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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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Chraibi Z, Jacquet A, Body G, Ouldamer L. [Interest of emergency endocervical specimens]. ACTA ACUST UNITED AC 2014; 42:494-8. [PMID: 24951186 DOI: 10.1016/j.gyobfe.2014.05.015] [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: 01/11/2014] [Accepted: 05/21/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To estimate the diagnosis profitability of endocervical specimen (ES) within the framework of a teaching gynecological emergency department by studying the circumstances of realization and its bacteriological results. PATIENTS AND METHODS We included in our study all the patients who had a gynecological exam with an ES during a consultation in our gynecological teaching emergency department of Tours between January 1st, 2012 and December 31st, 2012. We estimated the diagnosis profitability of realization of the ES (positivity rate within the population with ES, diagnosis correction in case of pelvic inflammatory disease). RESULTS Over the study period, 614 (12.4%) women consulting in our emergency department had an ES, which was positive among 102 (16.6%) of them, and a diagnosis of pelvic inflammatory disease in 64 patients. ES had a higher pertinence in case of abdominal pain and a lesser one in case of pregnancy for whom ES realisation must be limited. The diagnosis correction due to ES was observed in 46.8% of pelvic inflammatory disease. CONCLUSION The diagnostic profitability of the endocervical specimen in our emergency department was low, taking into account the whole cohort, but ES permitted to correct the diagnosis in about half of diagnosed pelvic inflammatory diseases. The endocervical specimens seem to have no profit in pregnant women.
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Affiliation(s)
- Z Chraibi
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - A Jacquet
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - G Body
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France
| | - L Ouldamer
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine François-Rabelais, 10, boulevard Tonnellé, 37044 Tours, France; Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours, France.
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Schmitz G, Tibbles C. Genitourinary emergencies in the nonpregnant woman. Emerg Med Clin North Am 2011; 29:621-35. [PMID: 21782078 DOI: 10.1016/j.emc.2011.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Lower abdominal and pelvic pains are common symptoms in women who present to the emergency department (ED). Once pregnancy has been ruled out, attention should focus on other potential life or fertility threats. Ultrasound remains the most helpful initial diagnostic modality. Time-sensitive and serious conditions, such as large ovarian masses or abnormal vaginal bleeding, need gynecologic consultation. Because many patients do not have access to primary care, ED physicians should be familiar with the treatment of sexually transmitted diseases. However, most nonpregnant women with pelvic complaints can safely be managed in the outpatient setting after ED evaluation.
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Affiliation(s)
- Gillian Schmitz
- Department of Emergency Medicine, Georgetown University, Washington Hospital Center, Washington, DC 20010, USA.
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Cropsey KL, Matthews C, Campbel S, Ivey S, Adawadkar S. Long-Term, Reversible Contraception Use Among High-Risk Women Treated in a University-Based Gynecology Clinic: Comparison Between IUD and Depo-Provera. J Womens Health (Larchmt) 2010; 19:349-53. [DOI: 10.1089/jwh.2009.1518] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Karen L. Cropsey
- University of Alabama at Birmingham, Department of Psychiatry, Birmingham, Alabama
| | - Catherine Matthews
- Virginia Commonwealth University, Department of Obstetrics and Gynecology, Richmond, Virginia
| | - Samuel Campbel
- Virginia Commonwealth University, Department of Obstetrics and Gynecology, Richmond, Virginia
| | - Sara Ivey
- Virginia Commonwealth University, Department of Obstetrics and Gynecology, Richmond, Virginia
| | - Swati Adawadkar
- Virginia Commonwealth University, Department of Obstetrics and Gynecology, Richmond, Virginia
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Toward improving the diagnosis and the treatment of adolescent pelvic inflammatory disease in emergency departments: results of a brief, educational intervention. Pediatr Emerg Care 2010; 26:85-92. [PMID: 20094001 DOI: 10.1097/pec.0b013e3181cdf349] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the utility of an abbreviated teaching tool (ATT) in improving emergency medicine pediatricians' knowledge of the diagnosis and the treatment of pelvic inflammatory disease (PID). METHODS An 18-question internet-based survey, which included questions about the diagnosis and the treatment of PID, was administered to members of the American Academy of Pediatrics Section on Emergency Medicine. Participants were randomized to receive either a weblink to the Centers for Disease Control and Prevention (CDC) sexually transmitted disease treatment guidelines (weblink group) or a 1-page ATT that summarized the CDC guidelines (ATT group) to assist with completion of the survey. We compared the accuracy of responses between the 2 groups. RESULTS Two hundred thirty-seven subjects responded to the survey (109 from the weblink group and 128 from ATT group). There were no significant differences between the groups with respect to sex, geographic location, practice setting, years of experience, or reported frequency of recent PID diagnoses. Ninety-seven percent of the ATT group correctly identified the appropriate antibiotic regimen in compliance with the CDC guidelines compared with 61% of the weblink group (OR, 19.4; 95% confidence interval, 6.6-76.9); the ATT group was also more likely to correctly identify appropriate treatment options overall (OR, 9.6; 95% confidence interval, 4.9-19.3). CONCLUSIONS Although the overall PID knowledge in our sample was low, the physicians with access to a 1-page teaching tool summarizing the CDC treatment recommendations for PID performed significantly better when asked questions involving PID treatment as compared with providers with access to the CDC Web site. Further studies should investigate whether access to a similar tool can improve patient care.
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Brotherton JML, Heywood A, Heley S. The incidence of genital warts in Australian women prior to the national vaccination program. Sex Health 2009; 6:178-84. [PMID: 19653953 DOI: 10.1071/sh08079] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Accepted: 05/26/2009] [Indexed: 11/23/2022]
Abstract
The quadrivalent human papillomavirus (HPV) vaccine currently being delivered to Australian women aged 12-26 years under the National HPV Vaccination Program promises to substantially reduce the incidence of genital warts. We review what is known about the burden of genital warts among Australian women. Incidence appears to peak among women aged 20-24 years, of whom 1.4% report genital warts in the previous year and who are hospitalised for treatment at a rate of 26 per 100,000. A surveillance system capable of documenting any decrease in the incidence of genital warts and recurrent respiratory papillomatosis after vaccination is urgently required.
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Affiliation(s)
- Julia M L Brotherton
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and the University of Sydney, Westmead, NSW 2145, Australia.
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Abstract
PURPOSE OF REVIEW We discuss the epidemiology, risk factors, microbiology, diagnosis, treatment and prevention of pelvic inflammatory disease in adolescents. RECENT FINDINGS Young age is one of the most important risk factors for sexually transmitted diseases and pelvic inflammatory disease. Sexually active adolescents have the highest incidence of Chlamydia trachomatis, Neisseria gonorrhoeae, and pelvic inflammatory disease of any sexually active age group. Long-term sequelae of pelvic inflammatory disease include ectopic pregnancy, tubal factor infertility, tubo-ovarian abscesses and chronic pelvic pain. Subclinical pelvic inflammatory disease is responsible for a significant portion of these long-term sequelae. New (2006) Centers for Disease Control and Prevention treatment guidelines for pelvic inflammatory disease are available. One of the best methods of prevention of pelvic inflammatory disease is to screen and treat sexually active adolescents for chlamydial infection. Implementation of nucleic acid amplification assays allows screening of adolescents via self-collected urine or vaginal swab samples. SUMMARY Pelvic inflammatory disease is a highly preventable source of reproductive morbidity for adolescents. It is prudent that clinicians provide counseling regarding healthy sexual behaviors, STD prevention, and contraception whenever an adolescent presents in need of STD screening or evaluation for pelvic inflammatory disease.
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Affiliation(s)
- M Rosanna Gray-Swain
- Washington University in St Louis, School of Medicine, Barnes-Jewish Hospital, MO 63110-1094, USA
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Haggerty CL, Ness RB. Epidemiology, pathogenesis and treatment of pelvic inflammatory disease. Expert Rev Anti Infect Ther 2006; 4:235-47. [PMID: 16597205 DOI: 10.1586/14787210.4.2.235] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pelvic inflammatory disease, the infection and inflammation of the female upper genital tract, is a common cause of infertility, chronic pain and ectopic pregnancy. Diagnosis and management are challenging, due largely to a polymicrobial etiology which is not fully delineated. Signs and symptoms of this syndrome vary widely, further complicating diagnosis and treatment. Due to the potential for serious sequelae, a low threshold for diagnosis and treatment is recommended. Since pelvic inflammatory disease has a multimicrobial etiology including Neisseria gonorrhoeae, Chlamydia trachomatis and anaerobic and mycoplasmal bacteria, treatment of pelvic inflammatory disease should be broad spectrum. Recent treatment trials have focused on shorter duration regimens such as azithromycin and monotherapies including ofloxacin, although data are sparse. Research comparing sequelae development by differing antimicrobial regimens is extremely limited, but will ultimately shape future treatment guidelines. Several promising short-duration and monotherapy antibiotic regimens should be evaluated in pelvic inflammatory disease treatment trials for compliance, microbiological and clinical cure, and reduction of subsequent adverse reproductive and gynecological morbidity.
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Affiliation(s)
- Catherine L Haggerty
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA 15261, USA.
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Ness RB, Smith KJ, Chang CCH, Schisterman EF, Bass DC. Prediction of pelvic inflammatory disease among young, single, sexually active women. Sex Transm Dis 2006; 33:137-42. [PMID: 16505735 DOI: 10.1097/01.olq.0000187205.67390.d1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess prediction strategies for pelvic inflammatory disease (PID). STUDY DESIGN One thousand one hundred seventy women were enrolled based on a high chlamydial risk score. Incident PID over a median of 3 years was diagnosed by either histologic endometritis or Centers for Disease Control and Prevention criteria. A multivariable prediction model for PID was assessed. RESULTS Women enrolled using the risk score were young, single, sexually active, and often had prior sexually transmitted infections. Incident PID was common (8.6%). From 24 potential predictors, significant factors included age at first sex, gonococcal/chlamydial cervicitis, history of PID, family income, smoking, medroxyprogesterone acetate use, and sex with menses. The model correctly predicted 74% of incident PID; in validation models, correct prediction was only 69%. CONCLUSIONS Our data validate a modified chlamydial risk factor scoring system for prediction of PID. Additional multivariable modeling contributed little to prediction. Women identified by a threshold value on the chlamydial risk score should undergo intensive education and screening.
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Affiliation(s)
- Roberta B Ness
- Graduate School of Public Health, University of Pittsburgh, Pennsylvania 15261, USA.
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Wilson JD, Ralph SG, Rutherford AJ. Rates of bacterial vaginosis in women undergoing in vitro fertilisation for different types of infertility. BJOG 2002; 109:714-7. [PMID: 12118653 DOI: 10.1111/j.1471-0528.2002.01297.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess whether the rate of bacterial vaginosis (BV) is higher in women with tubal factor infertility compared with those with other causes of infertility. DESIGN Cross-sectional study. SETTING Assisted conception unit of a teaching hospital in Leeds. POPULATION Consecutive women undergoing in vitro fertilisation. METHODS Women undergoing in vitro fertilisation (IVF) had a vaginal smear taken at the time of their egg collection. The smear was Gram-stained and graded as normal, intermediate or BV. MAIN OUTCOME MEASURES The presence of bacterial vaginosis and the causes of infertility. RESULTS A total of 749 women were included. The vaginal smears were normal in 63.6%, intermediate in 12.1%, and BV in 24.3%. The rates of BV in women with different types of infertility were 36.4% in tubal factor, 15.6% in male factor, 33.3% in anovulation, 12.5% in endometriosis and 18.9% in unexplained infertility. After controlling for the effects of age and smoking using a multivariate logistic regression model, women with tubal infertility were significantly more likely to have BV than women with endometriosis OR 3.63 (95% CI 1.52-8.67); male factor OR 2.98 (95% CI 1.80-4.90); and unexplained infertility OR 2.20 (95% CI 1.35-3.59). The adjusted figures for the increase of BV in women with anovulation were: endometriosis OR 3.77 (95% CI 1.28-11.08); male factor OR 3.09 (95% CI 1.37-6.96); and unexplained infertility OR 2.29 (95% CI 1.02-5.12). CONCLUSIONS Women with tubal infertility were three times more likely to have BV than women with endometriosis, male factor or unexplained infertility. These findings support the association between BV, pelvic inflammatory disease (PID) and tubal damage but do not help distinguish between cause and effect. Women with anovulation were also three times more likely to have BV than women with endometriosis or male factor infertility, supporting suggestions of hormonal influence on vaginal flora.
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