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Abed A, Torabi M, Mashreghi Z. Gonorrhea cluster detection in Manitoba, Canada: Spatial, temporal, and spatio-temporal analysis. Infect Dis Model 2024; 9:1045-1056. [PMID: 38974897 PMCID: PMC11222937 DOI: 10.1016/j.idm.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 07/09/2024] Open
Abstract
In Canada, Gonorrhea infection ranks as the second most prevalent sexually transmitted infection. In 2018, Manitoba reported an incidence rate three times greater than the national average. This study aims to investigate the spatial, temporal, and spatio-temporal patterns of Gonorrhea infection in Manitoba, using individual-level laboratory-confirmed administrative data provided by Manitoba Health from 2000 to 2016. Age and sex patterns indicate that females are affected by infections at younger ages compared to males. Moreover, there is an increase in repeated infections in 2016, accounting for 16% of the total infections. Spatial analysis at the 96 Manitoba regional health authority districts highlights significant positive spatial autocorrelation, demonstrating a clustered distribution of the infection. Northern districts of Manitoba and central Winnipeg were identified as significant clusters. Temporal analysis shows seasonal patterns, with higher infections in late summer and fall. Additionally, spatio-temporal analysis reveals clusters during high-risk periods, with the most likely cluster in the northern districts of Manitoba from January 2006 to June 2014, and a secondary cluster in central Winnipeg from June 2004 to November 2012. This study identifies that Gonorrhea infection transmission in Manitoba has temporal, spatial, and spatio-temporal variations. The findings provide vital insights for public health and Manitoba Health by revealing high-risk clusters and emphasizing the need for focused and localized prevention, control measures, and resource allocation.
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Affiliation(s)
- Amin Abed
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 0W3, Canada
| | - Mahmoud Torabi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 0W3, Canada
| | - Zeinab Mashreghi
- Department of Mathematics and Statistics, University of Winnipeg, Winnipeg, Manitoba, R3B 2E9, Canada
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2
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He D, Wang T, Ren W. Global burden of pelvic inflammatory disease and ectopic pregnancy from 1990 to 2019. BMC Public Health 2023; 23:1894. [PMID: 37784046 PMCID: PMC10544469 DOI: 10.1186/s12889-023-16663-y] [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: 10/17/2022] [Accepted: 08/30/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Pelvic inflammatory disease (PID) is a widespread female public problem worldwide. And it could lead to infertility, preterm labor, chronic pelvic pain, and ectopic pregnancy (EP) among reproductive-aged women. This study aimed to assess the global burden and trends as well as the chaning correlation between PID and EP in reproductive-aged women from 1990 to 2019. METHODS The data of PID and EP among reproductive-aged women (15 to 49 years old) were extracted from the Global Burden of Disease study 2019. The disease burden was assessed by calculating the case numbers and age-standardized rates (ASR). The changing trends and correlation were evaluated by calculating the estimated annual percentage changes (EAPC) and Pearson's correlation coefficient. RESULTS In 2019, the ASR of PID prevalence was 53.19 per 100,000 population with a decreasing trend from 1990 (EAPC: - 0.50), while the ASR of EP incidence was 342.44 per 100,000 population with a decreasing trend from 1990 (EAPC: - 1.15). Globally, PID and EP burdens changed with a strong positive correlation (Cor = 0.89) globally from 1990 to 2019. In 2019, Western Sub-Saharan Africa, Australasia, and Central Sub-Saharan Africa had the highest ASR of PID prevalence, and Oceania, Eastern Europe, and Southern Latin America had the highest ASR of EP incidence. Only Western Europe saw significant increasing PID trends, while Eastern Europe and Western Europe saw increasing EP trends. The highest correlations between PID and EP burden were observed in Burkina Faso, Laos, and Bhutan. General negative correlations between the socio-demographic index and the ASR of PID prevalence and the ASR of EP incidence were observed at the national levels. CONCLUSION PID and EP continue to be public health burdens with a strong correlation despite slightly decreasing trends detected in ASRs globally. Effective interventions and strategies should be established according to the local situation by policymakers.
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Affiliation(s)
- Deng He
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Tian Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
| | - Wu Ren
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
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3
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Syed Khaja AS, Zafar M, Alshammari AMA, Alharbi S, Alghaithi AMS, Alshahri B, Saleem M, Parveen N, Mohammed G. Assessment of Knowledge and Attitude Toward Pelvic Inflammatory Disease Among Women in Saudi Arabia. Cureus 2023; 15:e45013. [PMID: 37829952 PMCID: PMC10565605 DOI: 10.7759/cureus.45013] [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] [Accepted: 09/05/2023] [Indexed: 10/14/2023] Open
Abstract
Purpose Pelvic inflammatory disease (PID) is a serious infection of the female reproductive system that can lead to long-term complications such as infertility, chronic pelvic pain, and ectopic pregnancy. PID is also associated with an increased risk of HIV infection and other sexually transmitted infections (STIs). Early diagnosis and treatment of PID is crucial to prevent complications. Despite the severe consequences of PID, many women are unaware of the risks associated with this condition. This lack of awareness can lead to delayed diagnosis and treatment, increasing the risk of complications. This study explores women's knowledge and attitudes regarding PID. Methods A cross-sectional survey was conducted using a bilingual, community-based questionnaire, circulated using different social media platforms. A total of 239 participants were selected through convenient non-probability sampling from the public in the Kingdom of Saudi Arabia. The collected data was analyzed using SPSS Statistics version 26 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.). The chi-square test was applied to determine the differences between knowledge and attitude levels with participants' socio-demographic characteristics. A p-value <0.005 was considered statistically significant. Results Appropriate PID knowledge level was found only in 32% of the respondents and was significantly associated with the respondents' family history of the PID (p=0.025). A positive attitude toward PID/STI was also observed only in 36% of the study participants, which was significantly associated with the respondents' age (p˂0.001), marital status (p˂0.001), occupation (p˂ 0.001), past medical/surgical history (p=0.006), and family history of the PID (p˂0.009). Conclusion The present study reported average levels of appropriate knowledge and attitudes toward PID among female respondents, which could be further improved by increasing PID/STI awareness programs.
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Affiliation(s)
| | - Mubashir Zafar
- Department of Family and Community Medicine, University of Hail College of Medicine, Hail, SAU
| | | | - Saqer Alharbi
- Department of Pathology, University of Hail College of Medicine, Hail, SAU
| | | | - Badr Alshahri
- Department of Pathology, University of Hail College of Medicine, Hail, SAU
| | - Mohd Saleem
- Department of Pathology, University of Hail College of Medicine, Hail, SAU
| | - Nuzhat Parveen
- Department of Obstetrics and Gynecology, University of Hail College of Medicine, Hail, SAU
| | - Ghorashy Mohammed
- Department of Pathology, University of Hail College of Medicine, Hail, SAU
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Vaikundam Subramanian A, Nagarajan S, Santhana Kumarasamy P. Aftermath of Chlamydia Trachomatis - The Tip of an Iceberg in Female Reproductive Health. JOURNAL OF MOTHER AND CHILD 2023; 27:102-106. [PMID: 37843972 PMCID: PMC10578464 DOI: 10.34763/jmotherandchild.20232701.d-23-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/10/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE The magnitude of infertile couples worldwide was found to be 60-80 million. Genital infection due to Chlamydia trachomatis (C. trachomatis) is one of the most prevalent sexually transmitted infections (STIs) which may present as PID, leading to ectopic pregnancy, infertility or other adverse health outcomes. This study was done to assess the prevalence of C. trachomatis infections among female patients with infertility using real time PCR (RT-PCR) and to compare the findings of molecular testing with hysterosalpingography (HSG) and ultrasonography (USG). MATERIAL AND METHODS 50 endocervical swabs were collected from women of reproductive age group attending infertility clinic and stored at -80 ºC. DNA extraction was done with Helini bacterial mini spin kit and tested for C. trachomatis DNA by RT-PCR kit. RESULTS Of the 50 patients, 43 (86%) had primary infertility, and 7 (14%) had secondary infertility. Three (6%) were positive for C. trachomatis by RT-PCR. Two had primary infertility and one had secondary infertility. CONCLUSION Routine screening of C. trachomatis even in high-risk populations is not available in developing countries like India. The World Health Organization recommends syndromic approach for case management. Hence, a cost-effective, highly sensitive and specific test is the pressing priority in resource poor settings.
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Affiliation(s)
| | - Sruthi Nagarajan
- Department of Obstetrics and Gynecology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India
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Okoth K, Thomas GN, Nirantharakumar K, Adderley NJ. Risk of cardiometabolic outcomes among women with a history of pelvic inflammatory disease: a retrospective matched cohort study from the UK. BMC Womens Health 2023; 23:80. [PMID: 36823565 PMCID: PMC9948336 DOI: 10.1186/s12905-023-02214-5] [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: 07/16/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION To describe the incidence and prevalence of pelvic inflammatory disease (PID) and to estimate the risk of cardiometabolic outcomes among women with PID compared to women without PID. METHODS A UK retrospective matched cohort study using data from The Health Improvement Network. To assess cardiometabolic risk, women (aged ≥ 16 years) with PID were compared to matched controls without PID. Annual prevalence and incidence of PID (1998-2017) were estimated among women aged 16-50 years using annual cross-sectional and cohort analyses, respectively. Adjusted hazard ratios (aHR) and 95% CI for cardiometabolic outcomes were estimated using Cox proportional hazards models. The primary outcome was composite cardiovascular disease (CVD) and its subtypes, including ischaemic heart disease (IHD), heart failure (HF) and cerebrovascular disease. Secondary outcomes were hypertension, and type 2 diabetes mellitus (T2DM). RESULTS Among the 715 recorded composite CVD events, the crude incidence rate per 1000 person-years was 1.5 among women with history of PID compared to 1.3 in matched controls. Compared to women without PID (N = 73,769), the aHRs for cardiometabolic outcomes among women with PID (N = 19,804) were: composite CVD 1.10 (95% CI 0.93-1.30); IHD 1.19 (95% CI 0.93-1.53); cerebrovascular disease 1.13 (95% CI 0.90-1.43); HF 0.92 (95% CI 0.62-1.35) hypertension 1.10 (95% CI 1.01-1.20); and T2DM 1.25 (95% CI 1.09-1.43). The prevalence (per 10,000 population) of PID was 396.5 in 1998 and 237 in 2017. The incidence (per 10,000 person-years) of PID was 32.4 in 1998 and 7.9 in 2017. CONCLUSION There was no excess risk of composite CVD or its subtypes among women with history of PID compared to matched controls. Findings from our study suggest that history of PID was associated with an increased risk of hypertension and type 2 diabetes mellitus, two major risk factors for CVD. Additional studies are required to support these findings.
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Affiliation(s)
- Kelvin Okoth
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - G. Neil Thomas
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK. .,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK. .,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
| | - Nicola J. Adderley
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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6
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Frock-Welnak DN, Tam J. Identification and Treatment of Acute Pelvic Inflammatory Disease and Associated Sequelae. Obstet Gynecol Clin North Am 2022; 49:551-579. [PMID: 36122985 DOI: 10.1016/j.ogc.2022.02.019] [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: 10/14/2022]
Abstract
Pelvic inflammatory disease (PID) is an ascending polymicrobial infection of the upper female genital tract. The presentation of PID varies from asymptomatic cases to severe sepsis. The diagnosis of PID is often one of exclusion. Primary treatment for PID includes broad-spectrum antibiotics with coverage against gonorrhea, chlamydia, and common anaerobic and aerobic bacteria. If not clinically improved by antibiotics, percutaneous drain placement can promote efficient source control, as is often the case with large tubo-ovarian abscesses. Ultimately, even with treatment, PID can result in long-term morbidity, including chronic pelvic pain, infertility, and ectopic pregnancy.
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Affiliation(s)
- Danielle N Frock-Welnak
- Division of Academic Specialists in OB/GYN, University of Colorado School of Medicine, Aurora, CO, USA; Obstetrics and Gynecology, School of Medicine, CU Anschutz, Academic Office One, 12631 East 17th Avenue, 4th Floor, Aurora, CO 80045, USA.
| | - Jenny Tam
- Division of Academic Specialists in OB/GYN, Department of Obstetrics and Gynecology, University of Colorado, School of Medicine, CU Anschutz, Academic Office One, 12631 East 17th Avenue, 4th Floor, Aurora, CO 80045, USA
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Snow M, Vranich TM, Perin J, Trent M. Estimates of infertility in the United States: 1995-2019. Fertil Steril 2022; 118:560-567. [PMID: 35710598 DOI: 10.1016/j.fertnstert.2022.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To estimate the changes in infertility from 1995-2019 and determine the association of individual-level characteristics with fertility in the United States. DESIGN Cross-sectional study. SETTING Periodic data from 1995, 2002, 2006-2010, 2011-2013, 2013-2015, 2015-2017, and 2017-2019 cycles of the National Survey for Family Growth were used for this analysis. The National Survey for Family Growth comprises samples of the household-level population of women aged 15-44 years in the United States. PATIENT(S) Surveyed married and cohabiting women aged 15-44 years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The primary outcomes were the rates of infertility across subgroups of married or cohabiting women. For secondary outcomes, we performed bivariable and multivariable logistic regression models using the pooled sample (N = 53,764) to determine the association of individual-level characteristics, including age, parity, pelvic inflammatory disease treatment, education, income, race or ethnicity, and receipt of sexual and reproductive health services, with the odds of 12-month infertility among married or cohabiting women. RESULT(S) The fluctuations in infertility over this period, with a low of 5.8% in 2006-2010 and a high of 8.1% in 2017-2019, were not found to be statistically significant. This trend was present across nearly all subgroups. The multivariable model showed that women who were older and nulliparous, had fewer years of education, had lower income, were non-Hispanic black, or were not receiving sexual and reproductive health services were more likely to be infertile. CONCLUSION(S) This study confirms that parity, age, race, and education level continue to have an association with infertility. Further, the results demonstrate that access to sexual and reproductive health services plays an important role in infertility. In contrast to previous studies, infertility in the United States is no longer on the decline, and Hispanic ethnicity did not have a significant relationship with infertility. Given the rise of sexually transmitted infections and the persistent lack of access to sexual and reproductive health services, particularly among already vulnerable groups, the connection between access to care and infertility is ripe for further investigation.
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Affiliation(s)
- Morgan Snow
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Tyler M Vranich
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jamie Perin
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Maria Trent
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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8
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Munrós J, Vergara A, Bataller E, García-Lorenzo B, Álvarez-Martínez MJ, Bosch J. Performance of a rapid molecular test to detect Chlamydia trachomatis and Neisseria gonorrhoeae in women with pelvic inflammatory disease. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:377-380. [PMID: 35906032 DOI: 10.1016/j.eimce.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/17/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in women with pelvic inflammatory disease (PID) and the usefulness and cost-effectiveness of a rapid molecular test for the diagnosis and clinical management of PID. METHODS This observational study included 75 patients with mild-to-moderate PID (n=33), severe PID (n=29) and non-specific lower abdominal pain (NSAP) (n=13). CT/NG infections were analyzed using a standard and a rapid test. A cost analysis was carried out. RESULTS Samples of 19 patients (25.3%) were CT/NG positive. Concordance between rapid and standard tests was 100%. No significant differences were observed in the incidence of CT/NG in mild-to-moderate compared to severe PID. Costs differed according only to disease severity. CONCLUSIONS Rapid molecular tests could help with the diagnosis of PID in sexually active women in clinical settings in which a standard technique is not available.
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Affiliation(s)
- Jordina Munrós
- Department of Gynecology, Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain; Institut de Salut Global Barcelona - ISGlobal, Barcelona, Spain
| | - Andrea Vergara
- Institut de Salut Global Barcelona - ISGlobal, Barcelona, Spain; Department of Microbiology, Biomedical Diagnostic Center (CDB), Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
| | - Eduardo Bataller
- Department of Gynecology, Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Borja García-Lorenzo
- Assessment of Innovations and New Technologies Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Miriam José Álvarez-Martínez
- Institut de Salut Global Barcelona - ISGlobal, Barcelona, Spain; Department of Microbiology, Biomedical Diagnostic Center (CDB), Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Jordi Bosch
- Institut de Salut Global Barcelona - ISGlobal, Barcelona, Spain; Department of Microbiology, Biomedical Diagnostic Center (CDB), Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
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Scheidell JD, Dyer TV, Knittel AK, Caniglia EC, Thorpe LE, Troxel AB, Lejuez CW, Khan MR. Incarceration and Subsequent Pregnancy Loss: Exploration of Sexually Transmitted Infections as Mediating Pathways. J Womens Health (Larchmt) 2022; 31:242-251. [PMID: 34061656 PMCID: PMC8864438 DOI: 10.1089/jwh.2020.8980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Incarceration is linked to risk of sexually transmitted infection (STI) postrelease among women. There has been little examination of incarceration's association with related sexual and reproductive outcomes such as pelvic inflammatory disease (PID) and pregnancy loss, or the role of STI in this relationship and whether these relationships differ between Black and White women. Methods: Using data from the National Longitudinal Study of Adolescent to Adult Health, we examined cross-sectional associations between incarceration (Wave IV; 2007-2008; ages 24-34) and history of STI and PID (n = 5,968), and longitudinal associations between incarceration and later pregnancy loss in mid-adulthood (Wave V; 2016-2018; ages 34-43) among women who had ever been pregnant (n = 2,353); we estimated racial differences. Using causal mediation, we explored whether STI mediated associations with pregnancy loss. Results: Incarceration was associated with a history of STI (White adjusted prevalence ratio [APR]: 1.54, 95% confidence interval [CI] 1.14-2.06; Black APR: 1.26, 95% CI 1.02-1.56); the association between incarceration and PID was null among White women (APR: 0.99, 95% CI 0.47-2.09) and elevated among Black women (APR: 2.82, 95% CI 1.36-5.83). Prior incarceration did not appear associated with pregnancy loss among White women (APR: 1.01, 95% CI 0.70-1.45), but was associated among Black women (APR: 1.38, 95% CI: 0.97-1.97), with STI appearing to partially mediate. Conclusions: Pregnancy loss may be elevated among Black women who have been incarcerated, and incarceration-related increases in STI may account for some of this association.
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Affiliation(s)
- Joy D. Scheidell
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Address correspondence to: Joy D. Scheidell, PhD, MPH, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, 227 East 30th Street, Office 624, New York, NY 6402, USA
| | - Typhanye V. Dyer
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ellen C. Caniglia
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Lorna E. Thorpe
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Andrea B. Troxel
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Carl W. Lejuez
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Maria R. Khan
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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10
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Hillier SL, Bernstein KT, Aral S. A Review of the Challenges and Complexities in the Diagnosis, Etiology, Epidemiology, and Pathogenesis of Pelvic Inflammatory Disease. J Infect Dis 2021; 224:S23-S28. [PMID: 34396398 PMCID: PMC8365114 DOI: 10.1093/infdis/jiab116] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pelvic inflammatory disease (PID) is a syndrome that causes substantial morbidity, including chronic pelvic pain, to women globally. While limited data are available from low- and middle-income countries, national databases from the United States and Europe suggest that PID incidence may be decreasing but the rate of decrease may differ by the etiologic cause. Recent studies of women with PID have reported that fewer than half of women receiving a diagnosis of PID have gonococcal or chlamydial infection, while Mycoplasma genitalium, respiratory pathogens, and the constellation of bacteria associated with bacterial vaginosis may account for a substantial fraction of PID cases. The clinical diagnosis of PID is nonspecific, creating an urgent need to develop noninvasive tests to diagnose PID. Advances in serologic testing for Chlamydia trachomatis and Neisseria gonorrhoeae could advance epidemiologic studies, while the development of vaccines against these sexually transmitted pathogens could affect incident PID and associated morbidity.
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Affiliation(s)
- Sharon L Hillier
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh and the Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Kyle T Bernstein
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia, USA
| | - Sevgi Aral
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia, USA
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11
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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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12
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Cabello-Garcia E, Ferriols-Pérez E, Urpí-Tosar B, González-Comadran M. Pelvic inflammatory disease presenting 16 months after vaginal hysterectomy: A case report and literature review. Case Rep Womens Health 2021; 31:e00335. [PMID: 34178608 PMCID: PMC8214030 DOI: 10.1016/j.crwh.2021.e00335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 11/12/2022] Open
Abstract
Pelvic inflammatory disease after hysterectomy is rare and the underlying route of infection is highly heterogeneous. We report the case of a 52-year-old woman with a history of vaginal hysterectomy for uterine prolapse admitted to the emergency department with acute abdominal pain and fever. Vaginal discharge and pelvic tenderness were evident in the clinical examination. Ultrasound and computed tomography scans showed a cystic pelvic mass in contact with the vaginal cuff, suggesting the diagnosis of pelvic inflammatory disease. Laparoscopic examination revealed a bilateral tubo-ovarian abscess firmly attached and fistulized to the vaginal cuff, and after tubal removal and antibiotic coverage the patient had an optimal recovery. We performed a review of the case reports published on this subject, and concluded that pelvic inflammatory disease should not be excluded in patients with a history of hysterectomy when symptoms and findings are compatible. Pelvic inflammatory disease can develop in patients with previous hysterectomy. There are few cases reported in the literature of pelvic inflammatory disease after hysterectomy Pelvic inflammatory disease must be considered when symptoms suggest so, regardless of previous history of hysterectomy
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Affiliation(s)
- Eloy Cabello-Garcia
- Obstetrics and Gynecology Department, Consorci Parc de Salut MAR, Universitat Autònoma de Barcelona, Barcelona, Passeig marítim 25-29 (08003), Spain
| | - Elena Ferriols-Pérez
- Obstetrics and Gynecology Department, Consorci Parc de Salut MAR, Universitat Autònoma de Barcelona, Barcelona, Passeig marítim 25-29 (08003), Spain.,GRI-BCN, Barcelona Infertility Research Group, IMIM, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Dr. Aiguader Street, 88 (08003), Spain
| | - Berta Urpí-Tosar
- Obstetrics and Gynecology Department, Consorci Parc de Salut MAR, Universitat Autònoma de Barcelona, Barcelona, Passeig marítim 25-29 (08003), Spain
| | - Mireia González-Comadran
- Obstetrics and Gynecology Department, Consorci Parc de Salut MAR, Universitat Autònoma de Barcelona, Barcelona, Passeig marítim 25-29 (08003), Spain.,GRI-BCN, Barcelona Infertility Research Group, IMIM, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Dr. Aiguader Street, 88 (08003), Spain
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13
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Munrós J, Vergara A, Bataller E, García-Lorenzo B, Álvarez-Martínez MJ, Bosch J. Performance of a rapid molecular test to detect Chlamydia trachomatis and Neisseria gonorrhoeae in women with pelvic inflammatory disease. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00090-2. [PMID: 34024673 DOI: 10.1016/j.eimc.2021.03.016] [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: 01/21/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in women with pelvic inflammatory disease (PID) and the usefulness and cost-effectiveness of a rapid molecular test for the diagnosis and clinical management of PID. METHODS This observational study included 75 patients with mild-to-moderate PID (n=33), severe PID (n=29) and non-specific lower abdominal pain (NSAP) (n=13). CT/NG infections were analyzed using a standard and a rapid test. A cost analysis was carried out. RESULTS Samples of 19 patients (25.3%) were CT/NG positive. Concordance between rapid and standard tests was 100%. No significant differences were observed in the incidence of CT/NG in mild-to-moderate compared to severe PID. Costs differed according only to disease severity. CONCLUSIONS Rapid molecular tests could help with the diagnosis of PID in sexually active women in clinical settings in which a standard technique is not available.
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Affiliation(s)
- Jordina Munrós
- Department of Gynecology, Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain; Institut de Salut Global Barcelona - ISGlobal, Barcelona, Spain
| | - Andrea Vergara
- Institut de Salut Global Barcelona - ISGlobal, Barcelona, Spain; Department of Microbiology, Biomedical Diagnostic Center (CDB), Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
| | - Eduardo Bataller
- Department of Gynecology, Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Borja García-Lorenzo
- Assessment of Innovations and New Technologies Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Miriam José Álvarez-Martínez
- Institut de Salut Global Barcelona - ISGlobal, Barcelona, Spain; Department of Microbiology, Biomedical Diagnostic Center (CDB), Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Jordi Bosch
- Institut de Salut Global Barcelona - ISGlobal, Barcelona, Spain; Department of Microbiology, Biomedical Diagnostic Center (CDB), Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
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14
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Cowley G, Milne G, Teixeira da Silva E, Nakutum J, Rodrigues A, Vasileva H, Mabey D, Versteeg B, Last A. Prevalence of and risk factors for curable sexually transmitted infections on Bubaque Island, Guinea Bissau. Sex Transm Infect 2021; 97:51-55. [PMID: 32345631 PMCID: PMC7841470 DOI: 10.1136/sextrans-2019-054351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/05/2020] [Accepted: 03/17/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Complications from sexually transmitted infections (STIs) can result in severe morbidity and mortality. To date, no STI population studies have been conducted on the Bijagos Islands, Guinea Bissau. Our objective was to estimate the prevalence of and identify risk factors for Chlamydia trachomatis (Ct), Neisseria gonorrhoea (Ng), Mycoplasma genitalium (Mg), Trichomonas vaginalis (Tv) and Treponema pallidum (Tp) on Bubaque, the most populated island. METHODS A cross-sectional survey was conducted on the island of Bubaque among people aged 16-49 years. Participants were asked to answer a questionnaire on STI risk factors, to provide urine samples (men and women) and vaginal swabs (women) for PCR testing for Ct, Ng, Mg and Tv, and to provide dry blood spots for Tp particle agglutination assays. Data were analysed to estimate the prevalence of STIs and logistic regression was used to identify risk factors. RESULTS In total, 14.9% of participants were found to have a curable STI, with the highest prevalence being observed for Tv (5.9%) followed by Ct (3.8%), Ng (3.8%), Mg (1.9%) and Tp (0.8%). Significant risk factors for having any STI included being female, younger age and concurrent partnership. Having had a previous STI that was optimally treated was a protective factor. CONCLUSIONS This study demonstrates that there is a considerable burden of STI on the Bijagos Islands, stressing the need for diagnostic testing to facilitate early detection and treatment of these pathogens to stop ongoing transmission. Moreover, these results indicate the need to conduct further research into the STI burden on the Bijagos Islands to help inform and develop a national STI control strategy.
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Affiliation(s)
| | - Gregory Milne
- Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | | | - Jose Nakutum
- Hospital Regional de Bubaque Marcelino Banca, Bubaque, Guinea-Bissau
| | - Amabelia Rodrigues
- National Institute of Public Health, Guinea Bissau, Bissau, Guinea-Bissau
| | | | - David Mabey
- Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Bart Versteeg
- Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Last
- Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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15
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Elder HR, Gruber S, Willis SJ, Cocoros N, Callahan M, Flagg EW, Klompas M, Hsu KK. Can Machine Learning Help Identify Patients at Risk for Recurrent Sexually Transmitted Infections? Sex Transm Dis 2021; 48:56-62. [PMID: 32810028 PMCID: PMC10949112 DOI: 10.1097/olq.0000000000001264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A substantial fraction of sexually transmitted infections (STIs) occur in patients who have previously been treated for an STI. We assessed whether routine electronic health record (EHR) data can predict which patients presenting with an incident STI are at greatest risk for additional STIs in the next 1 to 2 years. METHODS We used structured EHR data on patients 15 years or older who acquired an incident STI diagnosis in 2008 to 2015 in eastern Massachusetts. We applied machine learning algorithms to model risk of acquiring ≥1 or ≥2 additional STIs diagnoses within 365 or 730 days after the initial diagnosis using more than 180 different EHR variables. We performed sensitivity analysis incorporating state health department surveillance data to assess whether improving the accuracy of identifying STI cases improved algorithm performance. RESULTS We identified 8723 incident episodes of laboratory-confirmed gonorrhea, chlamydia, or syphilis. Bayesian Additive Regression Trees, the best-performing algorithm of any single method, had a cross-validated area under the receiver operating curve of 0.75. Receiver operating curves for this algorithm showed a poor balance between sensitivity and positive predictive value (PPV). A predictive probability threshold with a sensitivity of 91.5% had a corresponding PPV of 3.9%. A higher threshold with a PPV of 29.5% had a sensitivity of 11.7%. Attempting to improve the classification of patients with and without repeat STIs diagnoses by incorporating health department surveillance data had minimal impact on cross-validated area under the receiver operating curve. CONCLUSIONS Machine algorithms using structured EHR data did not differentiate well between patients with and without repeat STIs diagnosis. Alternative strategies, able to account for sociobehavioral characteristics, could be explored.
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Affiliation(s)
- Heather R. Elder
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston
| | | | - Sarah J. Willis
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
| | - Noelle Cocoros
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
| | | | - Elaine W. Flagg
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
- Department of Medicine, Brigham and Women’s Hospital
| | - Katherine K. Hsu
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston
- Section of Pediatric Infectious Diseases, Boston University Medical Center, Boston, MA
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16
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Mann LM, Kreisel K, Llata E, Hong J, Torrone EA. Trends in Ectopic Pregnancy Diagnoses in United States Emergency Departments, 2006-2013. Matern Child Health J 2020; 24:213-221. [PMID: 31848926 DOI: 10.1007/s10995-019-02842-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Ectopic pregnancy is an important adverse pregnancy outcome that is under-surveilled. Emergency department (ED) data can help provide insight on the trends of ectopic pregnancy incidence in the United States (US). METHODS Data from the largest US all-payer ED database, the Healthcare Cost and Utilization Project Nationwide ED Sample, were used to identify trends in the annual ratio of ED ectopic pregnancy diagnoses to live births during 2006-2013, and the annual rate of diagnoses among all pregnancies during 2006-2010. Diagnoses were identified through International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes and CPT codes. RESULTS The overall ratio of weighted ED visits with an ectopic pregnancy diagnosis during 2006-2013 was 12.3 per 1000 live births. This ratio increased significantly from 2006 to 2013, from 11.0 to 13.7 ectopic pregnancies per 1000 live births, with no inflections in trend. The rate of ectopic pregnancy diagnoses per 1000 pregnancies increased during 2006-2010, from 7.0 to 8.3, with no inflections in trend. Females of all age groups experienced increases, though increases were less pronounced with increasing age. All geographic regions experienced increases, with increases being most pronounced in the Northeast. CONCLUSIONS Our study suggests that ED ectopic pregnancy diagnoses may be increasing in the US, although the drivers of these increases are not clear. Our results highlight the need for national measures of total pregnancies, stratified by pertinent demographic variables, to evaluate trends in pregnancy-related conditions among key populations.
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Affiliation(s)
- Laura M Mann
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 2500 Century Parkway NE, Rm 5209, MS E-33, Atlanta, GA, 30329, USA.
| | - Kristen Kreisel
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Eloisa Llata
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Jaeyoung Hong
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Elizabeth A Torrone
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
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17
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Wang L, Yang B, Tso LS, Zhao P, Ke W, Zhang X, Chen Z, Ren X, Liang C, Liao Y, Chen H, Huang J, Yang L. Prevalence of co-infections with other sexually transmitted infections in patients newly diagnosed with anogenital warts in Guangzhou, China. Int J STD AIDS 2020; 31:1073-1081. [PMID: 32842906 DOI: 10.1177/0956462419890496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prevalence of co-infecting sexually transmitted infections (STIs) among patients newly diagnosed with anogenital warts is under-reported. Our objective is to determine the prevalence of six common STIs, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), genital herpes (herpes simplex virus type 2 [HSV-2]), HIV, and syphilis for patients visiting a sexual health clinic in Guangzhou, China. Demographics, sexual health, and medical histories were collected at patient intake. Patients diagnosed with anogenital warts (N = 200) were invited to participate. We collected urine samples, and urethral, cervical, and rectal swabs to test for CT, NG, and MG, and blood samples for serological detection of HSV-2, syphilis, and HIV. Overall 49 (24.5%) had a co-infection (22.2% of men and 27.7% of women). All six STIs were observed among men: CT (6.8%), NG (3.4%), MG (5.1%), HIV (4.3%), HSV-2 (4.3%), and syphilis (1.7%). Women had fewer STIs, but at higher rates: CT (13.3%), MG (6.0%), and HSV-2 (8.4%). Individual men had up to two co-infections, while women had no more than one co-infection. Chlamydia was the most common STI. Patients aged 18-25 years (35.4%) had the highest prevalence. Although opportunistic screening is often applied for high-risk groups, expansion to patients with anogenital warts in all health-care settings would improve detection of problematic asymptomatic co-infections, thereby increasing China's capacity to contribute toward global surveillance systems.
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Affiliation(s)
- Liuyuan Wang
- Department of Dermatology and Venerology, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yang
- Department of Dermatology and Venerology, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Lai S Tso
- Department of Culture Studies and Oriental Languages, University of Oslo, Oslo, Norway.,Anthropology, Massachusetts Institute of Technology, Cambridge, MA, USA.,Center for Health and Human Development Studies, Sun Yat-sen University, Guangzhou, China
| | - Peizhen Zhao
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Wujian Ke
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Xiaohui Zhang
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Zhengyu Chen
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Xuqi Ren
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Chunmei Liang
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Yuying Liao
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Huiru Chen
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Jinmei Huang
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Ligang Yang
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
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18
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Viveros-Carreño DA, Grillo-Ardila CF, Amaya-Guio J. Removal of intrauterine device as part of the treatment for women with pelvic inflammatory disease. Hippokratia 2020. [DOI: 10.1002/14651858.cd013618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Carlos F. Grillo-Ardila
- Department of Obstetrics and Gynecology; Faculty of Medicine, Universidad Nacional de Colombia; Bogota Colombia
| | - Jairo Amaya-Guio
- Department of Obstetrics and Gynecology; Faculty of Medicine, Universidad Nacional de Colombia; Bogota Colombia
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19
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Chemaitelly H, Majed A, Abu-Hijleh F, Blondeel K, Matsaseng TC, Kiarie J, Toskin I, Abu-Raddad LJ. Global epidemiology of Neisseria gonorrhoeae in infertile populations: systematic review, meta-analysis and metaregression. Sex Transm Infect 2020; 97:157-169. [PMID: 32423944 PMCID: PMC7892374 DOI: 10.1136/sextrans-2020-054515] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/14/2020] [Indexed: 01/04/2023] Open
Abstract
Objective To provide an in-depth systematic assessment of the global epidemiology of gonorrhoea infection in infertile populations. Methods A systematic literature review was conducted up to 29 April 2019 on international databases and WHO regional databases, and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All prevalence measures of gonorrhoea infection among infertile populations, based on primary data, qualified for inclusion. Infertile populations were broadly defined to encompass women/men undergoing infertility evaluation or treatment (infertility clinic attendees and partners). Pooled mean prevalence by relevant strata was estimated using random-effects meta-analysis. Associations with prevalence and sources of heterogeneity were explored using metaregression. Risk of bias was assessed using four quality domains. Findings A total of 147 gonorrhoea prevalence studies were identified from 56 countries. The pooled mean prevalence of current gonorrhoea infection was estimated globally at 2.2% (95% CI 1.3% to 3.2%), with the highest prevalence in Africa at 5.0% (95% CI 1.9% to 9.3%). The mean prevalence was higher for populations with tubal factor infertility (3.6%, 95% CI 0.9%–7.7%) and mixed cause and unexplained infertility (3.6%, 95% CI 0.0% to 11.6%) compared with other diagnoses, such as ovarian and non-tubal infertility (0.1%, 95% CI 0.0% to 0.8%), and for secondary (2.5%, 95% CI 0.2% to 6.5%) compared with primary (0.5%, 95% CI 0.0% to 1.7%) infertility. Metaregression identified evidence of variations in prevalence by region and by infertility diagnosis, higher prevalence in women than men and a small-study effect. There was a trend of declining prevalence by about 3% per year over the last four decades (OR=0.97, 95% CI 0.95 to 0.99). Conclusions Gonorrhoea prevalence in infertile populations is several folds higher than that in the general population, with even higher prevalence in women with tubal factor infertility and in individuals with secondary infertility. These findings support the potential role of gonorrhoea in infertility and suggest that some infertility is possibly preventable by controlling gonorrhoea transmission. PROSPERO registration number CRD42018102934.
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Affiliation(s)
- Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
| | - Alzahraa Majed
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
| | - Farah Abu-Hijleh
- Department of Public Health, College of Health Sciences, Academic Quality Affairs Office, QU Health, Qatar University, Doha, Qatar
| | - Karel Blondeel
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Thabo Christopher Matsaseng
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Department of Obstetrics & Gynaecology, Stellenbosch University, Stellenbosch, South Africa
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar .,Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA
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20
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The association between sociodemographic, hormonal, tubo-ovarian factors and bacterial count in Chlamydia and Mycoplasma infections with infertility. Saudi J Biol Sci 2019; 26:20-23. [PMID: 30622402 PMCID: PMC6318781 DOI: 10.1016/j.sjbs.2016.11.006] [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: 04/26/2016] [Revised: 10/26/2016] [Accepted: 11/06/2016] [Indexed: 11/21/2022] Open
Abstract
Aim: To determine if there is an association between the Chlamydia and Mycoplasma infections with socio-demographic and clinical factors, and also with infertility. Methods: We conducted a study on 100 infertile married women and 100 control group, and collected data on the socio-demographic, hormonal and tubo-ovarian factors. The results of the endocervical swabs were analyzed for Mycoplasma and Chlamydia infection, the bacterial counts were also determined. Results: The percentage positivity to infection was significantly more among the infertile group compared to the control group, and also significantly more among the age group <30 years old. The positivity for infection with Chlamydia and/or Mycoplasma was significantly correlated with age, history of irregular menstruation, and history of previous abortion. Further sub-analysis of the infertile group showed that positivity to Chlamydia and/or Mycoplasma infection was significantly correlated to hormonal factors, ovarian factors, irregular menstruation, and previous abortion. Regression analysis showed that hormonal, ovarian factors, and irregular menstruation were the most significant factors in the positivity to Chlamydia and Mycoplasma infection. Bacterial count was significantly correlated with age, history of irregular menstruation, and history of previous abortion. Conclusion: Infection to Chlamydia and Mycoplasma is associated to younger age (⩽30 years old), and occurs in the infertile women. There is an interplay between infection in younger women, irregular menstruation, hormonal, and tubo-ovarian factors with infertility. Bacterial count was significantly correlated with age, history of irregular menstruation, and history of previous abortion.
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21
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Garton L, Dyda A, Guy R, Silver B, McGregor S, Hengel B, Rumbold A, Taylor-Thomson D, Knox J, Maher L, Kaldor J, Ward J. High chlamydia and gonorrhoea repeat positivity in remote Aboriginal communities 2009-2011: longitudinal analysis of testing for re-infection at 3 months suggests the need for more frequent screening. Sex Health 2018; 13:568-574. [PMID: 27764650 DOI: 10.1071/sh16025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/15/2016] [Indexed: 11/23/2022]
Abstract
Background Extremely high rates of diagnosis of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been recorded in remote communities across northern and central Australia. Re-testing at 3 months, after treatment administered, of CT or NG is recommended to detect repeat infections and prevent morbidity and ongoing transmission. METHODS Baseline CT and NG laboratory data (2009-2010) from 65 remote health services participating in a cluster randomised trial was used to calculate the proportion of individuals re-tested after an initial CT or NG diagnosis at <2 months (not recommended), 2-4 months (recommended) and 5-12 months and the proportion with repeat positivity on re-test. To assess if there were difference in re-testing and repeat positivity by age group and sex, t-tests were used. RESULTS There was a total of 2054 people diagnosed with CT and/or NG in the study period; 14.9% were re-tested at 2-4 months, 26.9% at 5-12 months, a total of 41.8% overall. Re-testing was higher in females than in males in both the 2-4-month (16.9% v. 11.5%, P<0.01) and 5-12-month (28.9% v. 23.5%, P=0.01) periods. Women aged 25-29 years had a significantly higher level of re-testing 5-12 months post-diagnosis than females aged 16-19 years (39.8% v. 25.4%, P<0.01). There was a total of 858 people re-tested at 2-12 months and repeat positivity was 26.7%. There was higher repeat NG positivity than repeat CT positivity (28.8% v. 18.1%, P<0.01). CONCLUSIONS Just under half the individuals diagnosed with CT or NG were re-tested at 2-12 months post-diagnosis; however, only 15% were re-tested in the recommended time period of 2-4 months. The higher NG repeat positivity compared with CT is important, as repeat NG infections have been associated with higher risk of pelvic inflammatory disease-related hospitalisation. Findings have implications for clinical practice in remote community settings and will inform ongoing sexual health quality improvement programs in remote community clinics.
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Affiliation(s)
- Linda Garton
- Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia
| | - Amalie Dyda
- Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - Bronwyn Silver
- Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia
| | - Skye McGregor
- Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - Belinda Hengel
- Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - Alice Rumbold
- Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia
| | - Debbie Taylor-Thomson
- Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia
| | - Janet Knox
- Lismore Sexual Health Service, New South Wales Health, Sydney, NSW 2480, Australia
| | - Lisa Maher
- Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - John Kaldor
- Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5001, Australia
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Goller JL, De Livera AM, Guy RJ, Low N, Donovan B, Law M, Kaldor JM, Fairley CK, Hocking JS. Rates of pelvic inflammatory disease and ectopic pregnancy in Australia, 2009-2014: ecological analysis of hospital data. Sex Transm Infect 2018; 94:534-541. [PMID: 29720385 DOI: 10.1136/sextrans-2017-053423] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/08/2018] [Accepted: 04/07/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To analyse yearly rates of pelvic inflammatory disease (PID) and ectopic pregnancy (EP) diagnosed in hospital settings in Australia from 2009 to 2014. METHODS We calculated yearly PID and EP diagnosis rates in three states (Victoria, New South Wales, Queensland) for women aged 15-44 years using hospital admissions and emergency department (ED) attendance data, with population and live birth denominators. We stratified PID diagnoses as chlamydial-related or gonorrhoeal-related (Chlamydia trachomatis (CT)-related or Neisseria gonorrhoeae (NG)-related), acute, unspecified and chronic, and analysed variations by year, age and residential area using Poisson regression models. RESULTS For PID, the rate of all admissions in 2014 was 63.3 per 100 000 women (95% CI 60.8 to 65.9) and of all presentations in EDs was 97.0 per 100 000 women (95% CI 93.9 to 100.2). Comparing 2014 with 2009, the rate of all PID admissions did not change, but the rate of all presentations in EDs increased (adjusted incidence rate ratio (aIRR) 1.34, 95% CI 1.24 to 1.45), and for admissions by PID category was higher for CT-related or NG-related PID (aIRR 1.73, 95% CI 1.31 to 2.28) and unspecified PID (aIRR 1.09, 95% CI 1.00 to 1.19), and lower for chronic PID (aIRR 0.84, 95% CI 0.74 to 0.95). For EP, in 2014 the rate of all admissions was 17.4 (95% CI 16.9 to 17.9) per 1000 live births and of all ED presentations was 15.6 (95% CI 15.1 to 16.1). Comparing 2014 with 2009, the rates of all EP admissions (aIRR 1.06, 95% CI 1.04 to 1.08) and rates in EDs (aIRR 1.24, 95% CI 1.18 to 1.31) were higher. CONCLUSIONS PID and EP remain important causes of hospital admissions for female STI-associated complications. Hospital EDs care for more PID cases than inpatient departments, particularly for young women. Updated primary care data are needed to better understand PID epidemiology and healthcare usage.
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Affiliation(s)
- Jane L Goller
- Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Alysha M De Livera
- Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Rebecca J Guy
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Law
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - John M Kaldor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University and Melbourne Sexual Health Centre, Carlton, Victoria, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, University of Melbourne, Parkville, Victoria, Australia
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Kreisel K, Flagg EW, Torrone E. Trends in pelvic inflammatory disease emergency department visits, United States, 2006-2013. Am J Obstet Gynecol 2018; 218:117.e1-117.e10. [PMID: 29045851 DOI: 10.1016/j.ajog.2017.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/25/2017] [Accepted: 10/06/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pelvic inflammatory disease is a female genital tract disorder with severe reproductive sequelae. Because of the difficulties in diagnosing pelvic inflammatory disease, it is not a reportable condition in many states. Females seeking care in emergency departments are a sentinel population for pelvic inflammatory disease surveillance. OBJECTIVE The objective of the study was to determine trends in diagnoses of acute pelvic inflammatory disease in a nationally representative sample of emergency departments. STUDY DESIGN All emergency department visits among females aged 15-44 years with an International Classification of Diseases, ninth revision, Clinical Modification diagnosis code indicating pelvic inflammatory disease during 2006-2013 were assessed from the HealthCare Utilization Project Nationwide Emergency Department Sample. Total and annual percentage changes in the proportion of pelvic inflammatory disease emergency department visits were estimated using trend analyses. RESULTS While the number of emergency department visits among females aged 15-44 years during 2006-2013 increased (6.5 million to 7.4 million), the percentage of visits due to pelvic inflammatory disease decreased from 0.57% in 2006 to 0.41% in 2013 (total percentage change, -28.4%; annual percent change, -4.3%; 95% confidence interval, -5.7% to -2.9%). The largest decreases were among those aged 15-19 years (total percent change, -40.6%; annual percentage change, -6.6%; 95% confidence interval, -8.6% to -4.4%) and living in the South (total percentage change, -38.0%; annual percentage change, -6.2%; 95% confidence interval, -7.8% to -4.6%). Females aged 15-19 years who lived in the South had a 47.9% decrease in visits due to pelvic inflammatory disease (annual percentage change, -8.4%, 95% confidence interval, -10.4 to -6.5). Patients living in ZIP codes with the lowest median income (<$38,000) had the highest percent of visits with a pelvic inflammatory disease diagnosis; the smallest declines over time were in patients living in ZIP codes with the highest median income (i.e., >$64,000, total percent change, -24.4%; annual percent change, -3.8%; 95% confidence interval, -5.2% to -2.4%). The percentage of emergency department visits due to pelvic inflammatory disease was highest among patients not charged for their visit, self-paying, or those covered by Medicaid, with total percentage changes in these 3 groups of -27.8%, -30.7%, and -35.1%, respectively. Patients with Medicaid coverage had the largest decrease in visits with a diagnosis of pelvic inflammatory disease (total percent change, -35.1%; annual percent change, -5.8%; 95% confidence interval, -7.2% to -4.3%). CONCLUSION Nationally representative data indicate the percentage of emergency department visits with a pelvic inflammatory disease diagnosis decreased during 2006-2013 among females aged 15-44 years, primarily driven by decreased diagnoses of pelvic inflammatory disease among females aged 15-19 years and among women living in the southern United States. Despite declines, a large number of females of reproductive age are receiving care for pelvic inflammatory disease in emergency departments. Patients with lower median income and no or public health insurance status, which may decrease access to and use of health care services, consistently had the highest percentage of emergency department visits due to pelvic inflammatory disease. Future research should focus on obtaining a better understanding of factors influencing trends in pelvic inflammatory disease diagnoses and ways to address the challenges surrounding surveillance for this condition.
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Affiliation(s)
- Kristen Kreisel
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Atlanta, GA.
| | - Elaine W Flagg
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Atlanta, GA
| | - Elizabeth Torrone
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Atlanta, GA
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Detection of genital chlamydial and gonococcal infection using urine samples: A community-based study from India. J Infect Public Health 2017; 11:75-79. [PMID: 28506737 DOI: 10.1016/j.jiph.2017.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 04/02/2017] [Accepted: 04/28/2017] [Indexed: 11/21/2022] Open
Abstract
Sexually transmitted infections (STI) have a major impact on the reproductive health of women. Among the different etiological agents of STIs, Chlamydia trachomatis and Neisseria gonorrhoeae are the main bacterial pathogens that cause sexually transmitted infections in women. The aim of the study was to estimate the prevalence of genital chlamydial and gonococcal infection among women in the age group of 18-65 years from a community-based setting. A community-based cross-sectional study was performed using the archived urine samples (n=811) of women in the age group of 18-65 years for C. trachomatis and N. gonorrhoeae using a multiplex conventional Polymerase Chain Reaction (PCR). Out of 811 samples tested in the present study, 2 (0.24%) were tested positive for C. trachomatis and none were positive for N. gonorrhoeae. The study demonstrates the very low prevalence of C. trachomatis and N. gonorrhoeae infection in a rural community. For large population-based screening, urine samples were observed to be more socially acceptable and cost-effective.
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25
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Caddy S, Yudin MH, Hakim J, Money DM. Pratiques optimales en vue de minimiser le risque d'infection au moment de l'insertion d'un dispositif intra-utérin. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S407-S417. [PMID: 28063552 DOI: 10.1016/j.jogc.2016.09.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Price MJ, Ades AE, Soldan K, Welton NJ, Macleod J, Simms I, DeAngelis D, Turner KM, Horner PJ. The natural history of Chlamydia trachomatis infection in women: a multi-parameter evidence synthesis. Health Technol Assess 2016; 20:1-250. [PMID: 27007215 DOI: 10.3310/hta20220] [Citation(s) in RCA: 256] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The evidence base supporting the National Chlamydia Screening Programme, initiated in 2003, has been questioned repeatedly, with little consensus on modelling assumptions, parameter values or evidence sources to be used in cost-effectiveness analyses. The purpose of this project was to assemble all available evidence on the prevalence and incidence of Chlamydia trachomatis (CT) in the UK and its sequelae, pelvic inflammatory disease (PID), ectopic pregnancy (EP) and tubal factor infertility (TFI) to review the evidence base in its entirety, assess its consistency and, if possible, arrive at a coherent set of estimates consistent with all the evidence. METHODS Evidence was identified using 'high-yield' strategies. Bayesian Multi-Parameter Evidence Synthesis models were constructed for separate subparts of the clinical and population epidemiology of CT. Where possible, different types of data sources were statistically combined to derive coherent estimates. Where evidence was inconsistent, evidence sources were re-interpreted and new estimates derived on a post-hoc basis. RESULTS An internally coherent set of estimates was generated, consistent with a multifaceted evidence base, fertility surveys and routine UK statistics on PID and EP. Among the key findings were that the risk of PID (symptomatic or asymptomatic) following an untreated CT infection is 17.1% [95% credible interval (CrI) 6% to 29%] and the risk of salpingitis is 7.3% (95% CrI 2.2% to 14.0%). In women aged 16-24 years, screened at annual intervals, at best, 61% (95% CrI 55% to 67%) of CT-related PID and 22% (95% CrI 7% to 43%) of all PID could be directly prevented. For women aged 16-44 years, the proportions of PID, EP and TFI that are attributable to CT are estimated to be 20% (95% CrI 6% to 38%), 4.9% (95% CrI 1.2% to 12%) and 29% (95% CrI 9% to 56%), respectively. The prevalence of TFI in the UK in women at the end of their reproductive lives is 1.1%: this is consistent with all PID carrying a relatively high risk of reproductive damage, whether diagnosed or not. Every 1000 CT infections in women aged 16-44 years, on average, gives rise to approximately 171 episodes of PID and 73 of salpingitis, 2.0 EPs and 5.1 women with TFI at age 44 years. CONCLUSIONS AND RESEARCH RECOMMENDATIONS The study establishes a set of interpretations of the major studies and study designs, under which a coherent set of estimates can be generated. CT is a significant cause of PID and TFI. CT screening is of benefit to the individual, but detection and treatment of incident infection may be more beneficial. Women with lower abdominal pain need better advice on when to seek early medical attention to avoid risk of reproductive damage. The study provides new insights into the reproductive risks of PID and the role of CT. Further research is required on the proportions of PID, EP and TFI attributable to CT to confirm predictions made in this report, and to improve the precision of key estimates. The cost-effectiveness of screening should be re-evaluated using the findings of this report. FUNDING The Medical Research Council grant G0801947.
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Affiliation(s)
- Malcolm J Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - A E Ades
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kate Soldan
- Public Health England (formerly Health Protection Agency), Colindale, London, UK
| | - Nicky J Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - John Macleod
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Ian Simms
- Public Health England (formerly Health Protection Agency), Colindale, London, UK
| | - Daniela DeAngelis
- Public Health England (formerly Health Protection Agency), Colindale, London, UK.,Medical Research Council Biostatistics Unit, Cambridge, UK
| | | | - Paddy J Horner
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,Bristol Sexual Health Centre, University Hospital Bristol NHS Foundation Trust, Bristol, UK
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Gabster A, Mohammed DY, Arteaga GB, Castillero O, Mojica N, Dyamond J, Varela M, Pascale JM. Correlates of Sexually Transmitted Infections among Adolescents Attending Public High Schools, Panama, 2015. PLoS One 2016; 11:e0163391. [PMID: 27657700 PMCID: PMC5033244 DOI: 10.1371/journal.pone.0163391] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 09/06/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) are common in adolescents worldwide. Vulnerability to STIs increases with risky sexual practices. This study described the sexual practices, estimated the prevalence of STIs, and identified correlates associated with STIs among participants, enrolled in public high schools, in the District of Panama, Panama. METHODS A cross sectional study, using multistage cluster sampling, was conducted among participants, aged 14-18 years, enrolled in public high schools, in the District of Panama, Panama City, Panama, from August to November, 2015. Participants completed a self-administered questionnaire and provided biological samples. The samples of those reporting sexual activity (oral, vaginal, and/or anal intercourse) were tested for STIs. Odds ratios were used to identify correlates of STIs in this population. RESULTS A total of 592 participants were included, of whom, 60.8% reported a history of sexual activity, and 24.4% tested positive for least one STI. STIs were more common in female participants, (33.5%). Compared to those without STIs, higher proportions of those with at least one STI reported ≥3 sexual partners in their lifetime (60.0%) and current sexual activity (76.3%). In the multivariable model, correlates of STI included female participants (Adjusted Odds Ratio (AOR) = 5.8, 95% Confidence Interval (CI) 2.3-14.6) and those who engaged in sexual intercourse with casual partners (AOR = 3.0, 95% CI: 1.2-7.5). CONCLUSIONS We report a high STI prevalence among adolescents attending public high schools, in the District of Panama. Reported risky sexual practices were common and correlated with STIs. Female participants and those reporting sexual intercourse with casual partners were more likely test positive for at least one STI. Our study identified a need for effective interventions to curb future infections in this population.
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Affiliation(s)
- Amanda Gabster
- Departmento de Genómica y Proteómica, Instituto Conmemorativo Gorgas de Estudios de la Salud, Calle 35, Ave Justo Arosemena, Panamá, Panamá
- * E-mail:
| | - Debbie Y. Mohammed
- William Paterson University, 300 Pompton Rd, Wayne, New Jersey, 07470, United States of America
- St. Michael’s Medical Center, 111 Central Avenue, Newark, New Jersey, 07102, United States of America
| | | | - Omar Castillero
- Departmento de Genómica y Proteómica, Instituto Conmemorativo Gorgas de Estudios de la Salud, Calle 35, Ave Justo Arosemena, Panamá, Panamá
| | - Nataly Mojica
- Facultad de Medicina, Universidad de Panamá, Transístmica, Panamá, Panamá
| | - José Dyamond
- Departmento de Genómica y Proteómica, Instituto Conmemorativo Gorgas de Estudios de la Salud, Calle 35, Ave Justo Arosemena, Panamá, Panamá
| | - Maria Varela
- Hospital Santo Tomás, Calle 37 Este, Panamá, Panamá
| | - Juan Miguel Pascale
- Departmento de Genómica y Proteómica, Instituto Conmemorativo Gorgas de Estudios de la Salud, Calle 35, Ave Justo Arosemena, Panamá, Panamá
- Facultad de Medicina, Universidad de Panamá, Transístmica, Panamá, Panamá
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Price MJ, Ades AE, Welton NJ, Simms I, Macleod J, Horner PJ. Proportion of Pelvic Inflammatory Disease Cases Caused by Chlamydia trachomatis: Consistent Picture From Different Methods. J Infect Dis 2016; 214:617-24. [PMID: 27260786 PMCID: PMC4957435 DOI: 10.1093/infdis/jiw178] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 04/27/2016] [Indexed: 11/27/2022] Open
Abstract
Background. Pelvic inflammatory disease (PID) is a leading cause of both tubal factor infertility and ectopic pregnancy. Chlamydia trachomatis is an important risk factor for PID, but the proportion of PID cases caused by C. trachomatis is unclear. Estimates of this are required to evaluate control measures. Methods. We consider 5 separate methods of estimating age-group-specific population excess fractions (PEFs) of PID due to C. trachomatis, using routine data, surveys, case-control studies, and randomized controlled trials, and apply these to data from the United Kingdom before introduction of the National Chlamydia Screening Programme. Results. As they are informed by randomized comparisons and national exposure and outcome estimates, our preferred estimates of the proportion of PID cases caused by C. trachomatis are 35% (95% credible interval [CrI], 11%–69%) in women aged 16–24 years and 20% (95% CrI, 6%–38%) in women aged 16–44 years in the United Kingdom. There is a fair degree of consistency between adjusted estimates of PEF, but all have wide 95% CrIs. The PEF decreases from 53.5% (95% CrI, 15.6%–100%) in women aged 16–19 years to 11.5% (95% CrI, 3.0%–25.7%) in women aged 35–44 years. Conclusions. The PEFs of PID due to C. trachomatis decline steeply with age by a factor of around 5-fold between younger and older women. Further studies of the etiology of PID in different age groups are required.
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Affiliation(s)
- Malcolm J Price
- Institute of Applied Health Research, University of Birmingham
| | - A E Ades
- School of Social and Community Medicine, University of Bristol
| | - Nicky J Welton
- School of Social and Community Medicine, University of Bristol
| | - Ian Simms
- Bristol Sexual Health Centre, University Hospital Bristol NHS Foundation Trust, United Kingdom
| | - John Macleod
- School of Social and Community Medicine, University of Bristol
| | - Paddy J Horner
- School of Social and Community Medicine, University of Bristol Public Health England, London
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Hay PE, Kerry SR, Normansell R, Horner PJ, Reid F, Kerry SM, Prime K, Williams E, Simms I, Aghaizu A, Jensen J, Oakeshott P. Which sexually active young female students are most at risk of pelvic inflammatory disease? A prospective study. Sex Transm Infect 2016; 92:63-6. [PMID: 26082320 PMCID: PMC4752626 DOI: 10.1136/sextrans-2015-052063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/26/2015] [Accepted: 05/30/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To identify risk factors for pelvic inflammatory disease (PID) in female students. METHODS We performed a prospective study set in 11 universities and 9 further education colleges in London. In 2004-2006, 2529 sexually experienced, multiethnic, female students, mean age 20.8 years, provided self-taken vaginal samples and completed questionnaires at recruitment to the Prevention of Pelvic Infection chlamydia screening trial. After 12 months, they were followed up by questionnaire backed by medical record search and assessed for PID by blinded genitourinary medicine physicians. RESULTS Of 2004 (79%) participants who reported numbers of sexual partners during follow-up, 32 (1.6%, 95% CI 1.1% to 2.2%) were diagnosed with PID. The strongest predictor of PID was baseline Chlamydia trachomatis (relative risk (RR) 5.7, 95% CI 2.6 to 15.6). After adjustment for baseline C. trachomatis, significant predictors of PID were ≥2 sexual partners or a new sexual partner during follow-up (RR 4.0, 95% CI 1.8 to 8.5; RR 2.8, 95% CI 1.3 to 6.3), age <20 years (RR 3.3, 95% CI 1.5 to 7.0), recruitment from a further education college rather than a university (RR 2.6, 95% CI 1.3 to 5.3) and history at baseline of vaginal discharge (RR 2.7, 95% CI 1.2 to 5.8) or pelvic pain (RR 4.1, 95% CI 2.0 to 8.3) in the previous six months. Bacterial vaginosis and Mycoplasma genitalium infection were no longer significantly associated with PID after adjustment for baseline C. trachomatis. CONCLUSIONS Multiple or new partners in the last 12 months, age <20 years and attending a further education college rather than a university were risk factors for PID after adjustment for baseline C. trachomatis infection. Sexual health education and screening programmes could be targeted at these high-risk groups. TRIAL REGISTRATION NUMBER (ClinicalTrials.gov NCT00115388).
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Affiliation(s)
- Phillip E Hay
- Department of Genitourinary Medicine, Courtyard Clinic, St George's Hospital, London, UK
| | - Sarah R Kerry
- Population Health Research Institute, St George's, University of London, London, UK
| | - Rebecca Normansell
- Population Health Research Institute, St George's, University of London, London, UK
| | - Paddy J Horner
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Fiona Reid
- Department of Primary Care & Public Health Sciences, Kings College London, London, UK
| | - Sally M Kerry
- Pragmatic Clinical Trials Unit, Queen Mary's, University of London, London, UK
| | - Katia Prime
- Department of Genitourinary Medicine, Courtyard Clinic, St George's Hospital, London, UK
| | - Elizabeth Williams
- Homerton Sexual Health Services, Homerton University Hospital, London, UK
| | - Ian Simms
- Health Protection Services, Public Health England, London, UK
| | - Adamma Aghaizu
- Health Protection Services, Public Health England, London, UK
| | | | - Pippa Oakeshott
- Population Health Research Institute, St George's, University of London, London, UK
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Balamuth F, Zhang Z, Rappaport E, Hayes K, Mollen C, Sullivan KE. RNA Biosignatures in Adolescent Patients in a Pediatric Emergency Department With Pelvic Inflammatory Disease. Pediatr Emerg Care 2015; 31:465-72. [PMID: 26125533 PMCID: PMC4495580 DOI: 10.1097/pec.0000000000000483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescents are at high risk for pelvic inflammatory disease (PID). Because accurate diagnosis of PID is difficult, and complications of untreated PID are significant, novel methods to improve diagnosis are essential. OBJECTIVES To determine if patients with PID have unique RNA expression patterns compared to controls. METHODS Peripheral blood was collected from adolescent females with PID in the emergency department, and from control patients in the operating room. RNA was isolated, and microarray analysis was performed. Initial analysis involved a training set of 18 patients (9 PID patients with either Neisseria gonorrhoeae or Chlamydia trachomatis infection and 9 control patients). Supervised and unsupervised cluster analyses were performed, followed by network analysis. The training set was used to classify a set of 15 additional PID patients and 2 controls. RESULTS Supervised cluster analysis of the training set revealed 170 genes which were differentially expressed in PID patients versus controls. Network analysis indicated that several differentially expressed genes are involved in immune activation. Analysis of additional PID patients based on the training set findings revealed that patients with positive testing for Trichomonas vaginalis partitioned with the PID group, whereas patients with no organism identified partitioned with both groups. CONCLUSIONS RNA sample collection from adolescents in the emergency department is feasible. Genes were identified which were differentially expressed in PID patients versus controls, many of which are involved in inflammation. Future studies should confirm the training set findings on a larger sample and may lead to improved accuracy of PID diagnosis.
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Affiliation(s)
- Fran Balamuth
- Division of Emergency Medicine, The Children's Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine
| | - Zhe Zhang
- Bioinformatics Core Facility, The Children's Hospital of Philadelphia
| | - Eric Rappaport
- Microarray Core Facility, The Children's Hospital of Philadelphia
| | - Katie Hayes
- Division of Emergency Medicine, Children's National Medical Center
| | - Cynthia Mollen
- Division of Emergency Medicine, The Children's Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine
| | - Kathleen E. Sullivan
- University of Pennsylvania Perelman School of Medicine
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia
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31
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Kerry SR, Nightingale CM, Hay P, Oakeshott P. Which sexually active female students get themselves tested for Chlamydia trachomatis? A cohort study. Int J STD AIDS 2015; 27:586-90. [PMID: 25999170 DOI: 10.1177/0956462415587636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 04/20/2015] [Indexed: 11/16/2022]
Abstract
Using data from the Prevention of Pelvic Infection (POPI) chlamydia screening trial, we compared the characteristics of female students who did or did not get tested for chlamydia outside the trial during 12 months' follow-up. Of the 2529 women in the trial, we excluded 68 chlamydia positives in the intervention group who were referred for treatment at baseline. Of the remaining 2461 women, 1980 (80%) answered the question about testing during follow-up on their 12 months' questionnaire and were included in the cohort. Of 1980 respondents, 529 (27%) reported having an independent chlamydia test, including 30 (48%) of 63 women with undiagnosed chlamydia at baseline. Predictors of testing included having undiagnosed chlamydia at baseline (adjusted odds ratio 2.44; 95% confidence interval 1.39-4.28), ≥2 sexual partners in the year prior to baseline (OR 1.99; 95% CI 1.60-2.48), history of sexually transmitted infection (1.63: 1.20-2.22); symptoms of pelvic discomfort, dyspareunia, abnormal vaginal discharge or inter-menstrual bleeding (1.38; 1.09-1.73); and black ethnicity (1.37, 1.06-1.76). Although more women with risk factors got tested, half of women with undiagnosed chlamydia did not get tested. To optimise detection of chlamydia, testing should be offered routinely.
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Affiliation(s)
- Sarah R Kerry
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, Tooting, London, UK
| | - Claire M Nightingale
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, Tooting, London, UK
| | - Phillip Hay
- Department of Genitourinary Medicine, St George's Hospital, London, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, Tooting, London, UK
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Wetten S, Mohammed H, Yung M, Mercer CH, Cassell JA, Hughes G. Diagnosis and treatment of chlamydia and gonorrhoea in general practice in England 2000-2011: a population-based study using data from the UK Clinical Practice Research Datalink. BMJ Open 2015; 5:e007776. [PMID: 26022269 PMCID: PMC4452740 DOI: 10.1136/bmjopen-2015-007776] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To determine the relative contribution of general practices (GPs) to the diagnosis of chlamydia and gonorrhoea in England and whether treatment complied with national guidelines. DESIGN Analysis of longitudinal electronic health records in the Clinical Practice Research Datalink (CPRD) and national sexually transmitted infection (STI) surveillance databases, England, 2000-2011. SETTING GPs, and community and specialist STI services. PARTICIPANTS Patients diagnosed with chlamydia (n=1,386,169) and gonorrhoea (n=232,720) at CPRD GPs, and community and specialist STI Services from 2000-2011. MAIN OUTCOME MEASURES Numbers and rates of chlamydia and gonorrhoea diagnoses; percentages of patients diagnosed by GPs relative to other services; percentage of GP patients treated and antimicrobials used; percentage of GP patients referred. RESULTS The diagnosis rate (95% CI) per 100,000 population of chlamydia in GP increased from 22.8 (22.4-23.2) in 2000 to 29.3 (28.8-29.7) in 2011 (p<0.001), while the proportion treated increased from 59.5% to 78.4% (p=0.001). Over 90% were prescribed a recommended antimicrobial. Over the same period, the diagnosis rate (95% CI) per 100,000 population of gonorrhoea in GP ranged between 3.2 (3-3.3) and 2.4 (2.2-2.5; p=0.607), and the proportion treated ranged between 32.7% and 53.6% (p=0.262). Despite being discontinued as a recommended therapy for gonorrhoea in 2005, ciprofloxacin accounted for 42% of prescriptions in 2007 and 20% in 2011. Over the study period, GPs diagnosed between 9% and 16% of chlamydia cases and between 6% and 9% of gonorrhoea cases in England. CONCLUSIONS GP makes an important contribution to the diagnosis and treatment of bacterial STIs in England. While most patients diagnosed with chlamydia were managed appropriately, many of those treated for gonorrhoea received antimicrobials no longer recommended for use. Given the global threat of antimicrobial resistance, GPs should remain abreast of national treatment guidelines and alert to treatment failure in their patients.
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Affiliation(s)
- Sally Wetten
- HIV & STI Department, Public Health England, London, UK
| | | | - Mandy Yung
- HIV & STI Department, Public Health England, London, UK
| | - Catherine H Mercer
- Centre for Sexual Health and HIV Research, University College London, Mortimer Market Centre, London, UK
| | - Jackie A Cassell
- Division of Primary Care & Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, UK
- Kent Surrey and Sussex Public Health England Centre. County Hall North. Chart Way, Horsham, West Sussex, UK
| | - Gwenda Hughes
- HIV & STI Department, Public Health England, London, UK
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Li M, McDermott R. Smoking, poor nutrition, and sexually transmitted infections associated with pelvic inflammatory disease in remote North Queensland Indigenous communities, 1998-2005. BMC WOMENS HEALTH 2015; 15:31. [PMID: 25887145 PMCID: PMC4392641 DOI: 10.1186/s12905-015-0188-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 03/17/2015] [Indexed: 11/10/2022]
Abstract
Background Indigenous women in remote North Queensland have a high prevalence of unhealthy lifestyle behaviors and associated health conditions such as sexual transmitted infections (STI). The association of severe pelvic inflammatory disease (PID) with these factors has not been studied. The purpose of this study is to associate the factors with severe PID, as indicated by hospitalization in a high risk population in North Queensland Indigenous communities. Methods A cross-sectional association of 1445 Indigenous women using linked hospital separation and survey data during 1998–2005. Results The mean age of participating women was 37.4 years, 60% were of Aboriginal and 40% were Torres Strait Island (TSI) people. More than half of them (52.5%) were smokers, 9.3% had chlamydia and 2.6% had gonorrhoea with the overall prevalence of STI among those less than 25 years of age being 23.9%. Among the 47 participants diagnosed with PID in the study period, 42.5% were under 25 years and 95.7% (45 cases) were under 55 years (OR 2.5, 95% CI 1.2-4.1 among women younger than 25 compared to those 25 years and over). PID was strongly associated with smoking (OR 3.1, 95% CI 1.4-9.2) independent of age, ethnicity, STI and folate status. Low red cell folate increased PID hospitalization by 4 times (95% CI 1.5-13.2 of lowest quartile compared to the highest quartile) regardless of age. Having a STI significantly increased the likelihood of severe PID by 2.2 times (95% CI: 1.03-4.5) in Indigenous women younger than 45 years, independent of smoking and folate level. The risk of PID hospitalization was higher for gonorrheal infections (OR 3.2, 955 CI 1.1-9.6) compared to chlamydial infections (OR 1.5 95% CI 0.7-3.5). Conclusions Young Indigenous women in North Queensland communities are at very high risk for STI and PID. Smoking, low folate, and STI are clustered, and are associated with PID hospitalizations. Much of this can be prevented with improved nutrition and access to preventive services, especially tobacco control, regular STI screening and treatment, as well as more investment in sexual health education and awareness. Electronic supplementary material The online version of this article (doi:10.1186/s12905-015-0188-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming Li
- School of Population Health, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia.
| | - Robyn McDermott
- School of Population Health, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia. .,Faculty of Medicine, Health & Molecular Sciences, James Cook University, Cairns, Australia.
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Awareness About Sexually Transmitted and Other Infections of the Reproductive Tract, Risk Factors and Other Predictors in Women. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2014. [DOI: 10.5812/archcid.18076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dhasmana D, Hathorn E, McGrath R, Tariq A, Ross JD. The effectiveness of nonsteroidal anti-inflammatory agents in the treatment of pelvic inflammatory disease: a systematic review. Syst Rev 2014; 3:79. [PMID: 25052765 PMCID: PMC4125595 DOI: 10.1186/2046-4053-3-79] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 06/10/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pelvic inflammatory disease (PID) is the result of infection ascending through the endocervix to the uterus and fallopian tubes. Inflammation driven by infected host cells appears to be central to the development of tissue damage and associated reproductive complications. Nonsteroidal anti-inflammatory agents (NSAIDs) therefore have the potential to reduce the sequelae associated with pelvic infection. METHODS A search of four electronic reference databases, an internet search for relevant grey literature and a review of the bibliographies of identified publications was used to identify studies evaluating NSAIDs in the management of PID. A predefined search strategy was used to identify studies that included women with PID aged over 16 and diagnosed after 1980. Randomized controlled trials, nonrandomized controlled trials, and cohort studies with comparison group data were included without language restriction. Two reviewers independently assessed the studies against agreed criteria and extracted relevant data using a standardized pro forma. A meta-analysis to calculate the relative risk associated with NSAID use was planned if appropriate. RESULTS Forty-three studies were identified. After reviewing abstracts or full texts, two randomized controlled trials were found to meet the selection criteria for inclusion. The use of NSAIDs was reported to improve tubal patency, reduce pelvic adhesions and reduce suprapubic pain but the studies were of poor quality with a high risk of bias. Meta-analysis of the data was not performed. CONCLUSIONS Insufficient data is available to support or refute the efficacy of NSAIDs in the prevention of short or long-term complications of PID.
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Affiliation(s)
- Divya Dhasmana
- Department of Genitourinary Medicine, Whittall Street Clinic, Whittall Street, Birmingham B4 6DH, UK.
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Sharma N, Ganesh D, Srinivasan J, S J, Mathew R. Retroperitoneal approach for dissection of inflamed pelvic viscera in acute pelvic inflammatory disease- case report. J Clin Diagn Res 2014; 8:OD03-5. [PMID: 24995219 DOI: 10.7860/jcdr/2014/7837.4331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/11/2014] [Indexed: 11/24/2022]
Abstract
Tubo-ovarian abscesses can rupture spontaneously after a manual examination or an accidental trauma. A critically ill patient with septic peritonitis will only deteriorate if timely surgical removal of pus is not done. The operation of choice is removal of free pus, together with the abscess, the uterus, the tubes and usually, the ovaries. Anatomy is distorted, dependable landmarks are obscured and tissues are thick and oedematous. Loops of densely adhered intestine are difficult to separate. If an intra peritoneal approach is used, it is likely that the fragments of ovary will be left behind. This can subsequently cause signs and symptoms of ovarian remnant syndrome. Injury to the serosa of distended bowel occurs inadvertently, thus increasing the morbidity which results from the procedure. We are hereby presenting a unique case of a ruptured tubo-ovarian abscess where a retroperitoneal approach was used.
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Affiliation(s)
- Nidhi Sharma
- Associate Professor, Department of Obstetrics and Gynaecology, Saveetha Medical College No.162 Poonamalle High Road, Tamilnadu, India
| | - Deepa Ganesh
- Assistant Professor, Department of Obstetrics and Gynaecology, Saveetha Medical College No.162 Poonamalle High Road, Tamilnadu, India
| | - Jayashree Srinivasan
- Professor, Head of the Department of Obstetrics and Gynaecology, Saveetha Medical College No.162 Poonamalle High Road, Tamilnadu, India
| | - Jayakumar S
- Associate Professor, Department of Microbiology, Saveetha Hospital Saveetha Medical College No.162 Poonamalle High Road, Tamilnadu, India
| | - Renu Mathew
- Professor, Department of Microbiology, Saveetha Hospital Saveetha Medical College No.162 Poonamalle High Road, Tamilnadu, India
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Radin RG, Hatch EE, Rothman KJ, Mikkelsen EM, Sørensen HT, Riis AH, Wise LA. Active and passive smoking and fecundability in Danish pregnancy planners. Fertil Steril 2014; 102:183-191.e2. [PMID: 24746741 DOI: 10.1016/j.fertnstert.2014.03.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/26/2014] [Accepted: 03/11/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the extent to which fecundability is associated with active smoking, time since smoking cessation, and passive smoking. DESIGN Prospective cohort study. SETTING Denmark, 2007-2011. PATIENT(S) A total of 3,773 female pregnancy planners aged 18-40 years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Self-reported pregnancy. Fecundability ratios (FRs) and 95% confidence intervals (CIs) were estimated using a proportional probabilities model that adjusted for menstrual cycle at risk and potential confounders. RESULT(S) Among current smokers, smoking duration of ≥10 years was associated with reduced fecundability compared with never smokers (FR, 0.85, 95% CI 0.72-1.00). Former smokers who had smoked ≥10 pack-years had reduced fecundability regardless of when they quit smoking (1-1.9 years FR, 0.83, 95% CI 0.54-1.27; ≥2 years FR, 0.73, 95% CI 0.53-1.02). Among never smokers, the FRs were 1.04 (95% CI 0.89-1.21) for passive smoking in early life and 0.92 (95% CI 0.82-1.03) for passive smoking in adulthood. CONCLUSION(S) Among Danish pregnancy planners, cumulative exposure to active cigarette smoking was associated with delayed conception among current and former smokers. Time since smoking cessation and passive smoking were not appreciably associated with fecundability.
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Affiliation(s)
- Rose G Radin
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts; RTI Health Solutions, Research Triangle Park, North Carolina
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anders H Riis
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts; Slone Epidemiology Center, Boston University, Boston, Massachusetts
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VISALLI G, PICERNO I, VITA G, SPATARO P, BERTUCCIO M. Knowledge of sexually transmitted infections among younger subjects of the city of Messina (Sicily). JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2014; 55:17-22. [PMID: 25916027 PMCID: PMC4718334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Sexually transmitted infections (STIs) are considered a serious public health problem worldwide, affecting especially young people. The international monitoring data indicate that 70% of patients with STIs are aged between 15 and 24 years and the World Health Organization estimates that one out of 20 teenagers contracts an STI each year. We wanted to evaluate, through this work, what high school students of Messina know about the STIs. MATERIAL AND METHODS From February to May 2013 questionnaires were distributed to students of the last three classes of seven high schools, three of which belonging to humanistic area and four to technical area. The completed questionnaires collected were 1588. RESULTS AND DISCUSSION The investigation carried out showed a better knowledge of the STIs by students of humanistic schools than students of technical-scientific schools, the percentage of correct answers was 74% and 60% respectively; this probably also depends on the family context, in fact, there is a statistically significant correlation between the percentage of correct answers and parents education level. Young people have a limited knowledge on the subject. We concluded our work by stressing the importance and the need to deepen and improve the training and information of the medical staff teachers and families, as it is from their knowledge and their ability to provide complete and accurate information about the risks posed by STIs that can derive knowledge and choices of appropriate lifestyle between the youth population.
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Affiliation(s)
- G. VISALLI
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina.
| | - I. PICERNO
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina.
| | - G. VITA
- UOSD of Tissue Typing AOU "G.Martino" University of Messina
| | - P. SPATARO
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina.
| | - M.P. BERTUCCIO
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina.;,Correspondence: Maria Paola Bertuccio, A.O.U. "G. Martino" via Consolare Valeria, 98100 Messina - Tel. +39 090 2213349 - Fax +39 090 2217099 - E-mail:
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Caddy S, Yudin MH, Hakim J, Money DM, Yudin MH, Allen VM, Bouchard C, Boucher M, Caddy S, Castillo E, Money DM, Murphy KE, Ogilvie G, Paquet C, Norman WV. Best Practices to Minimize Risk of Infection With Intrauterine Device Insertion. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:266-274. [DOI: 10.1016/s1701-2163(15)30636-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Svenstrup HF, Dave SS, Carder C, Grant P, Morris-Jones S, Kidd M, Stephenson JM. A cross-sectional study of Mycoplasma genitalium infection and correlates in women undergoing population-based screening or clinic-based testing for Chlamydia infection in London. BMJ Open 2014; 4:e003947. [PMID: 24503298 PMCID: PMC3918997 DOI: 10.1136/bmjopen-2013-003947] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To determine Mycoplasma genitalium infection and correlates among young women undergoing population-based screening or clinic-based testing for Chlamydia infection. DESIGN Cross-sectional study. SETTING National Chlamydia Screening Programme (NCSP) and two London sexually transmitted infection (STI) clinics. PARTICIPANTS 2441 women aged 15-64 years who participated in the NCSP and 2172 women who attended two London STI clinics over a 4-month period in 2009. OUTCOME MEASURES (1) M genitalium prevalence in defined populations (%). (2) Age-adjusted ORs (aORs) for correlates of M genitalium infection. RESULTS The overall frequency of M genitalium and Chlamydia trachomatis was 3% and 5.4%, respectively. Co-infection was relatively uncommon (0.5% of all women); however 9% of women with C trachomatis also had M genitalium infection. M genitalium was more frequently detected in swab than urine samples (3.9 vs 1.3%, p<0.001) with a significantly higher mean bacterial load (p ≤ 0.001). Among NCSP participants, M genitalium was significantly more likely to be diagnosed in women of black/black British ethnicity (aOR 2.3, 95% CI 1.2 to 4.5, p=0.01). M genitalium and C trachomatis and were both significantly associated with multiple sexual partners in the past year (aOR 2.4, 95% CI 1.3 to 4.4, p=0.01 and aOR 2.0, 95% CI 1.4 to 2.8, p<0.01). Among STI clinic attendees, M genitalium was more common in women who were less than 25 years in age. CONCLUSIONS M genitalium is a relatively common infection among young women in London. It is significantly more likely to be detected in vulvovaginal swabs than in urine samples. Co-infection with Chlamydia is uncommon. The clinical effectiveness of testing and treatment strategies for M genitalium needs further investigation.
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Affiliation(s)
- H F Svenstrup
- Research Department of Reproductive Medicine, Institute for Women's Health, University College London, UK
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Under-reporting of pelvic inflammatory disease in Hawaii: a comparison of state surveillance and hospitalization data. J Community Health 2013; 39:336-8. [PMID: 23999911 DOI: 10.1007/s10900-013-9766-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hawaii is one of only 19 states for which pelvic inflammatory disease (PID) is a mandated notifiable disease. In order to assess the completeness of PID reporting, we compared the number of hospitalized PID cases in the state of Hawaii with the total number of PID cases reported to the Hawaii State Department of Health surveillance system from 2007 through 2010. While 828 unique PID cases were diagnosed in Hawaii hospitals, only 240 unique PID cases were reported through the state's surveillance system. Severe PID underreporting was seen despite mandatory reporting laws.
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Price MJ, Ades AE, De Angelis D, Welton NJ, Macleod J, Soldan K, Simms I, Turner K, Horner PJ. Risk of pelvic inflammatory disease following Chlamydia trachomatis infection: analysis of prospective studies with a multistate model. Am J Epidemiol 2013; 178:484-92. [PMID: 23813703 PMCID: PMC3727337 DOI: 10.1093/aje/kws583] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Our objective in this study was to estimate the probability that a Chlamydia trachomatis (CT) infection will cause an episode of clinical pelvic inflammatory disease (PID) and the reduction in such episodes among women with CT that could be achieved by annual screening. We reappraised evidence from randomized controlled trials of screening and controlled observational studies that followed untreated CT-infected and -uninfected women to measure the development of PID. Data from these studies were synthesized using a continuous-time Markov model which takes into account the competing risk of spontaneous clearance of CT. Using a 2-step piecewise homogenous Markov model that accounts for the distinction between prevalent and incident infections, we investigated the possibility that the rate of PID due to CT is greater during the period immediately following infection. The available data were compatible with both the homogenous and piecewise homogenous models. Given a homogenous model, the probability that a CT episode will cause clinical PID was 0.16 (95% credible interval (CrI): 0.06, 0.25), and annual screening would prevent 61% (95% CrI: 55, 67) of CT-related PID in women who became infected with CT. Assuming a piecewise homogenous model with a higher rate during the first 60 days, corresponding results were 0.16 (95% CrI: 0.07, 0.26) and 55% (95% CrI: 32, 72), respectively.
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Affiliation(s)
- Malcolm J Price
- School of Health and Population Sciences, Public Health Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
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Gobin M, Verlander N, Maurici C, Bone A, Nardone A. Do sexual health campaigns work? An outcome evaluation of a media campaign to increase chlamydia testing among young people aged 15-24 in England. BMC Public Health 2013; 13:484. [PMID: 23683345 PMCID: PMC3671151 DOI: 10.1186/1471-2458-13-484] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 04/30/2013] [Indexed: 11/10/2022] Open
Abstract
Background A national multimedia campaign was launched in January 2010, to increase the proportion of young people tested for chlamydia. This study aimed to evaluate the impact of the campaign on the coverage and positivity within the National Chlamydia Screening Programme (NSCP) in England. Method An interrupted time series of anonymised NCSP testing reports for England for a 27 month period (1st April 2008 to 30th June 2010) was analysed. Reports were assigned to a pre-campaign, campaign and post campaign phase according to the test date. Exclusion criteria included tests for clinical reasons, contacts of known cases, and tests returned from prisons or military services. Negative binomial and logistic regression modelling was used to provide an estimate for the change in coverage and positivity, during, and after the campaign and estimates were adjusted for secular and cyclical trends. Results Adjusting for cyclical and secular trends, there was no change in the overall testing coverage either during (RR: 0.91; 95% CI: 0.72-1.14) or after (RR: 0.88; 95%CI: 0.69-1.11) the campaign. The coverage varied amongst different socio-demographic groups, testing of men increased during the campaign phase while testing of people of black and other ethnic groups fell in this phase. The positivity rate was increased during the campaign (OR: 1.18; 95% CI 1.13-1.23) and further increased in the post-campaign phase (OR: 1.40; 95% CI 1.30-1.51). The proportion of chlamydia infections detected increased for all socio-demographic and self-reported sexual behaviour groups both during and after the campaign. Conclusion The uptake of chlamydia testing rose during the campaign; however, this apparent increase was not maintained once overall trends in testing were taken into account. Nonetheless, once secular and cyclical trends were controlled for, the campaign was associated with an increased positivity linked to increased testing of high risk individuals groups in the target population who were previously less likely to come forward for testing. However, our study indicated that there may have been a disparity in the impact of the campaign on different population groups. The content and delivery of ongoing and future information campaigns aimed at increasing chlamydia screening should be carefully developed so that they are relevant to all sections of the target population.
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Affiliation(s)
- Maya Gobin
- Field Epidemiology Service, Public Health England, Bristol, UK.
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Tepper NK, Steenland MW, Gaffield ME, Marchbanks PA, Curtis KM. Retention of intrauterine devices in women who acquire pelvic inflammatory disease: a systematic review. Contraception 2013; 87:655-60. [DOI: 10.1016/j.contraception.2012.08.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 08/07/2012] [Indexed: 11/26/2022]
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Samkange-Zeeb F, Pöttgen S, Zeeb H. Higher risk perception of HIV than of chlamydia and HPV among secondary school students in two German cities. PLoS One 2013; 8:e61636. [PMID: 23637872 PMCID: PMC3634836 DOI: 10.1371/journal.pone.0061636] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/12/2013] [Indexed: 11/24/2022] Open
Abstract
Background Chlamydia and genital human papillomavirus (HPV) are the two most common sexually transmitted infections (STIs) among teens and young adults in industrialised countries. The majority of adolescents, however, have limited or no knowledge of these infections. Within the context of a cross-sectional survey on awareness and knowledge of sexually transmitted infections, secondary school students attending the 8th grade and above in Bremen and Bremerhaven, two cities in northern Germany, were asked to rate the risk of peers to get infected with HIV, HPV or chlamydia. Methods Between October and December 2011, students aged 12–20 years completed an anonymous, self-administered questionnaire at their school. In addition to answering questions on awareness and knowledge of sexually transmitted infections, all students were also asked to rate the risk of peers to get infected with HIV, HPV or chlamydia. Furthermore, those reporting ever having sexual intercourse were asked to rate their own risk of getting infected with each of the three infections. Results 1,148 students, 55% female, completed the questionnaire. 27% of the students reported having had sexual intercourse. 68% of all students rated the risk of same-aged students to get infected with HIV/AIDS as high/medium. The corresponding proportions for HPV and chlamydia were 19 and 25% respectively. Those reporting ever having sexual intercourse generally perceived their own risk of getting infected with HIV, chlamydia or HPV as lower than that of their peers. Conclusion Generally, the risk of getting infected with HIV was perceived as being higher than that of getting infected with HPV or chlamydia, most likely due to the fact that the students were more aware of HIV than of the other two infections. Efforts should be made to improve awareness and knowledge of HPV and chlamydia among school going adolescents, and to make them realize that these are common infections that are preventable.
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Mack E, Wee HY. Pelvic Inflammatory Disease Caused by Streptococcus Pneumoniae in a Heavy Smoker after Laparoscopic Surgery. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2012. [DOI: 10.47102/annals-acadmedsg.v41n7p309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Phrasisombath K, Thomsen S, Sychareun V, Faxelid E. Care seeking behaviour and barriers to accessing services for sexually transmitted infections among female sex workers in Laos: a cross-sectional study. BMC Health Serv Res 2012; 12:37. [PMID: 22333560 PMCID: PMC3347996 DOI: 10.1186/1472-6963-12-37] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 02/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prompt, correct diagnosis and treatment with health information are essential components of reproductive tract infection (RTI) and sexually transmitted infection (STI) services. This study aims to describe care seeking behaviour and barriers to accessing RTI/STI services among female sex workers (FSWs) in Laos. METHODS A cross-sectional survey using closed and open-ended questions was performed in six districts along Road 9, traversing Savannakhet province from Thailand to Vietnam. In total, 407 FSWs were interviewed. The data were analyzed and presented descriptively. Multiple logistic regression analysis was applied to assess associations between respondents' background characteristics and care seeking behaviour. RESULTS About half of the respondents (49%) were less than or equal to 19 years of age, and 50% had started or completed secondary school. Fifty-eight percent had been engaged in sex work for less than 1 year. Eighty-six percent of the respondents reported RTI/STI signs or symptoms currently or in the last 3 months but only two-thirds of those with symptoms sought treatment. Source of treatment for the last RTI/STI episode was the drop-in centre (53%) followed by a public hospital (23%), private clinic (12%), private pharmacy (9%), and herbalist (2%). The main barriers to service use were long waiting time, inconvenient location of the clinic, not knowing where to get the services needed, and negative attitudes among healthcare providers. Care seeking behaviour was associated with longer duration of sex work (OR = 2.6, 95%CI 1.52-5.36). Forty-four percent received health information from peer educators, 34% from fellow friends, 26% from a pimp, and 26% had received information from a healthcare provider during the visit. CONCLUSION There were several barriers to accessing RTI/STI services and they were related to both structural and individual factors. Innovative STI service strategies to inform FSWs about the importance of early diagnosis and treatment should be established. Continuous training for STI service providers focusing on counseling skills and awareness of the sexual health care needs for FSWs is recommended in order to minimize the barriers experienced by FSWs in this particular setting.
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Burnett AM, Anderson CP, Zwank MD. Laboratory-confirmed gonorrhea and/or chlamydia rates in clinically diagnosed pelvic inflammatory disease and cervicitis. Am J Emerg Med 2011; 30:1114-7. [PMID: 22030186 DOI: 10.1016/j.ajem.2011.07.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 07/13/2011] [Accepted: 07/15/2011] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the rates of laboratory confirmed gonorrhea (GC) and chlamydia (CT) in emergency department (ED) patients with pelvic inflammatory disease (PID) and cervicitis who were diagnosed clinically and treated empirically. A secondary goal examines which clinical criteria were present in patients with PID testing positive for GC/CT. METHODS We conducted a retrospective chart review of all ED patents diagnosed with PID or cervicitis during a 40-month period (January 2007-March 2010). Charts were reviewed for laboratory-confirmed GC or CT. For patients with positive GC or CT studies, the presence of key clinical criteria used in the diagnosis of PID was tallied. RESULTS A total of 1469 patients were diagnosed with cervicitis and 343 with PID. Of these patients, 27 (1.8%) of 1469 and 15 (4.4%) of 343 were GC positive, and 136 (9.3%) of 1469 and 34 (10%) of 343 were CT positive. Twenty-six cervicitis (1.8%) and 9 PID (2.6%) patients were positive for both infections. One hundred eighty-nine cervicitis (13%) and 58 PID (17%) patients were positive for at least 1 sexually transmitted infection. Of the 58 patients with PID with laboratory-confirmed GC/CT, the following clinical criteria were present: abdominal pain, 58 of 58; abdominal tenderness, 50 of 58; cervical discharge, 47 of 58; cervical motion tenderness, 46 of 58; adnexal tenderness, 32 of 58; vaginal bleeding, 8 of 58; and fever, 2 of 58. Ultrasound was preformed in 27 (47%) of 58 GC/CT-positive patients with PID, with findings suggestive of PID in 12 (44%) of 27 ultrasounds. One hundred percent of abnormal ultrasounds were associated with positive GC and/or CT results. CONCLUSION There is a generally low prevalence of GC and CT in this patient population diagnosed with cervicitis or PID. There is a very low prevalence of coinfection.
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Affiliation(s)
- Aaron M Burnett
- Department of Emergency Medicine, Regions Hospital, St Paul, MN 55101, USA.
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Vicetti Miguel RD, Chivukula M, Krishnamurti U, Amortegui AJ, Kant JA, Sweet RL, Wiesenfeld HC, Phillips JM, Cherpes TL. Limitations of the criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease research. Pathol Res Pract 2011; 207:680-5. [PMID: 21996319 DOI: 10.1016/j.prp.2011.08.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 07/22/2011] [Accepted: 08/27/2011] [Indexed: 11/24/2022]
Abstract
While endometrial neutrophils and plasma cells are criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease (PID) research, plasma cell misidentification and nonspecificity may limit the accuracy of these criteria. Herein, we examined: (1) the identification of endometrial plasma cells with conventional methyl green pyronin-based methodology versus plasma cell-specific (CD138) immunostaining, (2) the prevalence of endometrial plasma cells among women at low risk for PID, and (3) endometrial leukocyte subpopulations among women diagnosed with acute or chronic histologic endometritis by conventional criteria. We observed an absence of CD138+ cells in 25% of endometrial biopsies in which plasma cells had been identified by conventional methodology, while additional immunohistochemical analyses revealed indistinguishable inflammatory infiltrates among women diagnosed with acute or chronic endometritis by conventional criteria. Among women considered at lower risk for PID development, flow cytometric analyses detected plasma cells in 30% of endometrial biopsy specimens, suggesting that these cells, even when accurately identified, only nonspecifically identify upper genital tract inflammatory processes. Combined, our findings underscore the limitations of the criteria used to diagnose histologic endometritis in PID-related research and suggest that satisfactory understanding of PID pathogenesis, treatment, and prevention is hindered by continued use of these criteria.
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Samkange-Zeeb FN, Spallek L, Zeeb H. Awareness and knowledge of sexually transmitted diseases (STDs) among school-going adolescents in Europe: a systematic review of published literature. BMC Public Health 2011; 11:727. [PMID: 21943100 PMCID: PMC3189891 DOI: 10.1186/1471-2458-11-727] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 09/25/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexually transmitted diseases (STDs) are a major health problem affecting mostly young people, not only in developing, but also in developed countries.We conducted this systematic review to determine awareness and knowledge of school-going male and female adolescents in Europe of STDs and if possible, how they perceive their own risk of contracting an STD. Results of this review can help point out areas where STD risk communication for adolescents needs to be improved. METHODS Using various combinations of the terms "STD", "HIV", "HPV", "Chlamydia", "Syphilis", "Gonorrhoea", "herpes", "hepatitis B", "knowledge", "awareness", and "adolescents", we searched for literature published in the PubMed database from 01.01.1990 up to 31.12.2010. Studies were selected if they reported on the awareness and/or knowledge of one or more STD among school-attending adolescents in a European country and were published in English or German. Reference lists of selected publications were screened for further publications of interest. Information from included studies was systematically extracted and evaluated. RESULTS A total of 15 studies were included in the review. All were cross-sectional surveys conducted among school-attending adolescents aged 13 to 20 years. Generally, awareness and knowledge varied among the adolescents depending on gender.Six STDs were focussed on in the studies included in the review, with awareness and knowledge being assessed in depth mainly for HIV/AIDS and HPV, and to some extent for chlamydia. For syphilis, gonorrhoea and herpes only awareness was assessed. Awareness was generally high for HIV/AIDS (above 90%) and low for HPV (range 5.4%-66%). Despite knowing that use of condoms helps protect against contracting an STD, some adolescents still regard condoms primarily as an interim method of contraception before using the pill. CONCLUSION In general, the studies reported low levels of awareness and knowledge of sexually transmitted diseases, with the exception of HIV/AIDS. Although, as shown by some of the findings on condom use, knowledge does not always translate into behaviour change, adolescents' sex education is important for STD prevention, and the school setting plays an important role. Beyond HIV/AIDS, attention should be paid to infections such as chlamydia, gonorrhoea and syphilis.
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Affiliation(s)
| | - Lena Spallek
- Bremen Institute for Prevention Research and Social Medicine, University of Bremen, Germany
| | - Hajo Zeeb
- Bremen Institute for Prevention Research and Social Medicine, University of Bremen, Germany
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