatory diseases (PIDs) and the different diagnostic methods of PID. METHODS PubMed and International Guidelines search. RESULTS PIDs have various microbial causes. The pathogenic role of the main agents of sexually transmitted infections (STIs), Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium is well demonstrated (NP1). C. trachomatis is the most commonly described bacterium in PID (NP1), especially in women under 30 years old. PIDs also occur in situations that decrease the effectiveness of the cervix microbiological lock, such as bacterial vaginosis, allowing facultative vaginal bacteria such as Escherichia coli, Streptococcus agalactiae and anaerobes to ascend to the uterine cavity. Nevertheless, participation of the diverse bacteria of the vaginal microbiota, in particular anaerobes, and the polymicrobial character of PIDs are still differently appreciated. In the case of uncomplicated PID, to obtain a microbiological diagnosis, endocervical sampling is recommended during gynecological examination under speculum (grade B). A first swab allows for a smear on a slide for direct examination (Gram, MGG). A second swab, in an adapted transport medium, is useful for standard culture with N. gonorrhoeae and facultative vaginal flora bacteria cultures, with antibiotic susceptibility testing. A third swab, in an appropriate transport medium, allows for the search for N. gonorrhoeae, C. trachomatis, and if possible M. genitalium by nucleic acid amplification techniques (NAATs), (NP1). It is possible to only use one swab in a transport medium suitable for (i) survival of bacteria and (ii) NAATs. When the diagnosis of PID is clinically compatible, a positive NAAT for one or more of the three STI-associated bacteria on a genital sample supports the PID diagnosis (NP1). On the other hand, a negative NAAT does not allow the exclusion of an STI agent for PID diagnosis (NP1). In situations where speculum use is not possible, vaginal sampling will be performed by default. In case of complicated IGH, tuboperitoneal samples can be performed either radiologically or surgically. Since these sites are sterile, any bacteria present will be considered pathogenic (NP2). C. trachomatis serology is not interesting as a first line diagnostic tool for PID diagnosis and is not useful for monitoring the evolution of PID (NP1).
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Affiliation(s)
- C Cazanave
- Service des maladies infectieuses et tropicales, groupe hospitalier Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France; Infections humaines à mycoplasmes et chlamydiae, USC EA 3671, Institut national de la recherche agronomique, université Bordeaux, 33000 Bordeaux, France; Centre national de référence des infections sexuellement transmissibles bactériennes, CHU de Bordeaux, 33000 Bordeaux, France.
| | - B de Barbeyrac
- Infections humaines à mycoplasmes et chlamydiae, USC EA 3671, Institut national de la recherche agronomique, université Bordeaux, 33000 Bordeaux, France; Centre national de référence des infections sexuellement transmissibles bactériennes, CHU de Bordeaux, 33000 Bordeaux, France; Laboratoire de bactériologie, groupe hospitalier Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France
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Ross J, Guaschino S, Cusini M, Jensen J. 2017 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS 2017; 29:108-114. [PMID: 29198181 DOI: 10.1177/0956462417744099] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The European guideline for the management of pelvic inflammatory disease includes evidence-based advice on the investigation and treatment of pelvic inflammatory disease (PID). It has been updated to acknowledge the role of Mycoplasma genitalium as an important cause of PID with testing now recommended for women presenting with possible PID and for the male partners of women with confirmed M. genitalium infection. Recent evidence suggests that serious adverse events are uncommon when using moxifloxacin and its use is now recommended as a first-line therapy, especially in those women with M. genitalium PID. The potential utility of MRI scanning of the pelvis in excluding differential diagnoses has been highlighted. The use of doxycycline is now suggested as empirical treatment for male partners of women with PID to reduce exposure to macrolide antibiotics, which has been associated with increased resistance in M. genitalium.
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Affiliation(s)
- Jonathan Ross
- 1 University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Marco Cusini
- 3 Department of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Policlinico, Milano, Italy
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Pathak M, Coombes AGA, Ryu B, Cabot PJ, Turner MS, Palmer C, Wang D, Steadman KJ. Sustained Simultaneous Delivery of Metronidazole and Doxycycline From Polycaprolactone Matrices Designed for Intravaginal Treatment of Pelvic Inflammatory Disease. J Pharm Sci 2017; 107:863-869. [PMID: 29100864 DOI: 10.1016/j.xphs.2017.09.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/04/2017] [Accepted: 09/19/2017] [Indexed: 11/18/2022]
Abstract
Poly(ɛ-caprolactone) (PCL) intravaginal matrices were produced for local delivery of a combination of antibacterials, by rapidly cooling a mixture of drug powders dispersed in PCL solution. Matrices loaded with different combinations of metronidazole (10%, 15%, and 20% w/w) and doxycycline (10% w/w) were evaluated in vitro for release behavior and antibacterial activity. Rapid "burst release" of 8%-15% of the doxycycline content and 31%-37% of the metronidazole content occurred within 24 h when matrices were immersed in simulated vaginal fluid at 37°C. The remaining drug was extracted gradually over 14 days to a maximum of 65%-73% for doxycycline and 62%-71% for metronidazole. High levels of antibacterial activity up to 89%-91% against Gardnerella vaginalis and 84%-92% against Neisseria gonorrhoeae were recorded in vitro for release media collected on day 14, compared to "nonformulated" metronidazole and doxycycline solutions. Based on the in vitro data, the minimum levels of doxycycline and metronidazole released from PCL matrices in the form of intravaginal rings into vaginal fluid in vivo were predicted to exceed the minimum inhibitory concentrations for N. gonorrhea (reported range 0.5-4.0 μg/mL) and G. vaginalis (reported range 2-12.8 μg/mL) respectively, which are 2 of the major causative agents for pelvic inflammatory disease.
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Affiliation(s)
- Meenakshi Pathak
- The University of Queensland, School of Pharmacy, 20 Cornwall Street, Woolloongabba, Brisbane, Queensland 4102, Australia.
| | - Allan G A Coombes
- The University of Queensland, School of Pharmacy, 20 Cornwall Street, Woolloongabba, Brisbane, Queensland 4102, Australia
| | - BoMi Ryu
- The University of Queensland, School of Pharmacy, 20 Cornwall Street, Woolloongabba, Brisbane, Queensland 4102, Australia
| | - Peter J Cabot
- The University of Queensland, School of Pharmacy, 20 Cornwall Street, Woolloongabba, Brisbane, Queensland 4102, Australia
| | - Mark S Turner
- The University of Queensland, School of Agriculture and Food Sciences, St. Lucia, Brisbane, Queensland 4072, Australia
| | - Cheryn Palmer
- Princess Alexandra Hospital, Department of Sexual Health, Ipswich Road, Woolloongabba, Queensland 4102, Australia
| | - Dongjie Wang
- The University of Queensland, School of Agriculture and Food Sciences, St. Lucia, Brisbane, Queensland 4072, Australia
| | - Kathryn J Steadman
- The University of Queensland, School of Pharmacy, 20 Cornwall Street, Woolloongabba, Brisbane, Queensland 4102, Australia
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Abstract
BACKGROUND Pelvic inflammatory disease (PID) is an infection that affects 4% to 12% of young women, and is one of the most common causes of morbidity in this age group. The main intervention for acute PID is the use of broad-spectrum antibiotics which cover Chlamydia trachomatis, Neisseria gonorrhoeae, and anaerobic bacteria, administered intravenously, intramuscularly, or orally. In this review, we assessed the optimal treatment regimen for PID. OBJECTIVES To assess the effectiveness and safety of antibiotic regimens used to treat pelvic inflammatory disease. SEARCH METHODS We searched the Cochrane Sexually Transmitted Infections Review Group's Specialized Register, which included randomized controlled trials (RCTs) from 1944 to 2016, located through electronic searching and handsearching; the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid platform (1991 to July 2016); MEDLINE (1946 to July 2016); Embase (1947 to July 2016); LILACS, iAHx interface (1982 to July 2016); World Health Organization International Clinical Trials Registry Platform (July 2016); Web of Science (2001 to July 2016); OpenGrey (1990, 1992, 1995, 1996, and 1997); and abstracts in selected publications. SELECTION CRITERIA We included RCTs comparing the use of antibiotics with placebo or other antibiotics for the treatment of PID in women of reproductive age, either as inpatient or outpatient treatment. We limited our review to comparison of drugs in current use that are recommended for consideration by the 2015 US Centers for Disease Control and Prevention (CDC) guidelines for treatment of PID. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials for inclusion, extracted data, and assessed risk of bias. We contacted investigators to obtain missing information. We resolved disagreements by consensus or by consulting a fourth review author if necessary. We assessed the quality of the evidence using GRADE criteria, classifying it as high, moderate, low, or very low. We calculated Mantel-Haenszel risk ratios (RR), using either random-effects or fixed-effect models and number needed to treat for an additional beneficial outcome or for an additional harmful outcome, with their 95% confidence interval (CI), to measure the effect of the treatments. We conducted sensitivity analyses limited to studies at low risk of bias, for comparisons where such studies were available. MAIN RESULTS We included 37 RCTs (6348 women). The quality of the evidence ranged from very low to high, the main limitations being serious risk of bias (due to poor reporting of study methods and lack of blinding), serious inconsistency, and serious imprecision. Azithromycin versus doxycyclineThere was no clear evidence of a difference between the two drugs in rates of cure for mild-moderate PID (RR 1.18, 95% CI 0.89 to 1.55, I2 = 72%, 2 RCTs, 243 women, very low-quality evidence), severe PID (RR 1.00, 95% CI 0.96 to 1.05, 1 RCT, 309 women, low-quality evidence), or adverse effects leading to discontinuation of treatment (RR 0.71, 95% CI 0.38 to 1.34, 3 RCTs, 552 women, I2 = 0%, low-quality evidence). In a sensitivity analysis limited to a single study at low risk of bias, azithromycin was superior to doxycycline in achieving cure in mild-moderate PID (RR 1.35, 95% CI 1.10 to 1.67, 133 women, moderate-quality evidence). Quinolone versus cephalosporinThere was no clear evidence of a difference between the two drugs in rates of cure for mild-moderate PID (RR 1.04, 95% CI 0.98 to 1.10, 3 RCTs, 459 women, I2 = 5%, low-quality evidence), severe PID (RR 1.06, 95% CI 0.91 to 1.23, 2 RCTs, 313 women, I2 = 7%, low-quality evidence), or adverse effects leading to discontinuation of treatment (RR 2.24, 95% CI 0.52 to 9.72, 5 RCTs, 772 women, I2 = 0%, very low-quality evidence). Nitroimidazole versus no use of nitroimidazoleThere was no conclusive evidence of a difference between the nitroimidazoles (metronidazole) group and the group receiving other drugs with activity over anaerobes (e.g. amoxicillin-clavulanate) in rates of cure for mild-moderate PID (RR 1.01, 95% CI 0.93 to 1.10, 5 RCTs, 2427 women, I2 = 60%, moderate-quality evidence), severe PID (RR 0.96, 95% CI 0.92 to 1.01, 11 RCTs, 1383 women, I2 = 0%, moderate-quality evidence), or adverse effects leading to discontinuation of treatment (RR 1.00, 95% CI 0.63 to 1.59; participants = 3788; studies = 16; I2 = 0% , low-quality evidence). In a sensitivity analysis limited to studies at low risk of bias, findings did not differ substantially from the main analysis (RR 1.06, 95% CI 0.98 to 1.15, 2 RCTs, 1201 women, I2 = 32%, high-quality evidence). Clindamycin plus aminoglycoside versus quinoloneThere was no evidence of a difference between the two groups in rates of cure for mild-moderate PID (RR 0.88, 95% CI 0.69 to 1.13, 1 RCT, 25 women, very low-quality evidence), severe PID (RR 1.02, 95% CI 0.87 to 1.19, 2 studies, 151 women, I2 = 0%, low-quality evidence), or adverse effects leading to discontinuation of treatment (RR 0.21, 95% CI 0.02 to 1.72, 3 RCTs, 163 women, very low-quality evidence). Clindamycin plus aminoglycoside versus cephalosporinThere was no clear evidence of a difference between the two groups in rates of cure for mild-moderate PID (RR 1.02, 95% CI 0.95 to 1.09, 2 RCTs, 150 women, I2 = 0%, low-quality evidence), severe PID (RR 1.00, 95% CI 0.95 to 1.06, 10 RCTs, 959 women, I2 = 21%, moderate-quality evidence), or adverse effects leading to discontinuation of treatment (RR 0.78, 95% CI 0.18 to 3.42, 10 RCTs, 1172 women, I2 = 0%, very low-quality evidence). AUTHORS' CONCLUSIONS We found no conclusive evidence that one regimen of antibiotics was safer or more effective than any other for the cure of PID, and there was no clear evidence for the use of nitroimidazoles (metronidazole) compared to use of other drugs with activity over anaerobes. Moderate-quality evidence from a single study at low risk of bias suggested that a macrolide (azithromycin) may be more effective than a tetracycline (doxycycline) for curing mild-moderate PID. Our review considered only the drugs that are currently used and mentioned by the CDC.
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Affiliation(s)
- Ricardo F Savaris
- UFRGS‐FAMEDGinecologia e ObstetriciaRamiro Barcelos 2350/1124Porto AlegreBrazil90035‐903
| | - Daniele G Fuhrich
- UFRGS‐FAMEDGinecologia e ObstetriciaRamiro Barcelos 2350/1124Porto AlegreBrazil90035‐903
| | - Rui V Duarte
- University of LiverpoolLiverpool Reviews and Implementation GroupWhelan BuildingThe Quadrangle, Brownlow HillLiverpoolUKL69 3GB
| | - Sebastian Franik
- Radboud University NijmegenFaculty of Medical SchoolGeert Grooteplein 9PO Box 9101NijmegenNetherlands6500HB
| | - Jonathan Ross
- The Whittall Street ClinicDepartment of G U MedicineWhittall StreetBirminghamUKB4 6DH
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Pathak M, Coombes AG, Turner MS, Palmer C, Wang D, Steadman KJ. Investigation of Polycaprolactone Matrices for Intravaginal Delivery of Doxycycline. J Pharm Sci 2015; 104:4217-4222. [DOI: 10.1002/jps.24652] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 08/24/2015] [Accepted: 08/26/2015] [Indexed: 11/05/2022]
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A review of antibiotic therapy for pelvic inflammatory disease. Int J Antimicrob Agents 2015; 46:272-7. [PMID: 26126798 DOI: 10.1016/j.ijantimicag.2015.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 11/20/2022]
Abstract
Pelvic inflammatory disease (PID) is a gynaecological inflammatory disorder with a high incidence that can lead to sequelae such as infertility, ectopic pregnancy and chronic pelvic pain. The International Union against Sexually Transmitted Infections (IUSTI) and the US Centers for Disease Control and Prevention (CDC) have issued treatment recommendations for the management of PID. The purpose of this review is to summarise the available evidence for the use of IUSTI- and CDC-recommended antibiotic therapies for PID. The main differences between recommendations concern alternative regimens for inpatient treatment and the use of oral moxifloxacin as an alternative outpatient regimen in the IUSTI guidelines. There is evidence supporting the use of the recommended antibiotic regimens, although with some variation in reported cure rates. This variation can be explained, in part, by the different diagnostic and evaluation criteria used in different trials. Adverse events that require discontinuation of antibiotic therapy are rarely observed. The main limitation of the current available evidence is the short-term follow-up, which does not allow full evaluation of the risks of long-term sequelae.
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Zarucheynova OV. THE METHODS OF LABORATORY DIAGNOSTICS OF UROGENITAL INFECTIONS ASSOCIATED WITH MYCOPLASMA HOMINIS AND UREAPLASMA SPP. ACTA ACUST UNITED AC 2015. [DOI: 10.15789/2220-7619-2014-4-331-338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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12
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Ross J, Judlin P, Jensen J. 2012 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS 2013; 25:1-7. [DOI: 10.1177/0956462413498714] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This guideline was produced by the European region of the International Union against sexually transmitted infections (IUSTI) and refers to ascending infections in the female genital tract unrelated to delivery and surgery and does not include actinomyces-related infection.
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Affiliation(s)
| | - Philippe Judlin
- Clinique Universitaire de Gynécologie-Obstétrique, Nancy, France
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Bourret A, Fauconnier A, Brun JL. Prise en charge d’une infection génitale haute non compliquée. ACTA ACUST UNITED AC 2012; 41:864-74. [DOI: 10.1016/j.jgyn.2012.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Quentin R, Verdon R. [Microbiologic basis of diagnosis and treatment of pelvic inflammatory disease]. ACTA ACUST UNITED AC 2012; 41:850-63. [PMID: 23140621 DOI: 10.1016/j.jgyn.2012.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pelvic inflammatory disease (PID) is caused by a large spectrum of micro-organisms. However, the microbiological cause is unknown in approximately half of cases according to varying series. In the context of sexually transmitted disease (STD), the most frequently identified microorganisms causing PID are Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium. In such cases, bacterial vaginosis and Trichomonas vaginalis are frequently associated. In case of complicated PID or when PID is the consequence of delivery, abortion, intra-uterine procedure, bacteria that come from vaginal carriage may be encountered: Enterobacteriacae, Staphylococcus spp., Streptococcus spp., anaerobes. Mycopslama hominis as well as Ureaplasma urealyticum may also be found in this context. The microbiological diagnosis may be performed on samples of vaginal liquid, endocervix or, when available, surgical specimens. The microbiological diagnostic procedures that are used to identify these microrgansims are reviewed. Vaginal sampling may help to identify N. gonorrhoeae, C. trachomatis and M. genitalium using nucleic acid amplification tests (NAAT), and is also of interest because of the epidemiological association of PID to bacterial vaginosis and trichomoniasis. Samples from the endocervix, and if available, from endometrial biopsy surgical procedures, should be processed to detect N. gonorrhoeae, C. trachomatis and M. genitalium using NAAT, and to search for the presence of Neisseria gonorrhoeae (antibiogram should be performed), facultative anaerobes, anaerobes and capnophilic bacteria. The antibiotic treatment should at least cover N. gonorrhoeae, C. trachomatis and M. genitalium, and for most of the authors, anaerobes. In case, microbiological studies demonstrate the role of other bacteria (e.g., Enterobacteriacae), theses should be treated according to the results of antibiogram.
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Affiliation(s)
- R Quentin
- Service de bactériologie et hygiène hospitalière, CHRU de Tours, 37044 Tours, France.
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Dalhoff A. Global fluoroquinolone resistance epidemiology and implictions for clinical use. Interdiscip Perspect Infect Dis 2012; 2012:976273. [PMID: 23097666 PMCID: PMC3477668 DOI: 10.1155/2012/976273] [Citation(s) in RCA: 212] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 06/26/2012] [Indexed: 12/22/2022] Open
Abstract
This paper on the fluoroquinolone resistance epidemiology stratifies the data according to the different prescription patterns by either primary or tertiary caregivers and by indication. Global surveillance studies demonstrate that fluoroquinolone resistance rates increased in the past years in almost all bacterial species except S. pneumoniae and H. influenzae, causing community-acquired respiratory tract infections. However, 10 to 30% of these isolates harbored first-step mutations conferring low level fluoroquinolone resistance. Fluoroquinolone resistance increased in Enterobacteriaceae causing community acquired or healthcare associated urinary tract infections and intraabdominal infections, exceeding 50% in some parts of the world, particularly in Asia. One to two-thirds of Enterobacteriaceae producing extended spectrum β-lactamases were fluoroquinolone resistant too. Furthermore, fluoroquinolones select for methicillin resistance in Staphylococci. Neisseria gonorrhoeae acquired fluoroquinolone resistance rapidly; actual resistance rates are highly variable and can be as high as almost 100%, particularly in Asia, whereas resistance rates in Europe and North America range from <10% in rural areas to >30% in established sexual networks. In general, the continued increase in fluoroquinolone resistance affects patient management and necessitates changes in some guidelines, for example, treatment of urinary tract, intra-abdominal, skin and skin structure infections, and traveller's diarrhea, or even precludes the use in indications like sexually transmitted diseases and enteric fever.
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Affiliation(s)
- Axel Dalhoff
- Institute for Infection-Medicine, Christian-Albrechts Univerity of Kiel and University Medical Center Schleswig-Holstein, Brunswiker Straße 4, 24105 Kiel, Germany
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Weinstein SA, Stiles BG. Recent perspectives in the diagnosis and evidence-based treatment of Mycoplasma genitalium. Expert Rev Anti Infect Ther 2012; 10:487-99. [PMID: 22512757 DOI: 10.1586/eri.12.20] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Mycoplasma genitalium is a globally important sexually transmitted pathogen. Men infected with M. genitalium frequently present with dysuria, while women may present with or without urogenital symptoms. In some populations, M. genitalium is significantly associated with HIV-1 infection, and is also an etiological agent in pelvic inflammatory disease. However, there is insufficient evidence to establish a causative role of the organism in obstetric complications, including tubal factor infertility. Although several nucleic acid amplification tests offer rapid, sensitive methods for detecting M. genitalium, there is no standardized assay. Available evidence supports treatment of M. genitalium infections with an extended regimen of azithromycin and resistant strains respond to moxifloxacin. Accumulating evidence indicates growing fluoroquinolone resistance, including against moxifloxacin, emphasizing the need for new therapeutic strategies to treat M. genitalium infections.
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Affiliation(s)
- Scott A Weinstein
- Women's and Children's Hospital, North Adelaide, South Australia, Australia.
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Weinstein SA, Stiles BG. A review of the epidemiology, diagnosis and evidence-based management of Mycoplasma genitalium. Sex Health 2011; 8:143-58. [PMID: 21592428 DOI: 10.1071/sh10065] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Accepted: 08/30/2010] [Indexed: 11/23/2022]
Abstract
Mycoplasma genitalium is attracting increasing recognition as an important sexually transmitted pathogen. Presented is a review of the epidemiology, detection, presentation and management of M. genitalium infection. Accumulating evidence suggests that M. genitalium is an important cause of non-gonococcal, non-chlamydial urethritis and cervicitis, and is linked with pelvic inflammatory disease and, possibly, obstetric complications. Although there is no standard detection assay, several nucleic acid amplification tests have >95% sensitivity and specificity for M. genitalium. To date, there is a general lack of established protocols for screening in public health clinics. Patients with urethritis or cervicitis should be screened for M. genitalium and some asymptomatic sub-groups should be screened depending on individual factors and local prevalence. Investigations estimating M. genitalium geographic prevalence document generally low incidence, but some communities exhibit infection frequencies comparable to that of Chlamydia trachomatis. Accumulating evidence supports an extended regimen of azithromycin for treatment of M. genitalium infection, as data suggest that stat 1 g azithromycin may be less effective. Although data are limited, azithromycin-resistant cases documented to date respond to an appropriate fluoroquinolone (e.g. moxifloxacin). Inconsistent clinical recognition of M. genitalium may result in treatment failure and subsequent persistence due to ineffective antibiotics. The contrasting nature of existing literature regarding risks of M. genitalium infection emphasises the need for further carefully controlled studies of this emerging pathogen.
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Affiliation(s)
- Scott A Weinstein
- Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5003, Australia.
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Serfaty D. Infections sexuellement transmissibles. Contraception 2011. [DOI: 10.1016/b978-2-294-70921-0.00012-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Judlin P, Liao Q, Liu Z, Reimnitz P, Hampel B, Arvis P. Efficacy and safety of moxifloxacin in uncomplicated pelvic inflammatory disease: the MONALISA study. BJOG 2010; 117:1475-84. [DOI: 10.1111/j.1471-0528.2010.02687.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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LYSENKO OV, KUZNECHENKOVA TV, IGLIKOV VA, DERYABINA VP. Prevalence of urogenital inflammatory diseases associated with genital mycoplasms. Treatment efficacy. VESTNIK DERMATOLOGII I VENEROLOGII 2010. [DOI: 10.25208/vdv939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Examination of 15765 women by PCR or culture method in the Southern Urals revealed genital mycoplasmas (M.hominis, M.genitalium, Ureaplasma spp.) in 25.8% of cases; they were more frequently met among socially non-adapted women (65,9% vs 17,2% in socially adapted group of women). Prescription of Josamycin (Wilprafen®), 500 mg TID for 10 days to women of both social groups provided the high level of antimicrobial effectiveness (92%) and favorable safety profile.
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