Subclinical pelvic inflammatory disease and infertility.

Objective: The reported incidence of acute pelvic inflammatory disease (PID) has decreased but rates of tubal infertility have not, suggesting that a large proportion of PID leading to infertility may be undetected. Subclinical PID is common in women with uncomplicated chlamydial or gonococcal cervicitis or with bacterial vaginosis. We assessed whether women with subclinical PID are at an increased risk for infertility.

Pelvic Inflammatory Disease: Current Concepts of Diagnosis and Management.

Pelvic inflammatory disease (PID), one of the most common infections in non-pregnant women of reproductive age, remains an important public health problem. It is associated with major long-term sequelae, including tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. In addition, treatment of acute PID and its complications incurs substantial health care costs.

Treatment of acute pelvic inflammatory disease.

Pelvic inflammatory disease (PID), one of the most common infections in nonpregnant women of reproductive age, remains an important public health problem. It is associated with major long-term sequelae, including tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. In addition, treatment of acute PID and its complications incurs substantial health care costs.

Limitations of the criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease research.

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.

Gonorrhea infection in women: prevalence, effects, screening, and management.

Gonorrhea is a set of clinical conditions resulting from infection with the sexually-acquired bacterial pathogen Neisseria gonorrhoeae. Acquisition may involve multiple mucosal sites in the lower female genital tract, including the urethra, cervix, Bartholin's and Skene's glands, as well as the anorectal canal, pharynx, and conjunctivae. It may spread to the upper genital tract, uterine tubes, abdominal cavity, and other systemic sites.

Endometrial leukocyte subpopulations associated with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis genital tract infection.

Objective: The objective of the study was to characterize endometrial inflammation associated with common genital tract pathogens.

Study Design: The design of the study was the immunohistochemical characterization of the endometrial leukocyte subpopulations from 37 controls and 45 women infected with Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis.

Results: Compared with uninfected women, endocervical infection with C trachomatis, N gonorrhoeae, or T vaginalis was associated with significant increases in endometrial T cells, B cells, plasma cells, and polymorphonuclear leukocytes.

Combined hormonal contraception may be protective against Neisseria gonorrhoeae infection.

Background: The role of hormonal contraception on acquisition of gonorrhea has not been well-characterized, as the transmission dynamics of Neisseria gonorrhoeae are poorly understood. The purpose of this study is to determine the influence of hormonal contraception on gonococcal infection in women exposed to males with gonococcal urethritis.

Methods: Females aged 15 to 35 years reporting sexual contact to a male partner diagnosed with N.

Self-reported anxiety, depressive, and vasomotor symptoms: a study of perimenopausal women presenting to a specialized midlife assessment center.

Objective: The aim of this study was to examine the association of vasomotor symptoms (VMS) with anxiety and/or depressive symptoms in perimenopausal women.

Methods: A retrospective chart review of 487 women 40 to 64 years old seen during October 2004 to December 2006 in the Women's Midlife Assessment Program at the University of California, Davis, was performed. Of these, 395 women were included in the analysis: 58 (15%) were premenopausal, 199 (50%) were perimenopausal, and 138 (35%) were postmenopausal.

Treatment strategies for pelvic inflammatory disease.

Background: Pelvic inflammatory disease (PID) is one of the most common infections seen in nonpregnant reproductive-age women. It is a major public health problem associated with substantial medical complications (e.g.

Hospitalizations for pelvic inflammatory disease and tuboovarian abscess.

Objective: To describe the demographic characteristics of and procedures for patients hospitalized for pelvic inflammatory disease (PID) and tuboovarian abscess in California from 1991 to 2001.

Methods: We used the International Classification of Diseases, 9th Revision, Clinical Modification, diagnostic and procedural codes in the California Patient Discharge Database and census data to calculate hospitalization rates for PID and tuboovarian abscess by age and race/ethnicity. We estimated the proportion of PID and tuboovarian abscess hospitalizations associated with procedures and estimated average length of hospital stay, readmission rates, and mortality.

A cluster analysis of bacterial vaginosis-associated microflora and pelvic inflammatory disease.

Controversy surrounds the association between bacterial vaginosis (BV) and pelvic inflammatory disease (PID). Women (N = 1,140) were ascertained at five US centers, enrolled (1999-2001), and followed up for a median of 3 years. Serial vaginal swabs were obtained for Gram's stain and cultures.

Bacterial vaginosis (BV) and the risk of incident gonococcal or chlamydial genital infection in a predominantly black population.

Objective: The objective of this study was to assess in prospective data whether bacterial vaginosis (BV) is associated with gonococcal/chlamydial cervicitis.

Study: A total of 1179 women at high risk for sexually transmitted infections was followed for a median of 3 years. Every 6 to 12 months, vaginal swabs were obtained for Gram stain, culture of microflora, and Neisseria gonorrhoeae and Chlamydia trachomatis.

Comparison of acute and subclinical pelvic inflammatory disease.

Objective: The objective of this study was to compare the demographic, clinical, and microbiologic findings in women with subclinical pelvic inflammatory disease (PID) and women with acute PID.

Study: A cross-sectional study was performed using cohorts from 2 separate studies of 1293 women at risk for PID. Most participants were recruited from emergency departments, sexually transmitted disease clinics, and family planning clinics in metropolitan centers.

Antibiotic prophylaxis and non-group B streptococcal neonatal sepsis.

Objective: To assess the effect of increased use of intravenous penicillin for group B streptococcus (Streptococcus agalactiae, GBS) antibiotic prophylaxis on non-GBS neonatal sepsis and antibiotic resistance.

Methods: We undertook a nonconcurrent cohort study. Microbiology cultures originating from infants with early-onset neonatal sepsis in our neonatal intensive care unit (NICU) from 1992 to 1999 were reviewed.

Douching, pelvic inflammatory disease, and incident gonococcal and chlamydial genital infection in a cohort of high-risk women.

Douching has been linked to gonococcal or chlamydial cervicitis and pelvic inflammatory disease (PID) in retrospective studies. The authors conducted a 1999-2004 prospective observational study of 1,199 US women who were at high risk of acquiring chlamydia and were followed for up to 4 years. Cervical Neisseria gonorrhoeae and Chlamydia trachomatis were detected from vaginal swabs by nucleic acid amplification.

Bacterial vaginosis and risk of pelvic inflammatory disease.

Background: Bacterial vaginosis commonly is found in women with pelvic inflammatory disease (PID), but it is unclear whether bacterial vaginosis leads to incident PID.

Methods: Women (n = 1,179) from 5 U.S.

Condom use and the risk of recurrent pelvic inflammatory disease, chronic pelvic pain, or infertility following an episode of pelvic inflammatory disease.

Among 684 sexually active women with pelvic inflammatory disease (PID) followed up for a mean of 35 months, we related contraceptive use to self-reported PID recurrence, chronic pelvic pain, and infertility. Persistent use of condoms during the study reduced the risk of recurrent PID, chronic pelvic pain, and infertility. Consistent condom use (about 60% of encounters) at baseline also reduced these risks, after adjustment for confounders, by 30% to 60%.

Can known risk factors explain racial differences in the occurrence of bacterial vaginosis?

Background: Black women are more likely to have bacterial vaginosis (BV) than are non-Hispanic white women. We examined whether this disparity can be explained by racial differences in known BV risk factors.

Methods: Nine hundred black and 235 white women were enrolled from five US sites.

Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection.

To evaluate whether bacterial vaginosis predicts the acquisition of sexually transmitted diseases (STDs), we studied 255 nonpregnant female subjects aged 15-30 who reported recent sexual contact with a male partner in whom either gonococcal or chlamydial urethritis or nongonococcal urethritis was diagnosed. Compared to subjects with normal vaginal flora, subjects with bacterial vaginosis were more likely to test positive for Neisseria gonorrhoeae (odds ratio [OR], 4.1; 95% confidence interval [CI], 1.

Vaginal polymorphonuclear leukocytes and bacterial vaginosis as markers for histologic endometritis among women without symptoms of pelvic inflammatory disease.

Objective: The study was performed to determine whether vaginal polymorphonuclear leukocytes can be used as predictors of histologic endometritis among women at risk for, but without symptoms of, acute pelvic inflammatory disease.

Study Design: Five hundred thirty-seven women with, or at risk for, pelvic infection underwent pelvic examinations, including endometrial biopsies. These women were assessed for the presence of vaginal polymorphonuclear leukocytes, bacterial vaginosis, sexually transmitted diseases, and histologic endometritis.

Endometritis does not predict reproductive morbidity after pelvic inflammatory disease.

Objective: We investigated the association between endometritis and reproductive morbidity.

Study Design: Participants were 614 women in the PID Evaluation and Clinical Health (PEACH) Study with pelvic pain, pelvic organ tenderness, and leukorrhea, mucopurulent cervicitis, or untreated cervicitis. We compared women with endometritis (>or=5 neutrophils or >or=2 plasma cells), Neisseria gonorrhoeae or Chlamydia trachomatis upper genital tract infection (UGTI) or both to women without endometritis/UGTI for outcomes of pregnancy, infertility, recurrent pelvic inflammatory disease (PID), and chronic pelvic pain (CPP), adjusting for age, race, education, PID history, and baseline infertility.

Why women douche and why they may or may not stop.

Background: Although douching is common, it is a potentially harmful habit.

Goal: We studied attitudes and knowledge around the behavior of douching.

Study Design: Of 1,200 women enrolled in this multisite study, 532 douched and answered questions on a structured interview regarding douching behaviors.

Douching in relation to bacterial vaginosis, lactobacilli, and facultative bacteria in the vagina.

Objective: To study how frequency, recentness, and reason for douching impact bacterial vaginosis-related vaginal microflora and the occurrence of cervical pathogens. Douching has been linked to bacterial vaginosis as well as to chlamydial cervicitis in some, but not all, studies.

Methods: A total of 1200 women at high risk for sexually transmitted infections were enrolled from five clinical sites around the United States.

Lower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease.

Objective: To investigate the association between lower genital tract infections and subclinical PID. Fallopian tube damage is a common complication of acute symptomatic pelvic inflammatory disease (PID), yet most women with tubal factor infertility do not have a history of acute PID. Subclinical PID is believed to be an important cause of tubal factor infertility.