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Sharon L Hillier - One of the best experts on this subject based on the ideXlab platform.
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analysis of factors driving incident and ascending Infection and the role of serum antibody in chlamydia trachomatis Genital Tract Infection
The Journal of Infectious Diseases, 2016Co-Authors: Ali N Russell, Sharon L Hillier, Harold C. Wiesenfeld, Catherine M Oconnell, Xiaojing Zheng, Brandie D Taylor, Wujuan Zhong, Toni DarvilleAbstract:Background. Chlamydia trachomatis Genital Tract Infection is a major cause of female reproductive morbidity. Risk factors for ascending Infection are unknown, and the role for antibody in protection is not well established. Methods. We recruited 225 women from urban outpatient clinics and followed them for a median of 12 months. We performed a cross-sectional analysis of serum anti-chlamydial immunoglobulin G (IgG), behavioral factors, and microbiological factors associated with endometrial Infection at enrollment, and a longitudinal analysis of factors associated with incident Infection. Results. Oral contraceptives (adjusted relative risk [RR], 2.02 [95% confidence interval {CI}, 1.38–2.97]) and gonorrhea (adjusted RR, 1.66 [95% CI, 1.07–2.60]) were associated with endometrial Infection. Gonorrhea (adjusted hazard ratio [HR], 3.09 [95% CI, 1.41–6.78]), cervical Infection at enrollment (adjusted HR, 2.33 [95% CI, 1.07–5.11]), and exposure to uncircumcised partners (adjusted HR, 2.65 [95% CI, 1.21–5.82]) or infected partners (adjusted HR, 4.99 [95% CI, 2.66–9.39]) significantly increased the risk of incident Infection. Seropositivity was associated with a reduced cervical burden (P < .05) but no differences in rates of ascending Infection (adjusted RR, 1.24 [95% CI, .71–2.19]) or incident Infection (adjusted HR, 0.94 [95% CI, .52–1.69]). Conclusions. Serum anti-chlamydial IgG is not associated with a lowered rate of ascending or repeat Infection. Identification of factors associated with ascending Infection and increased risk of incident Infection provide guidance for targeted screening of women at increased risk for sequelae.
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racial disparity in risk of preterm birth associated with lower Genital Tract Infection
Paediatric and Perinatal Epidemiology, 2007Co-Authors: Jane Hitti, Robert P Nugent, Doris M Boutain, Carolyn Gardella, Sharon L Hillier, David A EschenbachAbstract:Summary The objective of this study was to examine the associations between lower Genital Tract Infection, racial group and preterm birth in the Vaginal Infections and Prematurity Study, a large prospective cohort study conducted between 1984 and 1989. This analysis included 11 910 women enrolled at 23–26 weeks' gestation with equal representation from self-identified African American, Hispanic and white women. Subjects were screened for Chlamydia trachomatis, Trichomonas vaginalis and bacterial vaginosis at study entry, and their pregnancy outcomes were ascertained after delivery. The primary outcome of interest was preterm delivery of a low-birthweight infant (<37 weeks and <2500 g). The associations between lower Genital Tract Infection and preterm delivery of a low-birthweight infant were examined within each racial group, with adjustment for potential confounders using multivariable logistic regression. In this cohort, 6.4% of African Americans, 3.8% of Hispanics, and 4.4% of whites had a preterm delivery of a low-birthweight infant (P < 0.001). Lower Genital Tract Infection was significantly associated with preterm delivery of a low-birthweight infant among African Americans, but not among other racial groups. The proportion of preterm birth associated with lower Genital Tract Infection was 21% among African Americans and 5% among whites. The increase in Infection-associated preterm birth among African Americans appears to be related both to an increased prevalence of lower Genital Tract Infection, and also to an increased risk of preterm delivery of a low-birthweight infant in the context of lower Genital Tract Infection.
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Racial disparity in risk of preterm birth associated with lower Genital Tract Infection.
Paediatric and perinatal epidemiology, 2007Co-Authors: Jane Hitti, Robert P Nugent, Doris M Boutain, Carolyn Gardella, Sharon L Hillier, David A EschenbachAbstract:Summary The objective of this study was to examine the associations between lower Genital Tract Infection, racial group and preterm birth in the Vaginal Infections and Prematurity Study, a large prospective cohort study conducted between 1984 and 1989. This analysis included 11 910 women enrolled at 23–26 weeks' gestation with equal representation from self-identified African American, Hispanic and white women. Subjects were screened for Chlamydia trachomatis, Trichomonas vaginalis and bacterial vaginosis at study entry, and their pregnancy outcomes were ascertained after delivery. The primary outcome of interest was preterm delivery of a low-birthweight infant (
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predictive value of the clinical diagnosis of lower Genital Tract Infection in women
American Journal of Obstetrics and Gynecology, 2004Co-Authors: Daniel V Landers, Marijane A Krohn, Harold C. Wiesenfeld, Phillip R Heine, Sharon L HillierAbstract:AbsTract Objective We hypothesized that diagnostic approaches to lower Genital Tract Infections are inaccurate and proposed this study to evaluate typical approaches. Study design Clinical diagnoses were made with symptoms, direct observation, wet mount, vaginal pH, and amines in 598 women with Genital complaints. Laboratory testing for N gonorrhoeae , yeast, T vaginalis , C trachomatis , and bacterial vaginosis by Gram stain. Results The most frequent symptoms were vaginal discharge (64%), change in discharge (53%), malodor (48%), and pruritis (32%). The Infection rates were 46% bacterial vaginosis, 29% yeast, 12% trichomoniasis, 11% chlamydia or gonorrhea; 21% of the patients had no Infection. The symptoms did not predict laboratory diagnosis. Clinical signs and symptoms with office-based tests and microscopy improved the accuracy of diagnoses. Amsel's clinical diagnosis of bacterial vaginosis was the most sensitive at 92%. The sensitivity of wet mount diagnosis of trichomoniasis was 62%, of yeast by microscopy was 22%, and of mucopus for the prediction of gonorrhea and/or chlamydia was 30%. Conclusion Symptoms alone should not be used to direct treatment in instances in which resources permit more complete evaluation with office-based testing that includes microscopy. Treatment failures or diagnostic uncertainty should prompt specific laboratory testing.
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decreased cervical proinflammatory cytokines permit subsequent upper Genital Tract Infection during pregnancy
American Journal of Obstetrics and Gynecology, 2003Co-Authors: Hyagriv N Simhan, Marijane A Krohn, Daniel V Landers, Steve N Caritis, Begona Martinez De Tejada, Sharon L HillierAbstract:AbsTract OBJECTIVE: The purpose of this study was to test the hypothesis that suppressed immune function in the lower Genital Tract, as represented by decreased concentrations of cervical proinflammatory cytokines early in pregnancy, is a risk factor for clinical chorioamnionitis. STUDY DESIGN: Interleukin-1β, interleukin-6, and interleukin-8 were measured by enzyme-linked immunosorbent assay in cervical fluid from a cohort of 403 women at 8 to 20 weeks of gestation. RESULTS: Of the 88 women with one low cytokine concentration, 8.0% of the women had clinical chorioamnionitis compared with 4.4% among the 228 women with no low cytokines (adjusted odds ratio, 2.0; 95% CI, 0.7-5.8). Clinical chorioamnionitis occurred in 15 of the 87 women (17.2%), with two or three depressed cytokine concentrations compared with women with no low cytokines (adjusted odds ratio, 5.1; 95% CI, 2.0-13.0). CONCLUSION: Genital Tract immune hyporesponsiveness, as represented by low cervical concentrations of multiple cytokines, permits subsequent clinical chorioamnionitis.
Jeffrey F. Peipert - One of the best experts on this subject based on the ideXlab platform.
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Performance of Clinical and Laparoscopic Criteria for the Diagnosis of Upper Genital Tract Infection
2013Co-Authors: Jeffrey F. Peipert, Lori A. Boardman, James C. SungAbstract:Objective: The purpose of this study was to validate the standard minimal clinical criteria and the laparoscopic triad of tubal edema, erythema, and purulent exudate used to diagnose acute upper Genital Tract Infection. Methods: Subjects included women who either met the Centers for Disease Control and Prevention’s (CDC) minimal criteria for acute pelvic inflammatory disease or had other signs of upper Genital Tract Infection (i.e., atypical pelvic pain, abnormal uterine bleeding, or cervicitis). The subjects were evaluated with a baseline interview, comprehensive laboratory testing, and either an endometrial biopsy or laparoscopy with endometrial and fimbrial biopsies for definitive diagnosis of upper Genital Tract Infection. Patients were considered positive for upper Genital Tract Infection if they had any of the following findings: 1) histologic evidence of endometritis or salpingitis; 2) laparoscopic visualization of purulent exudate in the pelvis without another source; or 3) positive testing for Neisseria gonorrhoeae or Chlamydia trachomatis from the endometrium, fallopian tubes, or pelvis. Results: One hundred twenty-nine women with adequate endometrial samples were evaluated between August 1993 and September 1997, and 62 had complete laparoscopic evaluations. The sensitivities of the CDC’s minimal clinical criteria for pelvic inflammatory disease and the laparoscopic triad of edema, erythema, and purulent exudate were 65 % and 60%, respectively. Conclusions: Commonly used minimal clinical criteria for pelvic inflammatory disease and the laparoscopic triad of tubal edema, erythema, and purulent exudate have limited sensitivity wit
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douching and endometritis results from the pid evaluation and clinical health peach study
Sexually Transmitted Diseases, 2001Co-Authors: Roberta B. Ness, Jeffrey F. Peipert, Sharon L Hillier, David E. Soper, Richard L Sweet, Robert L Holley, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Antonio J. AmorteguiAbstract:Background Douching has been related to risk of pelvic inflammatory disease (PID). Goal To examine the association between douching and PID in a large, multicenter, clinical trial of PID after adjustment for race/ethnicity. Study Design Interviews were conducted with 654 women who had signs and symptoms of PID. Vaginal Gram stains and upper Genital Tract pathology/cultures were obtained from all the women. Women with evidence of plasma cell endometritis and/or gonococcal or chlamydial upper Genital Tract Infections were compared with women who had neither endometritis nor upper Genital Tract Infection. Results Women with endometritis or upper Genital Tract Infection were more likely to have douched more than once a month or within 6 days of enrollment than women who never douched. These associations remained after adjustment for confounding factors, after analysis of black women only; and among women with normal or intermediate vaginal flora but not bacterial vaginosis. Conclusion Among a predominantly black group of women with clinical PID, frequent and recent douching was associated with endometritis and upper Genital Tract Infection.
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Association of Lower Genital Tract Inflammation With Objective Evidence of Endometritis
Hindawi Limited, 2000Co-Authors: Jeffrey F. Peipert, Roberta B. Ness, David E. Soper, Debra BassAbstract:The purpose of this report is to evaluate the association between lower Genital Tract inflammation and objectively diagnosed endometritis. We analyzed the first 157 patients enrolled in the PEACH study, a multicenter randomized clinical trial designed to compare the effectiveness of outpatient and inpatient therapy for PID. Women less than 38 years of age, who presented with a history of pelvic discomfort for 30 days or less and who were found to have pelvic organ tenderness (uterine or adnexal tenderness) on bimanual examination, were initially invited to participate. After recruitment of the first 58 patients (group 1) we added the presence of leukorrhea, mucopurulent cervicitis, or untreated positive test for N. gonorrhoeae or C. trachomatis to the inclusion criteria (group 2, N = 99). We compared rates of endometritis in the two groups and calculated the sensitivity, specificity, and predicted values of the presence of white blood cells in the vaginal wet preparation. The rate of upper Genital Tract Infection in group 1 was 46.5% (27/58) compared to 49.5% (49/99) in group 2. Microbiologic evidence of either N. gonorrhoeae or C. trachomatis increased from 22.4% in group 1 to 38.3% in group 2. The presence of Vaginal white blood cells or mueopus has a high sensitivity (88.9%), but a low specificity (19.4%) for the diagnosis of upper Genital-Tract Infection. Assessment of the lower Genital Tract for evidence of Infection or inflammation is a valuable component of the diagnostic evaluation of pelvic inflammatory disease. The presence of either mucopus or vaginal white blood cells is a highly sensitive test for endometritis in patients with pelvic pain and tenderness. Infect. Dis. Obstet. Gynecol. 8:83–87, 2000
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Factors Predicting Upper Genital Tract Inflammation among Women with Lower Genital Tract Infection
Journal of women's health, 1998Co-Authors: Deborah B. Nelson, Jeffrey F. Peipert, Roberta B. Ness, David E. Soper, Antonio J. Amortegui, Julie Gluck, Harold C. Wiesenfeld, Peter A. RiceAbstract:This study identified factors that discriminate between women with a lower Genital Tract Infection (LGTI) and women with a LGTI and endometritis. Study samples included 214 women of which 84.6% were African American with a mean age of 24.2 years who were at risk for LGTI with Chlamydia trachomatis or Neisseria gonorrhea. The primary comparison was between women having a lower Genital Tract Infection without endometritis and women having a lower Genital Tract Infection with endometritis. Women with LGTI and endometritis were older and reported a history of more sexually transmitted diseases abdominal pain and use of barrier methods of contraception than women with LGTI alone. The regression model found that women with LGTI and endometritis were 7.1 times more likely to report abdominal pain and 4.6 times more likely to use barrier methods of contraception than women with LGTI alone. The results indicate that behavioral factors in addition to symptoms can be used to identify women with and without upper Genital Tract involvement.
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Bacterial vaginosis as a risk factor for upper Genital Tract Infection
American journal of obstetrics and gynecology, 1997Co-Authors: Jeffrey F. Peipert, Andrea Montagno, Amy S. Cooper, C. James SungAbstract:AbsTract Objective: The objective of this study was to determine whether the clinical diagnosis of bacterial vaginosis is associated with objective evidence of acute upper Genital Tract Infection. Study Design : Women who either met the Centers for Disease Control and Prevention's minimal criteria for acute pelvic inflammatory disease or had other "nonclassic" signs of upper Genital Tract Infection (i.e., atypical pelvic pain, abnormal uterine bleeding, or cervicitis) were evaluated with either an endometrial biopsy or a laparoscopy with endometrial and fimbrial biopsies for objective evidence of upper Genital Tract Infection. Bacterial vaginosis was considered present if three of the four following criteria were found: (1) homogeneous gray-white vaginal discharge, (2) vaginal pH >4.5, (3) positive "whiff" test result, and (4) the presence of >20% of epithelial cells classified as clue cells. Patients were considered to have upper Genital Tract Infection if they had histologic, microbiologic, or laparoscopic evidence of upper Tract Infection. Results: One hundred sixteen women were evaluated between August 1993 and March 1997 with complete evaluations. Objective evidence of upper Tract Infection was present in 56% (14/25) of women with the clinical diagnosis of bacterial vaginosis compared with 30% of women (27/91) who did not meet the clinical criteria ( p = 0.015). Using logistic regression to control for confounding variables, we found that the presence of bacterial vaginosis was associated with a threefold increased risk of upper Genital Tract Infection (adjusted odds ratio=3.0, 95% confidence interval 1.2 to 7.6). Conclusions: Bacterial vaginosis is associated with an increased risk of objective evidence of acute upper Genital Tract Infection. Future prospective studies are needed to determine whether treatment of bacterial vaginosis can reduce the risk of ascending Infection.
David A Eschenbach - One of the best experts on this subject based on the ideXlab platform.
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racial disparity in risk of preterm birth associated with lower Genital Tract Infection
Paediatric and Perinatal Epidemiology, 2007Co-Authors: Jane Hitti, Robert P Nugent, Doris M Boutain, Carolyn Gardella, Sharon L Hillier, David A EschenbachAbstract:Summary The objective of this study was to examine the associations between lower Genital Tract Infection, racial group and preterm birth in the Vaginal Infections and Prematurity Study, a large prospective cohort study conducted between 1984 and 1989. This analysis included 11 910 women enrolled at 23–26 weeks' gestation with equal representation from self-identified African American, Hispanic and white women. Subjects were screened for Chlamydia trachomatis, Trichomonas vaginalis and bacterial vaginosis at study entry, and their pregnancy outcomes were ascertained after delivery. The primary outcome of interest was preterm delivery of a low-birthweight infant (<37 weeks and <2500 g). The associations between lower Genital Tract Infection and preterm delivery of a low-birthweight infant were examined within each racial group, with adjustment for potential confounders using multivariable logistic regression. In this cohort, 6.4% of African Americans, 3.8% of Hispanics, and 4.4% of whites had a preterm delivery of a low-birthweight infant (P < 0.001). Lower Genital Tract Infection was significantly associated with preterm delivery of a low-birthweight infant among African Americans, but not among other racial groups. The proportion of preterm birth associated with lower Genital Tract Infection was 21% among African Americans and 5% among whites. The increase in Infection-associated preterm birth among African Americans appears to be related both to an increased prevalence of lower Genital Tract Infection, and also to an increased risk of preterm delivery of a low-birthweight infant in the context of lower Genital Tract Infection.
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Racial disparity in risk of preterm birth associated with lower Genital Tract Infection.
Paediatric and perinatal epidemiology, 2007Co-Authors: Jane Hitti, Robert P Nugent, Doris M Boutain, Carolyn Gardella, Sharon L Hillier, David A EschenbachAbstract:Summary The objective of this study was to examine the associations between lower Genital Tract Infection, racial group and preterm birth in the Vaginal Infections and Prematurity Study, a large prospective cohort study conducted between 1984 and 1989. This analysis included 11 910 women enrolled at 23–26 weeks' gestation with equal representation from self-identified African American, Hispanic and white women. Subjects were screened for Chlamydia trachomatis, Trichomonas vaginalis and bacterial vaginosis at study entry, and their pregnancy outcomes were ascertained after delivery. The primary outcome of interest was preterm delivery of a low-birthweight infant (
Harold C. Wiesenfeld - One of the best experts on this subject based on the ideXlab platform.
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analysis of factors driving incident and ascending Infection and the role of serum antibody in chlamydia trachomatis Genital Tract Infection
The Journal of Infectious Diseases, 2016Co-Authors: Ali N Russell, Sharon L Hillier, Harold C. Wiesenfeld, Catherine M Oconnell, Xiaojing Zheng, Brandie D Taylor, Wujuan Zhong, Toni DarvilleAbstract:Background. Chlamydia trachomatis Genital Tract Infection is a major cause of female reproductive morbidity. Risk factors for ascending Infection are unknown, and the role for antibody in protection is not well established. Methods. We recruited 225 women from urban outpatient clinics and followed them for a median of 12 months. We performed a cross-sectional analysis of serum anti-chlamydial immunoglobulin G (IgG), behavioral factors, and microbiological factors associated with endometrial Infection at enrollment, and a longitudinal analysis of factors associated with incident Infection. Results. Oral contraceptives (adjusted relative risk [RR], 2.02 [95% confidence interval {CI}, 1.38–2.97]) and gonorrhea (adjusted RR, 1.66 [95% CI, 1.07–2.60]) were associated with endometrial Infection. Gonorrhea (adjusted hazard ratio [HR], 3.09 [95% CI, 1.41–6.78]), cervical Infection at enrollment (adjusted HR, 2.33 [95% CI, 1.07–5.11]), and exposure to uncircumcised partners (adjusted HR, 2.65 [95% CI, 1.21–5.82]) or infected partners (adjusted HR, 4.99 [95% CI, 2.66–9.39]) significantly increased the risk of incident Infection. Seropositivity was associated with a reduced cervical burden (P < .05) but no differences in rates of ascending Infection (adjusted RR, 1.24 [95% CI, .71–2.19]) or incident Infection (adjusted HR, 0.94 [95% CI, .52–1.69]). Conclusions. Serum anti-chlamydial IgG is not associated with a lowered rate of ascending or repeat Infection. Identification of factors associated with ascending Infection and increased risk of incident Infection provide guidance for targeted screening of women at increased risk for sequelae.
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predictive value of the clinical diagnosis of lower Genital Tract Infection in women
American Journal of Obstetrics and Gynecology, 2004Co-Authors: Daniel V Landers, Marijane A Krohn, Harold C. Wiesenfeld, Phillip R Heine, Sharon L HillierAbstract:AbsTract Objective We hypothesized that diagnostic approaches to lower Genital Tract Infections are inaccurate and proposed this study to evaluate typical approaches. Study design Clinical diagnoses were made with symptoms, direct observation, wet mount, vaginal pH, and amines in 598 women with Genital complaints. Laboratory testing for N gonorrhoeae , yeast, T vaginalis , C trachomatis , and bacterial vaginosis by Gram stain. Results The most frequent symptoms were vaginal discharge (64%), change in discharge (53%), malodor (48%), and pruritis (32%). The Infection rates were 46% bacterial vaginosis, 29% yeast, 12% trichomoniasis, 11% chlamydia or gonorrhea; 21% of the patients had no Infection. The symptoms did not predict laboratory diagnosis. Clinical signs and symptoms with office-based tests and microscopy improved the accuracy of diagnoses. Amsel's clinical diagnosis of bacterial vaginosis was the most sensitive at 92%. The sensitivity of wet mount diagnosis of trichomoniasis was 62%, of yeast by microscopy was 22%, and of mucopus for the prediction of gonorrhea and/or chlamydia was 30%. Conclusion Symptoms alone should not be used to direct treatment in instances in which resources permit more complete evaluation with office-based testing that includes microscopy. Treatment failures or diagnostic uncertainty should prompt specific laboratory testing.
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vaginal polymorphonuclear leukocytes and bacterial vaginosis as markers for histologic endometritis among women without symptoms of pelvic inflammatory disease
American Journal of Obstetrics and Gynecology, 2003Co-Authors: Mark H Yudin, Sharon L Hillier, Harold C. Wiesenfeld, Marijane A Krohn, A Amortegui, Richard L SweetAbstract:AbsTract 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. Results: Vaginal neutrophils were present in 240 (44.7%) and histologic endometritis was present in 77 (14.3%) of the study population. Women with histologic endometritis were significantly more likely to have vaginal neutrophils present, with an odds ratio of 3.2 (95% CI 1.9-5.7). When study subjects were stratified by the presence of sexually transmitted diseases and vaginal neutrophils, the prevalence of histologic endometritis was highest in women with both conditions present, with an odds ratio of 7.0 (95% CI 3.5-14.3). When subjects were stratified by the presence of bacterial vaginosis and vaginal neutrophils, the prevalence of histologic endometritis was again highest in women with both conditions present, with an odds ratio of 4.8 (95% CI 1.4-16.3). The presence of vaginal neutrophils diagnosed by saline wet mount had a high sensitivity (90.9%) and negative predictive value (94.5%), but a low specificity (26.3%) and positive predictive value (17.1%) for the diagnosis of upper Genital Tract Infection. Conclusion: The presence of vaginal polymorphonuclear leukocytes has a high sensitivity and negative predictive value for the diagnosis of upper Genital Tract Infection. (Am J Obstet Gynecol 2003;188:318-23.)
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lower Genital Tract Infection and endometritis insight into subclinical pelvic inflammatory disease
Obstetrics & Gynecology, 2002Co-Authors: Harold C. Wiesenfeld, Sharon L Hillier, Antonio J. Amortegui, Marijane A Krohn, Phillips R Heine, Daniel V Landers, Richard L SweetAbstract: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. METHODS: We conducted a cross-sectional study among women attending a sexually transmitted diseases or ambulatory gynecology clinic. A convenience sample of 556 women with bacterial vaginosis, gonorrhea, or chlamydia, or women at risk for gonorrhea or chlamydia were enrolled. Women diagnosed with acute PID were not eligible to participate. The main outcome was subclinical PID, as defined by the presence of histologic endometritis. RESULTS: Subclinical PID was more common in women with lower Genital Tract Infection than in uninfected women. Subclinical PID was present in 27% of women with Chlamydia trachomatis (odds ratio 3.4; 95% confidence interval [CI] 1.8, 6.3) and in 26% of women infected with Neisseria gonorrhoeae (odds ratio 2.4; 95% CI 1.1, 5.1). Among women with bacterial vaginosis, 15% had endometritis (odds ratio 2.7; 95% CI 1.02, 7.2). CONCLUSION: Subclinical PID is common among women with lower Genital Tract Infections. Additional prospective studies are necessary to determine the reproductive impact of these asymptomatic upper Genital Tract Infections.
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Factors Predicting Upper Genital Tract Inflammation among Women with Lower Genital Tract Infection
Journal of women's health, 1998Co-Authors: Deborah B. Nelson, Jeffrey F. Peipert, Roberta B. Ness, David E. Soper, Antonio J. Amortegui, Julie Gluck, Harold C. Wiesenfeld, Peter A. RiceAbstract:This study identified factors that discriminate between women with a lower Genital Tract Infection (LGTI) and women with a LGTI and endometritis. Study samples included 214 women of which 84.6% were African American with a mean age of 24.2 years who were at risk for LGTI with Chlamydia trachomatis or Neisseria gonorrhea. The primary comparison was between women having a lower Genital Tract Infection without endometritis and women having a lower Genital Tract Infection with endometritis. Women with LGTI and endometritis were older and reported a history of more sexually transmitted diseases abdominal pain and use of barrier methods of contraception than women with LGTI alone. The regression model found that women with LGTI and endometritis were 7.1 times more likely to report abdominal pain and 4.6 times more likely to use barrier methods of contraception than women with LGTI alone. The results indicate that behavioral factors in addition to symptoms can be used to identify women with and without upper Genital Tract involvement.
Toni Darville - One of the best experts on this subject based on the ideXlab platform.
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t cell independent gamma interferon and b cells cooperate to prevent mortality associated with disseminated chlamydia muridarum Genital Tract Infection
Infection and Immunity, 2018Co-Authors: Taylor B Poston, Jeanne E Sullivan, Uma M Nagarajan, Amy M Scurlock, Catherine M Oconnell, Jenna Girardi, Anthony D Marinov, Toni DarvilleAbstract:CD4 T cells and antibody are required for optimal acquired immunity to Chlamydia muridarum Genital Tract Infection, and T cell-mediated gamma interferon (IFN-γ) production is necessary to clear Infection in the absence of humoral immunity. However, the role of T cell-independent immune responses during primary Infection remains unclear. We investigated this question by inoculating wild-type and immune-deficient mice with C. muridarum CM001, a clonal isolate capable of enhanced extraGenital replication. Genital inoculation of wild-type mice resulted in transient dissemination to the lungs and spleen that then was rapidly cleared from these organs. However, CM001 Genital Infection proved lethal for STAT1-/- and IFNG-/- mice, in which IFN-γ signaling was absent, and for Rag1-/- mice, which lacked T and B cells and in which innate IFN-γ signaling was retained. In contrast, B cell-deficient muMT mice, which can generate a Th1 response, and T cell-deficient mice with intact B cell and innate IFN-γ signaling survived. These data collectively indicate that IFN-γ prevents lethal CM001 dissemination in the absence of T cells and suggests a B cell corequirement. Adoptive transfer of convalescent-phase immune serum but not naive IgM to Rag1-/- mice infected with CM001 significantly increased the survival time, while transfer of naive B cells completely rescued Rag1-/- mice from CM001 lethality. Protection was associated with a significant reduction in the lung chlamydial burden of Genitally infected mice. These data reveal an important cooperation between T cell-independent B cell responses and innate IFN-γ in chlamydial host defense and suggest that interactions between T cell-independent antibody and IFN-γ are essential for limiting extraGenital dissemination.
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analysis of factors driving incident and ascending Infection and the role of serum antibody in chlamydia trachomatis Genital Tract Infection
The Journal of Infectious Diseases, 2016Co-Authors: Ali N Russell, Sharon L Hillier, Harold C. Wiesenfeld, Catherine M Oconnell, Xiaojing Zheng, Brandie D Taylor, Wujuan Zhong, Toni DarvilleAbstract:Background. Chlamydia trachomatis Genital Tract Infection is a major cause of female reproductive morbidity. Risk factors for ascending Infection are unknown, and the role for antibody in protection is not well established. Methods. We recruited 225 women from urban outpatient clinics and followed them for a median of 12 months. We performed a cross-sectional analysis of serum anti-chlamydial immunoglobulin G (IgG), behavioral factors, and microbiological factors associated with endometrial Infection at enrollment, and a longitudinal analysis of factors associated with incident Infection. Results. Oral contraceptives (adjusted relative risk [RR], 2.02 [95% confidence interval {CI}, 1.38–2.97]) and gonorrhea (adjusted RR, 1.66 [95% CI, 1.07–2.60]) were associated with endometrial Infection. Gonorrhea (adjusted hazard ratio [HR], 3.09 [95% CI, 1.41–6.78]), cervical Infection at enrollment (adjusted HR, 2.33 [95% CI, 1.07–5.11]), and exposure to uncircumcised partners (adjusted HR, 2.65 [95% CI, 1.21–5.82]) or infected partners (adjusted HR, 4.99 [95% CI, 2.66–9.39]) significantly increased the risk of incident Infection. Seropositivity was associated with a reduced cervical burden (P < .05) but no differences in rates of ascending Infection (adjusted RR, 1.24 [95% CI, .71–2.19]) or incident Infection (adjusted HR, 0.94 [95% CI, .52–1.69]). Conclusions. Serum anti-chlamydial IgG is not associated with a lowered rate of ascending or repeat Infection. Identification of factors associated with ascending Infection and increased risk of incident Infection provide guidance for targeted screening of women at increased risk for sequelae.
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cd4 t cell expression of myd88 is essential for normal resolution of chlamydia muridarum Genital Tract Infection
Journal of Immunology, 2013Co-Authors: Lauren C Frazer, Jeanne E Sullivan, Matthew A Zurenski, Margaret Mintus, Tammy E Tomasak, Daniel Prantner, Uma M Nagarajan, Toni DarvilleAbstract:Resolution of Chlamydia Genital Tract Infection is delayed in the absence of MyD88. In these studies, we first used bone marrow chimeras to demonstrate a requirement for MyD88 expression by hematopoietic cells in the presence of a wild-type epithelium. Using mixed bone marrow chimeras we then determined that MyD88 expression was specifically required in the adaptive immune compartment. Furthermore, adoptive transfer experiments revealed that CD4+ T cell expression of MyD88 was necessary for normal resolution of Genital Tract Infection. This requirement was associated with a reduced ability of MyD88−/−CD4+ T cells to accumulate in the draining lymph nodes and Genital Tract when exposed to the same inflammatory milieu as wild-type CD4+ T cells. We also demonstrated that the impaired Infection control we observed in the absence of MyD88 could not be recapitulated by deficiencies in TLR or IL-1R signaling. In vitro, we detected an increased frequency of apoptotic MyD88−/−CD4+ T cells upon activation in the absence of exogenous ligands for receptors upstream of MyD88. These data reveal an intrinsic requirement for MyD88 in CD4+ T cells during Chlamydia Infection and indicate that the importance of MyD88 extends beyond innate immune responses by directly influencing adaptive immunity.
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interleukin 17 contributes to generation of th1 immunity and neutrophil recruitment during chlamydia muridarum Genital Tract Infection but is not required for macrophage influx or normal resolution of Infection
Infection and Immunity, 2011Co-Authors: Amy M Scurlock, Lauren C Frazer, Charles W Andrews, Catherine M Oconnell, Isaac P Foote, Sarabeth L Bailey, Kumar Chandrakuntal, Jay K Kolls, Toni DarvilleAbstract:ABSTract Interleukin 17 (IL-17) contributes to development of Th1 immunity and neutrophil influx during Chlamydia muridarum pulmonary Infection, but its role during C. muridarum Genital Tract Infection has not been described. We detected similar numbers of Chlamydia-specific Th17 and Th1 cells in iliac nodes of wild-type mice early during Genital C. muridarum Infection, while Th1 cells predominated later. il17ra−/− mice exhibited a reduced chlamydia-specific Th1 response in draining iliac nodes and decreased local IFN-γ production. Neutrophil influx into the Genital Tract was also decreased. However, il17ra−/− mice resolved Infection normally, and no difference in pathology was observed compared to the wild type. Macrophage influx and tumor necrosis factor alpha (TNF-α) production were increased in il17ra−/− mice, providing a compensatory mechanism to effectively control chlamydial Genital Tract Infection despite a reduced Th1 response. In ifnγ−/− mice, a marked increase in cellular infiltrates and chronic pathology was associated with an increased Th17 response. Although neutralization of IL-17 in ifnγ−/− mice decreased neutrophil influx, macrophage infiltration remained intact and the bacterial burden was not increased. Collectively, these results indicate that IL-17 contributes to the generation of Th1 immunity and neutrophil recruitment but is not required for macrophage influx or normal resolution of C. muridarum Genital Infection. These data highlight the redundant immune mechanisms operative at this mucosal site and the importance of examining site-specific responses to mucosal pathogens.
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toll like receptor 2 but not toll like receptor 4 is essential for development of oviduct pathology in chlamydial Genital Tract Infection
Journal of Immunology, 2003Co-Authors: Toni Darville, Uma M Nagarajan, Joshua M Oneill, Charles W Andrews, Lynn Stahl, David M OjciusAbstract:The roles of Toll-like receptor (TLR) 2 and TLR4 in the host inflammatory response to Infection caused by Chlamydia trachomatis have not been elucidated. We examined production of TNF-α and IL-6 in wild-type TLR2 knockout (KO), and TLR4 KO murine peritoneal macrophages infected with the mouse pneumonitis strain of C. trachomatis . Furthermore, we compared the outcomes of Genital Tract Infection in control, TLR2 KO, and TLR4 KO mice. Macrophages lacking TLR2 produced significantly less TNF-α and IL6 in response to active Infection. In contrast, macrophages from TLR4 KO mice consistently produced higher TNF-α and IL-6 responses than those from normal mice on in vitro Infection. Infected TLR2-deficient fibroblasts had less mRNA for IL-1, IL-6, and macrophage-inflammatory protein-2, but TLR4-deficient cells had increased mRNA levels for these cytokines compared with controls, suggesting that ligation of TLR4 by whole chlamydiae may down-modulate signaling by other TLRs. In TLR2 KO mice, although the course of Genital Tract Infection was not different from that of controls, significantly lower levels of TNF-α and macrophage-inflammatory protein-2 were detected in Genital Tract secretions during the first week of Infection, and there was a significant reduction in oviduct and mesosalpinx pathology at late time points. TLR4 KO mice responded to in vivo Infection similarly to wild-type controls and developed similar pathology. TLR2 is an important mediator in the innate immune response to C. trachomatis Infection and appears to play a role in both early production of inflammatory mediators and development of chronic inflammatory pathology.