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Jung J, Biezen R, Goller JL, Hocking J, Chondros P, Manski-Nankervis J. The chlamydia care cascade of young people attending Australian general practices; a descriptive study to assess gaps in care. Sex Health 2023; 20:542-549. [PMID: 37778743 DOI: 10.1071/sh23096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Most chlamydia infections in Australia are diagnosed in general practice. The care cascade concept (testing, treatment and re-testing) can be utilised to explore the management of chlamydia infections. We explored the chlamydia care cascade among young people attending general practices in Australia. METHODS We analysed de-identified electronic medical record data for 16-29-year-old individuals attending 70 Australian general practices between January 2018 and December 2020. Five outcomes: (1) chlamydia testing, (2) positivity, (3) treatment, (4) re-testing and (5) re-infection were summarised as annual counts and proportions per calendar year. Logistic regression was used to investigate the association of age, gender and clinic location with each outcome. RESULTS During the study period, a total of 220909 clinical episodes involving 137358 16-29-year-olds were recorded. Of these episodes, 10.45% (n =23077, 95% CI 8.73-12.46) involved a chlamydia test. Of 1632 chlamydia cases, 88.79% (n =1449, 95% CI 86.37-90.82) had appropriate antibiotics recorded as defined in Australian sexually transmitted infection management guidelines. Of 183 chlamydia cases that did not have appropriate antibiotics recorded, 46.45% (n =85) had re-attended the clinic within 90days of diagnosis. Among 1068 chlamydia cases that had appropriate antibiotic recorded in 2018 and 2019, 22.57% (n =241, 95% CI 20.15-25.18) were re-tested within 6weeks to 4months of their diagnosis. One-third of episodes of chlamydia cases that did not have a re-test recorded (n =281) had re-attended the clinics within 4months of diagnosis. CONCLUSION Our study provides insight into chlamydia management by analysing general practice medical records, indicating substantial gaps in testing and re-testing for 16-29-year-olds. These data can also be used to explore the impact of future interventions to optimise chlamydia management.
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Affiliation(s)
- J Jung
- Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Vic., Australia; and Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia
| | - R Biezen
- Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Vic., Australia
| | - J L Goller
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Vic., Australia
| | - J Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Vic., Australia
| | - P Chondros
- Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Vic., Australia
| | - J Manski-Nankervis
- Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Vic., Australia
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Bittleston H, Hocking JS, Goller JL, Coombe J, Bateson D, Sweeney S, Fleming K, Huston WM. Is there a place for a molecular diagnostic test for pelvic inflammatory disease in primary care? An exploratory qualitative study. PLoS One 2022; 17:e0274666. [PMID: 36121793 PMCID: PMC9484633 DOI: 10.1371/journal.pone.0274666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 09/01/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
There is currently no test for pelvic inflammatory disease (PID) that is non-invasive and sufficiently sensitive and specific. Clinicians must therefore diagnose PID clinically, ruling out medical emergencies and conducting pelvic examinations where possible. While guidelines state that clinicians should be prepared to over-diagnose PID, it remains an under-diagnosed condition, with severe reproductive health impacts when left untreated. This research is the first to consider the perspectives of end-users on the development of a diagnostic test for PID.
Methods
Semi-structured live video feed online (Zoom) interviews were conducted with 11 clinicians and nine women (aged 18–30 years) in Australia to understand how a diagnostic test might be used, and what characteristics a test would need for it to be acceptable to clinicians and young women. Participants were recruited via researcher and university student networks. Reflexive thematic analysis was used to identify key themes relating to the acceptability and characteristics of a diagnostic test for PID.
Results
Seven general practitioners, four clinicians working in sexual health clinics, and nine young women (aged 21–27 years) were interviewed. Clinicians were aged between 31–58 years and were predominantly female. Clinicians recognised that the development of an accurate test to diagnose PID would be valuable to themselves and other clinicians, particularly those who lack experience diagnosing PID, and those working in certain settings, including emergency departments. They discussed how they might use a test to enhance their clinical assessment but highlighted that it would not replace clinical judgement. Clinicians also considered how a test would impact the patient experience and time to treatment, emphasising that it should be minimally invasive and have a quick turnaround time. Young women said a test would be acceptable if endorsed by a trustworthy clinician.
Conclusions
PID remains a challenging diagnosis. Development of a minimally invasive and sufficiently accurate diagnostic test would be acceptable to young women and benefit some clinicians, although no test would completely replace an experienced clinician’s judgement in making a PID diagnosis.
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Affiliation(s)
- Helen Bittleston
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- * E-mail: (HB); (WMH)
| | - Jane S. Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane L. Goller
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Bateson
- Family Planning NSW, Newington, New South Wales, Australia
- Specialty of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sally Sweeney
- Family Planning NSW, Newington, New South Wales, Australia
| | | | - Wilhelmina M. Huston
- Faculty of Science, School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
- * E-mail: (HB); (WMH)
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Zhang Y, Chen S, Chen X, Zhang H, Huang X, Xue X, Guo Y, Ruan X, Liu X, Deng G, Luo S, Gao J. Association Between Vaginal Gardnerella and Tubal Pregnancy in Women With Symptomatic Early Pregnancies in China: A Nested Case-Control Study. Front Cell Infect Microbiol 2022; 11:761153. [PMID: 35111691 PMCID: PMC8801712 DOI: 10.3389/fcimb.2021.761153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/20/2021] [Indexed: 12/01/2022] Open
Abstract
The early diagnosis and treatment of ectopic pregnancy (EP) remains a major challenge. Despite a known link between vaginal microbiota and female reproductive health, few studies have focused on the association between vaginal microbiota and pregnancy location. This nested case-control study aimed to characterize the vaginal microbiota in tubal pregnancy (TP) among symptomatic women in early pregnancy. Women with symptomatic early pregnancy of unknown location (PUL) were included in this study. 16S rDNA gene sequencing was performed to assess vaginal microbial diversity and relative abundance. Machine learning and multivariate logistic regression were also used to evaluate the association between Gardnerella and TP. The results indicate that the vaginal microbiome in TP was more diverse (Shannon, p < 0.05) and was different in composition to that of women with intrauterine pregnancy (IUP) (weighted Unifrac, R = 0.08, p = 0.01). The genus Gardnerella was significantly enriched in TP. The XGBoost analysis was able to classify Gardnerella-induced TP more reliably (AUC = 0.621). Moreover, after adjusting potential confounders, our results indicate a robust association between Gardnerella and TP (as a continuous variable, adjusted OR: 12.0, 95% CI: 2.1–67.4, p < 0.01; as a categorical variable (≥0.85%), and adjusted OR: 4.2, 95% CI: 2.0–8.8, p < 0.01). In conclusion, we found that higher virginal Gardnerella levels were associated with TP in women with symptomatic early pregnancy.
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Affiliation(s)
- Yingxuan Zhang
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Si Chen
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaofeng Chen
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huimin Zhang
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuge Huang
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaomeng Xue
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yinan Guo
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaofeng Ruan
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaorong Liu
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gaopi Deng
- Department of Gynecology, The First Affiliated Hospital of Guangzhou University of Chinese, Guangzhou, China
| | - Songping Luo
- Department of Gynecology, The First Affiliated Hospital of Guangzhou University of Chinese, Guangzhou, China
- *Correspondence: Songping Luom, ; Jie Gao,
| | - Jie Gao
- Department of Gynecology, The First Affiliated Hospital of Guangzhou University of Chinese, Guangzhou, China
- *Correspondence: Songping Luom, ; Jie Gao,
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Fan YY, Liu YN, Mao XT, Fu Y. The Prevalence of Ectopic Gestation: A Five-Year Study of 1273 Cases. Int J Gen Med 2021; 14:9657-9661. [PMID: 34934342 PMCID: PMC8684394 DOI: 10.2147/ijgm.s344648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aims to investigate the prevalence, related risk factors, manifestations, and management of ectopic pregnancy in the first hospital of the Jilin University over a five-year period. Methods A retrospective study of ectopic pregnancy was conducted in the First Hospital of the Jilin University between January 1, 2010 and December 31, 2014. The results were analyzed using simple descriptive statistics and reported as frequencies and percentages. Results The results revealed that out of 16,050 gynecological admissions to the hospital over the five-year period, there were 1273 ectopic pregnancies, with a prevalence rate of 7.93% of all gynecological admissions. The majority of these patients were aged 25-34 y and had a past history of abortion (61%) and uterine cavity surgery (38.6%), and a significant number were nulliparous (549, 43.1%). Bleeding accompanied by abdominal pain were the most common presenting complaints (65.2%). A unilateral salpingectomy was performed for most of these patients. Conclusion Ectopic pregnancy had notable morbidity over the five-year period under study, and a history of abortion and uterine cavity surgery were identified as associated risk factors that limited the future reproductive potential of nulliparous women. Therefore, targeted health education campaigns should be conducted in order to enlighten this group of women and the public at large.
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Affiliation(s)
- Yan-Yan Fan
- Department of Obstetrics and Gynecology, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
| | - Yi-Nan Liu
- Department of Otorhinolaryngology, Jilin Province Faw General Hospital, Changchun, 130011, People's Republic of China
| | - Xin-Tong Mao
- Department of Obstetrics and Gynecology, Beijing Hospital of Traditional Chinese Medicine, Beijing, 10010, People's Republic of China
| | - Yan Fu
- Department of Obstetrics and Gynecology, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
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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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Callan T, Debattista J, Berry B, Brown J, Woodcock S, Hocking JS, Huston WM. A retrospective cohort study examining STI testing and perinatal records demonstrates reproductive health burden of chlamydia and gonorrhea. Pathog Dis 2021; 78:5903269. [PMID: 32901793 DOI: 10.1093/femspd/ftaa052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/06/2020] [Indexed: 01/20/2023] Open
Abstract
Adverse reproductive health outcomes, such as pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility, have been associated with Chlamydia trachomatis and Neisseria gonorrhoea infections. These reproductive health outcomes could be complemented by measuring subsequent pregnancies to assess impact on fertility. The study design was a cohort study of women in Queensland (QLD), Australia, using data linkage methods to link chlamydia and/or gonorrhea testing records (including an unexposed group undergoing full blood count tests; 2000 and 2005) with the QLD Perinatal Registry (2000-2013). The cohort included 132 962 women, with 69 533 records of pregnancies. Women in the exposed group, with no prior pregnancy, had a reduced odds of a pregnancy during the follow up of the study (20-year-old (at 2005) aOR 0.91 95% CI 0.87-0.95, and 25-year-old aOR 0.71 95% CI 0.68-0.75). Women in the exposed group with a prior pregnancy had increased odds of pregnancy during the follow up of the study (20-year-old (at 2005) aOR 1.72 95% CI 1.59-1.86, and 25-year-old aOR 1.35 95% CI 1.26-1.45). Our data provides further evidence at a population level of the significant impact on reproductive outcomes associated with chlamydia and gonorrhea.
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Affiliation(s)
- Torrington Callan
- Faculty of Science, School of Mathematical and Physical Sciences, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
| | - Joseph Debattista
- Metro North Public Health Unit, Queensland Health, Bryden Street, Windsor, 4030, Australia
| | - Brooke Berry
- Pathology Queensland, Health Support Queensland, Queensland Health, Herston Road, Herston, 4006, Australia
| | - James Brown
- Faculty of Science, School of Mathematical and Physical Sciences, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
| | - Stephen Woodcock
- Faculty of Science, School of Mathematical and Physical Sciences, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie St, Carlton, Victoria 3053, Australia
| | - Wilhelmina M Huston
- Faculty of Science, School of Life Sciences, University of Technology Sydney, Broadway, NSW 2007, Australia
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Hua F, Li H, Xiong J, Huang S, Xiang J, Zhou X. Moxibustion for treating chronic pelvic inflammatory disease: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21925. [PMID: 32871930 PMCID: PMC7458211 DOI: 10.1097/md.0000000000021925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic pelvic inflammatory disease (CPID) is a difficult-to-treat gynaecological disorder, which has complex etiologies, among married women. In recent years, moxibustion has gradually shown its clinical advantages and been more and more widely used In China. The protocol is try to synthesize and assess the effectiveness and safety of moxibustion for patients with CPID. METHODS Seven databases as following: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, WangFang Database, Chinese Scientific Journal Database, Chinese Biomedical Literatures Database will be searched from their inception to May 2020. No restrictions about language and status. Study selection, data collection, and quality assessment will be respectively conducted by 2 researchers. Based on the heterogeneity test results, the fixed-effects or random-effects model will be selected to synthesize data. The effective rate, Pelvic inflammatory mass diameter and Pelvic fluid depth will be the primary outcomes. Patient reported outcome scale, visual analog scale, C-reactive protein, transforming growth factor β1 = transforming growth factor β, incidence of any adverse events will be the secondary outcomes. Revman 5.4 software will be implemented for data synthesis. Dichotomous data will be represented by risk ratio for efficacy and safety of CPID treated with moxibustion, while continuous data will be represented by mean difference with a 95% confidence interval. RESULTS The results of this study will be published in a peer-reviewed journal. This study will provide a comprehensive review of the available evidence for the treatment of moxibustion with CPID. CONCLUSIONS This study expects to provide high-quality, evidence-based recommendations on further treatment for clinical guidance of CPID. TRIAL REGISTRATION NUMBER CRD42020158744 in PROSPERO 2020.
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Affiliation(s)
- Fanghui Hua
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Honglian Li
- Haiyang people's Hospital of Shandong Province, Haiyang
| | - Jun Xiong
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Shouqiang Huang
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Jie Xiang
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Xiaohong Zhou
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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Ye X, Li Y, Wang L, Fang X, Kong J. All-in-one microfluidic nucleic acid diagnosis system for multiplex detection of sexually transmitted pathogens directly from genitourinary secretions. Talanta 2020; 221:121462. [PMID: 33076082 DOI: 10.1016/j.talanta.2020.121462] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 12/23/2022]
Abstract
Sexually transmitted infections are a serious public health concern worldwide, especially in young people. More than 30 pathogens can cause sexually transmitted diseases and co-infection often occurs. Therefore, the development of fast, low-cost and easy-to-use diagnostic screening methods is urgently needed for disease prevention and control. Herein, we established an all-in-one microfluidic nucleic acid diagnosis system, which could simultaneously detect Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis and Ureaplasma urealyticum directly from genitourinary secretions with minimal manual manipulations. This system integrated nucleic acid extraction, amplification, and detection on a single microfluidic chip and could be automatically performed in an integrated detection device. This novel diagnosis tool showed good detection limits, stability (coefficient of variation <6%), specificity (no cross-reaction with 23 other pathogens for each target) and resistance to interference by other substances and the diagnostic efficacy was similar to that of PCR. The turn-around time was reduced to 50 min from sample to answer with automated testing steps. This novel diagnosis tool has the advantages of highly integrated, automated, sample-to-answer detection, and could thus replace the traditional method. This could significantly improve the prevention and control of sexually transmitted diseases.
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Affiliation(s)
- Xin Ye
- Department of Chemistry and Institutes of Biomedical Sciences, Fudan University, Shanghai, 200433, PR China
| | - Yang Li
- Shanghai Suxin Biotechnology Co. Ltd and Suchuang Diagnostic Products Co., Ltd, Shanghai, 201318, PR China
| | - Lijuan Wang
- Shanghai Suxin Biotechnology Co. Ltd and Suchuang Diagnostic Products Co., Ltd, Shanghai, 201318, PR China
| | - Xueen Fang
- Department of Chemistry and Institutes of Biomedical Sciences, Fudan University, Shanghai, 200433, PR China.
| | - Jilie Kong
- Department of Chemistry and Institutes of Biomedical Sciences, Fudan University, Shanghai, 200433, PR China.
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9
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Goller JL, De Livera AM, Donovan B, Fairley CK, Low N, Hocking JS. Epididymitis rates in Australian hospitals 2009-2018: ecological analysis. Sex Transm Infect 2020; 97:387-390. [PMID: 32727927 DOI: 10.1136/sextrans-2020-054473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/01/2020] [Accepted: 07/06/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate rates of acute epididymitis diagnosed in Australian hospital settings. METHODS Yearly hospital admission and emergency department (ED) rates of epididymitis as primary diagnoses were calculated for 15-44-year-old men for three states (Victoria, New South Wales, Queensland) from 2009 to 2014 using population denominators. Zero inflated Poisson regression models were used to analyse variation in rates by year, age, and residential area. Additionally, we investigated national epididymitis admission trends from 2009 to 2018 using generalised linear models. RESULTS Between 2009 and 2014, there was a total of 7375 admissions and 17 281 ED presentations for which epididymitis was the main reason for care. Most epididymitis diagnoses (94.0% in admissions, 99.7% in EDs) were without abscess, and 2.5% of admissions were for chlamydial epididymitis. Almost a quarter (23.3%) of epididymitis diagnosed in EDs resulted in hospital admission. In 2014, the epididymitis rate per 100 000 men was 38.7 in admissions and 91.9 in EDs. Comparing 2014 with 2009, the overall epididymitis diagnosis rate increased in admissions by 32% (adjusted incident rate ratio (aIRR) 1.32, 95% CI 1.20 to 1.44) and in ED attendances by 40% (aIRR 1.40, 95% CI 1.31 to 1.49). By age, the highest rates were among men 35-44 years in admissions and men 15-24 years in EDs. National admission rates of epididymitis during 2009-2018 showed a similar pattern. CONCLUSION Rates of epididymitis diagnosis in hospital admission and ED presentations increased. Different age-related rates in these settings suggest a different aetiology or differential severity by age group.
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Affiliation(s)
- Jane L Goller
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alysha M De Livera
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Basil Donovan
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, New South Wales, Australia.,Sydney Sexual Health Centre, Sydney, New South Wales, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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10
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King AL, Stamatopoulos N. Concurrent Escherichia coli tubo-ovarian abscess and Campylobacter jejuni gastroenteritis: A case report. Case Rep Womens Health 2020; 26:e00192. [PMID: 32257830 PMCID: PMC7113427 DOI: 10.1016/j.crwh.2020.e00192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/10/2020] [Accepted: 03/23/2020] [Indexed: 11/06/2022] Open
Abstract
Haematogenous or direct spread of bacterial infection causing pelvic inflammatory disease of the upper female reproductive tract is uncommon. We report a diagnostically challenging case of a 41-year-old woman with a background of Stage 4 endometriosis presenting with fever, diarrhoea and abdominal pain with recent history of pyelonephritis. Initially managed for undifferentiated abdominal pain with unclear focus of infection, a broad range of investigations were undertaken. Laboratory samples confirmed the presence of Campylobacter jejuni and appropriate treatment for Campylobacteriosis was commenced. Despite treatment, her condition deteriorated and repeat radiological imaging revealed bilateral tubo-ovarian abscess requiring surgical drainage for control of severe sepsis. Sterile surgical samples of the abscess revealed Escherichia coli. This case adds to the growing body of evidence of the association between pelvic inflammatory disease, severe endometriosis and development of tubo-ovarian abscess. Sepsis associated with tubo-ovarian abscess has a mortality rate of up to 10%. Hence, we present this case to highlight severe endometriosis as a risk factor for disease and the need for prompt reassessment of the deteriorating woman with sepsis and pelvic pain to direct efforts to minimise morbidity and mortality. Few cases of tubo-ovarian abscess caused by haematogenous or direct spread of bacterial infection have been reported. Tubo-ovarian abscess in women with known endometriosis are 8 times more likely to require surgical intervention than women without endometriosis. Prompt recognition of the patients deterioration in the case reported led to additional investigations, prompt multidisciplinary management and a favourable outcome.
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Affiliation(s)
- Alison Laura King
- Department of Obstetrics and Gynaecology, Nepean Hospital, Penrith, Australia
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11
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Xia Q, Wang T, Xian J, Song J, Qiao Y, Mu Z, Liu H, Sun Z. Relation of Chlamydia trachomatis infections to ectopic pregnancy: A meta-analysis and systematic review. Medicine (Baltimore) 2020; 99:e18489. [PMID: 31895782 PMCID: PMC6946389 DOI: 10.1097/md.0000000000018489] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In a multitude of previous studies, Chlamydia trachomatis (CT) plays an important role in the occurrence of ectopic pregnancy (EP). However, the predictive value of CT infections in the occurrence of EP has not been estimated worldwide. We thus evaluated, by means of a meta-analysis, the current status of the association between CT infections with EP and the potential predictive value of CT infections in EP. METHODS We evaluated studies performed between the database construction time and August 2018 published in PubMed, the Cochrane Library, EMBASE, and the Web of Science (SCI). The relationship between CT and EP was calculated based upon the predetermined entry criteria for control group selection and the original data. The related articles were analyzed using a random-effects model, and the heterogeneity of the studies was assessed using the I index. Data were analyzed with the STATA 12.0 software. RESULTS Twenty-five studies that recruited 11960 patients were included in the present meta-analysis, and the relation of CT infections with EP were assessed. The association between CT infections and EP risk showed an odds ratio (OR) of 3.03, with a 95% confidence interval (CI) of 2.37 to 3.89. Our results showed that there was a statistically significant difference between the intervention and control groups. The prevalence of CT infections in EP was then calculated by a subgroup analysis: African (OR, 2.22; 95% CI, 1.14-4.31), European (OR, 3.16; 95% CI, 2.10-4.47), North American (OR, 3.07; 95% CI, 1.78-5.31), and Asian (OR, 3.39; 95% CI, 1.95-5.90). CONCLUSIONS From the results of numerous studies conducted on different continents, this meta-analysis showed a clear association between EP and prior CT infections, that is, CT infections increase the risk of EP occurrence.
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Affiliation(s)
- Qingchang Xia
- Master of Gynecology in Traditional Chinese Medicine, First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
| | - Tianqi Wang
- Medical history of Chinese medicine, Institute for Literature and Culture of Chinese Medicine Shandong University of Traditional Chinese Medicine
| | - Jin Xian
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine
| | - Jingyan Song
- Department of Gynecology of Traditional Chinese Medicine, College of Traditional Chinese Medicine
| | - Yan Qiao
- Master of Gynecology in Traditional Chinese Medicine, First College of Clinical Medicine
| | - Zhenni Mu
- Master of Gynecology in Traditional Chinese Medicine, College of Traditional Chinese Medicine
| | - Honggen Liu
- Master of Gynecology in Traditional Chinese Medicine, College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine
| | - Zhengao Sun
- Reproductive Medicine Center of Integration of Traditional and Western Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Jelocnik M. Chlamydiae from Down Under: The Curious Cases of Chlamydial Infections in Australia. Microorganisms 2019; 7:microorganisms7120602. [PMID: 31766703 PMCID: PMC6955670 DOI: 10.3390/microorganisms7120602] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/16/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022] Open
Abstract
In Australia, the most researched and perhaps the most successful chlamydial species are the human pathogen Chlamydia trachomatis, animal pathogens Chlamydia pecorum and Chlamydia psittaci. C. trachomatis remains the leading cause of sexually transmitted infections in Australians and trachoma in Australian Indigenous populations. C. pecorum is globally recognised as the infamous koala and widespread livestock pathogen, whilst the avian C. psittaci is emerging as a horse pathogen posing zoonotic risks to humans. Certainly not innocuous, the human infections with Chlamydia pneumoniae seem to be less prevalent that other human chlamydial pathogens (namely C. trachomatis). Interestingly, the complete host range for C. pecorum and C. psittaci remains unknown, and infections by other chlamydial organisms in Australian domesticated and wildlife animals are understudied. Considering that chlamydial organisms can be encountered by either host at the human/animal interface, I review the most recent findings of chlamydial organisms infecting Australians, domesticated animals and native wildlife. Furthermore, I also provide commentary from leading Australian Chlamydia experts on challenges and future directions in the Chlamydia research field.
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Affiliation(s)
- Martina Jelocnik
- Genecology Research Centre, University of the Sunshine Coast, Sippy Downs 4557, Australia
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13
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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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Lin HW, Wang PH, Lee CY, Huang JY, Yang SF, Hsiao YH. The Risk of Gynecologic and Urinary Tract Cancer with Pelvic Inflammatory Disease: A Population-Based Cohort Study. J Cancer 2019; 10:28-34. [PMID: 30662522 PMCID: PMC6329849 DOI: 10.7150/jca.29278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/05/2018] [Indexed: 11/14/2022] Open
Abstract
Purpose: The aim of the study was to determine the association between pelvic inflammatory disease (PID) and breast, colorectal, gynecologic and urinary tract cancer. Methods: The source of data was a longitudinal dataset compiled by the Longitudinal Health Insurance Database 2000 (LHID2000) which was collected by the National Health Insurance program. Cases of PID, at least two outpatient visits and one admission, were diagnosed from 2000 to 2013. The data for controls, age matched women who were not diagnosed with PID from 2000 to 2013, were also obtained. Results: A total of 47,333 PID cases and 189,332 for control group were included in the study. The ectopic pregnancy incidence rate (per 10000 person months) was 1.912 and 0.595 in the PID and control group, respectively; the rate ratio was 3.211 (confidence interval, CI = 2.931-3.519). There were significantly different in gynecologic cancers and urinary tract cancers between the PID and control group; the rate ratios (95% C.I.) were 1.903 (1.672-2.166) and 1.566 (1.211-2.025), respectively. Conclusion: Our study found that PID was associated with increased risks of gynecologic and urinary tract cancer but not colorectal or breast cancer. The information may lead to a strategy for cancer prevention and a reasonable healthcare usage through understanding PID epidemiology and controlling the inflammatory responses.
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Affiliation(s)
- Hui-Wen Lin
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Po-Hui Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chung-Yuan Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, Chiayi Chang Gung Memorial Hospital Chiayi, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yi-Hsuan Hsiao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
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Cassell JA. Highlights from this issue. Sex Transm Infect 2018. [DOI: 10.1136/sextrans-2018-053864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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