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Roberta B Ness - One of the best experts on this subject based on the ideXlab platform.
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Presence and Concentrations of Select Bacterial Vaginosis-Associated Bacteria Are Associated With Increased Risk of Pelvic Inflammatory Disease.
Sexually transmitted diseases, 2020Co-Authors: Catherine L Haggerty, Roberta B Ness, Patricia A. Totten, Fouzia Farooq, Gong Tang, Xuezhou Hou, Tina L. Fiedler, Sujatha Srinivasan, Sabina G. AsteteAbstract:In a vaginal 16S ribosomal RNA gene quantitative PCR study of 17 Pelvic Inflammatory Disease (PID) cases and 17 controls who tested positive for Chlamydia trachomatis, women who additionally tested positive for Atopobium vaginae, Sneathia spp., Megasphaera spp., Eggerthella-like bacterium or Prevotella amnii were more likely to develop PID.
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identification of novel microbes associated with Pelvic Inflammatory Disease and infertility
Sexually Transmitted Infections, 2016Co-Authors: Catherine L Haggerty, Patricia A. Totten, Gong Tang, Sabina G. Astete, Debra C Bass, Brandie D Taylor, Michael J Ferris, Johana Norori, David H Martin, Roberta B NessAbstract:Objectives As Pelvic Inflammatory Disease (PID) aetiology is not completely understood, we examined the relationship between select novel bacteria, PID and long-term sequelae. Methods Fastidious bacterial vaginosis (BV)-associated bacteria ( Sneathia (Leptotrichia) sanguinegens , Sneathia amnionii , Atopobium vaginae and BV-associated bacteria 1 (BVAB1)), as well as Ureaplasma urealyticum and Ureaplasma parvum were identified in cervical and endometrial specimens using organism-specific PCR assays among 545 women enrolled in the PID Evaluation and Clinical Health study. Risk ratios and 95% CIs were constructed to determine associations between bacteria, histologically confirmed endometritis, recurrent PID and infertility, adjusting for age, race, gonorrhoea and chlamydia. Infertility models were additionally adjusted for baseline infertility. Results Persistent detection of BV-associated bacteria was common (range 58% for A. vaginae to 82% for BVAB1) and elevated the risk for persistent endometritis (RR adj 8.5, 95% CI 1.6 to 44.6) 30 days post-cefoxitin/doxycycline treatment, independent of gonorrhoea and chlamydia. In models adjusted for gonorrhoea and chlamydia, endometrial BV-associated bacteria were associated with recurrent PID (RR adj 4.7, 95% CI 1.7 to 12.8), and women who tested positive in the cervix and/or endometrium were more likely to develop infertility (RR adj 3.4, 95% CI 1.1 to 10.4). Associations between ureaplasmas and PID sequelae were modest. Conclusions To our knowledge, this is the first prospective study to demonstrate that S. sanguinegens , S. amnionii , BVAB1 and A. vaginae are associated with PID, failure of the Centers for Disease Control and Prevention-recommended treatment to eliminate short-term endometritis, recurrent PID and infertility. Optimal antibiotic regimens for PID may require coverage of novel BV-associated microbes.
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adverse adolescent reproductive health outcomes after Pelvic Inflammatory Disease
JAMA Pediatrics, 2011Co-Authors: Maria Trent, Catherine L Haggerty, Jacky M Jennings, Sunghee Lee, Debra C Bass, Roberta B NessAbstract:Objective To compare longitudinal adolescent and adult reproductive outcomes after Pelvic Inflammatory Disease (PID). Design Secondary analysis of longitudinal data from the Pelvic Inflammatory Disease Evaluation and Clinical Health study. Setting A large multicenter randomized clinical trial assessing PID treatment strategies in the United States. Participants Eight hundred thirty-one female patients aged 14 to 38 years with a diagnosis of PID. Main Exposure Adverse longitudinal outcomes were compared in adolescents (≤19 years) and adults (>19 years). Outcome Measures Primary outcome measures included recurrent sexually transmitted infection at 30 days, recurrent PID, chronic abdominal pain, infertility, pregnancy, and times to recurrent PID and pregnancy. Cox proportional hazards modeling was used to examine the effect of young age on times to pregnancy and recurrent PID. Results Adolescents were more likely than adults to have positive results of sexually transmitted infection testing at baseline and at 30 days. There were no significant group differences in chronic abdominal pain, infertility, and recurrent PID at 35 or 84 months, but adolescents were more likely to have a pregnancy at both time points. Adjusted hazard ratios (95% confidence intervals) also demonstrated that adolescents had shorter times to pregnancy (1.48 [1.18-1.87]) and recurrent Pelvic Inflammatory Disease (1.54 [1.03-2.30]). Conclusion Adolescents may require a different approach to clinical care and follow-up after PID to prevent recurrent sexually transmitted infections, recurrent PID, and unwanted pregnancies.
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chlamydia antibodies chlamydia heat shock protein and adverse sequelae after Pelvic Inflammatory Disease the pid evaluation and clinical health peach study
Sexually Transmitted Diseases, 2008Co-Authors: Roberta B Ness, Jeffrey Peipert, Hugh Randall, David E. Soper, Holly E Richter, Deborah B Nelson, Diane Schubeck, Gene S Mcneeley, Wayne Trout, Debra C BassAbstract:Background:Among women with Pelvic Inflammatory Disease (PID), we assessed the associations among antibodies to Chlamydia trachomatis elementary bodies (EB), antibodies to chlamydia heat shock protein (Chsp60), rates of pregnancy, and PID recurrence.Methods:Four hundred forty-three women with clinic
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newest approaches to treatment of Pelvic Inflammatory Disease a review of recent randomized clinical trials
Clinical Infectious Diseases, 2007Co-Authors: Catherine L Haggerty, Roberta B NessAbstract:Treatment of Pelvic Inflammatory Disease (PID) should provide high rates of clinical and microbiological cure for a range of pathogens and should ultimately prevent reproductive morbidity. Between 1992 and 2006, 5 randomized clinical trials of moxifloxacin (1 trial), ofloxacin (1 trial), clindamycin-ciprofloxacin (1 trial), and azithromycin (2 trials) treatment among women with mild to moderate PID were found to have clinical cure rates of 90%-97%. Trials of ofloxacin and clindamycin-ciprofloxacin reported rates of cure of Neisseria gonorrhoeae and Chlamydia trachomatis infection of 100%, although microbiological cure data for other pathogens were not presented. One azithromycin trial reported a 98% eradication of C. trachomatis, N. gonorrhoeae, Mycoplasma hominis, and anaerobes. Moxifloxacin exhibited high eradication rates for N. gonorrhoeae, C. trachomatis, M. hominis, Mycobacterium genitalium, and gram-negative anaerobes. Clinical cure rates from 2 doxycycline-metronidazole trials were low (35% and 55%). Although a handful of studies have shown that monotherapies for PID achieve high rates of clinical cure, the efficacy of these regimens in treating anaerobic PID and in preventing adverse reproductive sequelae is not fully elucidated.
Richard L. Sweet - One of the best experts on this subject based on the ideXlab platform.
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subclinical Pelvic Inflammatory Disease and infertility
Obstetrics & Gynecology, 2012Co-Authors: Harold C. Wiesenfeld, Antonio J Amortegui, Sharon L Hillier, Leslie A Meyn, Richard L. SweetAbstract: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 cervic
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treatment of acute Pelvic Inflammatory Disease
Infectious Diseases in Obstetrics & Gynecology, 2011Co-Authors: Richard L. SweetAbstract: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. Prevention of these long-term sequelae is dependent upon development of treatment strategies based on knowledge of the microbiologic etiology of acute PID. It is well accepted that acute PID is a polymicrobic infection. The sexually transmitted organisms, Neisseria gonorrhoeae and Chlamydia trachomatis, are present in many cases, and microorganisms comprising the endogenous vaginal and cervical flora are frequently associated with PID. This includes anaerobic and facultative bacteria, similar to those associated with bacterial vaginosis. Genital tract mycoplasmas, most importantly Mycoplasma genitalium, have recently also been implicated as a cause of acute PID. As a consequence, treatment regimens for acute PID should provide broad spectrum coverage that is effective against these microorganisms.
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a cluster analysis of bacterial vaginosis associated microflora and Pelvic Inflammatory Disease
American Journal of Epidemiology, 2005Co-Authors: Roberta B Ness, Richard L. Sweet, David E. Soper, Sharon L Hillier, Carol A Stamm, Peter A Rice, Holly E RichterAbstract:: 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. PID was defined as 1) histologic endometritis or 2) Pelvic pain and tenderness plus oral temperature >38.8 degrees C, leukorrhea or mucopus, erythrocyte sedimentation rate >15 mm/hour, white blood cell count >10,000, or gonococcal/chlamydial lower genital infection. Exploratory factor analysis identified two discrete clusters of genital microorganisms. The first correlated with BV by Gram's stain and consisted of the absence of hydrogen peroxide-producing lactobacillus, Gardnerella vaginalis, Mycoplasma hominis, anaerobic gram-negative rods, and, to a lesser degree, Ureaplasma urealyticum. The second, unrelated to BV by Gram's stain, consisted of Enterococcus species and Escherichia coli. Being in the highest tertile in terms of growth of BV-associated microorganisms increased PID risk (adjusted rate ratio = 2.03, 95% confidence interval: 1.16, 3.53). Carriage of non-BV-associated microorganisms did not increase PID risk. Women with heavy growth of BV-associated microorganisms and a new sexual partner appeared to be at particularly high risk (adjusted rate ratio = 8.77, 95% confidence interval: 1.11, 69.2). When identified by microbial culture, a combination of BV-related microorganisms significantly elevated the risk of acquiring PID.
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comparison of acute and subclinical Pelvic Inflammatory Disease
Sexually Transmitted Diseases, 2005Co-Authors: Harold C. Wiesenfeld, Antonio J Amortegui, Richard L. Sweet, Roberta B Ness, Marijane A Krohn, Sharon L HillierAbstract: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
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condom use and the risk of recurrent Pelvic Inflammatory Disease chronic Pelvic pain or infertility following an episode of Pelvic Inflammatory Disease
American Journal of Public Health, 2004Co-Authors: Roberta B Ness, Jeffrey Peipert, Hugh Randall, Richard L. Sweet, David E. Soper, Holly E Richter, Andrea Montagno, Deborah B Nelson, Diane SchubeckAbstract: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%. Self-reported persistent and consistent condom use was associated with lower rates of PID sequelae.
Harold C. Wiesenfeld - One of the best experts on this subject based on the ideXlab platform.
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pathogenesis diagnosis and management of severe Pelvic Inflammatory Disease and tuboovarian abscess
Clinical Obstetrics and Gynecology, 2012Co-Authors: Catherine A Chappell, Harold C. WiesenfeldAbstract:Severe Pelvic Inflammatory Disease and tuboovarian abscesses (TOAs) are common Pelvic infections requiring inpatient admission. There are few large randomized trials guiding appropriate clinical management of TOA, including antibiotic selection and timing of surgical management and drainage. The pathogenesis, diagnosis, and management of severe Pelvic Inflammatory Disease and TOA are summarized and reviewed from the most current literature.
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subclinical Pelvic Inflammatory Disease and infertility
Obstetrics & Gynecology, 2012Co-Authors: Harold C. Wiesenfeld, Antonio J Amortegui, Sharon L Hillier, Leslie A Meyn, Richard L. SweetAbstract: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 cervic
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the associations between Pelvic Inflammatory Disease trichomonas vaginalis infection and positive herpes simplex virus type 2 serology
Sexually Transmitted Diseases, 2006Co-Authors: Thomas L Cherpes, Harold C. Wiesenfeld, Leslie A Meyn, Melissa A Melan, Jeffrey A Kant, Lisa A Cosentino, Sharon L HillierAbstract:Objective: Roles for Chlamydia trachomatis and Neisseria gonorrhoeae infections in Pelvic Inflammatory Disease pathogenesis are well delineated; however, the etiologic contributions of herpes simplex virus type 2 (HSV-2) and Trichomonas vaginalis have been underexplored. Goal: The goal of this study was to investigate the association between acute and plasma cell endometritis, fallopian tube obstruction, HSV-2 serology, and T. vaginalis infection. Study Design: The authors conducted a cross-sectional secondary analysis of 736 women at risk for bacterial sexually transmitted Diseases that used endometrial biopsy data obtained at enrollment as well as hysterosalpingography results obtained 12 weeks after enrollment. Results: Women diagnosed with T. vaginalis at enrollment were more likely to have histologic evidence of acute endometritis. Both plasma cell and acute endometritis were significantly more common among women with positive serology HSV-2; furthermore, women coinfected with HSV-2 and C. trachomatis, N. gonorrhoeae, T. vaginalis, or bacterial vaginosis were much more likely to be diagnosed with acute endometritis than were women infected with HSV-2 or one of these pathogens alone. Among women with available HSV-2 serology and hysterosalpingogram results, HSV-2 was the only genital tract pathogen infection associated with fallopian tube obstruction. Conclusions: Our analyses demonstrate that T. vaginalis infection and positive HSV-2 serology are associated with endometritis. Further work will be needed to determine the specific roles these pathogens may play in Pelvic Inflammatory Disease pathogenesis. Pelvic Inflammatory Disease (PID) IS defined as an Inflammatory disorder of the female upper genital tract that includes variable combinations of endometritis, salpingitis, Pelvic peritonitis, and tuboovarian abscess. 1 Long-term sequelae of PID include tubal infertility, ectopic pregnancy, and chronic Pelvic pain. Neisseria gonorrhoeae, Chlamydia trachomatis, and endogenous facultative and anaerobic bacteria are frequently isolated from the upper genital tract of women with acute PID, but often times no putative etiologic agent is recovered. 2
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comparison of acute and subclinical Pelvic Inflammatory Disease
Sexually Transmitted Diseases, 2005Co-Authors: Harold C. Wiesenfeld, Antonio J Amortegui, Richard L. Sweet, Roberta B Ness, Marijane A Krohn, Sharon L HillierAbstract: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
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predictors of chronic Pelvic pain in an urban population of women with symptoms and signs of Pelvic Inflammatory Disease
Sexually Transmitted Diseases, 2005Co-Authors: Catherine L Haggerty, Robert L Holley, Jeffrey Peipert, Hugh Randall, Susan L Hendrix, David E. Soper, Harold C. Wiesenfeld, Deborah B Nelson, Sherry Weitzen, Roberta B NessAbstract:Objective:The objective of this study was to assess the risk profile for chronic Pelvic pain (CPP) after Pelvic Inflammatory Disease (PID).Study:Multivariate logistic regression was used to assess risk factors for CPP in a longitudinal study of 780 predominately black, urban women with clinically su
Catherine L Haggerty - One of the best experts on this subject based on the ideXlab platform.
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Presence and Concentrations of Select Bacterial Vaginosis-Associated Bacteria Are Associated With Increased Risk of Pelvic Inflammatory Disease.
Sexually transmitted diseases, 2020Co-Authors: Catherine L Haggerty, Roberta B Ness, Patricia A. Totten, Fouzia Farooq, Gong Tang, Xuezhou Hou, Tina L. Fiedler, Sujatha Srinivasan, Sabina G. AsteteAbstract:In a vaginal 16S ribosomal RNA gene quantitative PCR study of 17 Pelvic Inflammatory Disease (PID) cases and 17 controls who tested positive for Chlamydia trachomatis, women who additionally tested positive for Atopobium vaginae, Sneathia spp., Megasphaera spp., Eggerthella-like bacterium or Prevotella amnii were more likely to develop PID.
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identification of novel microbes associated with Pelvic Inflammatory Disease and infertility
Sexually Transmitted Infections, 2016Co-Authors: Catherine L Haggerty, Patricia A. Totten, Gong Tang, Sabina G. Astete, Debra C Bass, Brandie D Taylor, Michael J Ferris, Johana Norori, David H Martin, Roberta B NessAbstract:Objectives As Pelvic Inflammatory Disease (PID) aetiology is not completely understood, we examined the relationship between select novel bacteria, PID and long-term sequelae. Methods Fastidious bacterial vaginosis (BV)-associated bacteria ( Sneathia (Leptotrichia) sanguinegens , Sneathia amnionii , Atopobium vaginae and BV-associated bacteria 1 (BVAB1)), as well as Ureaplasma urealyticum and Ureaplasma parvum were identified in cervical and endometrial specimens using organism-specific PCR assays among 545 women enrolled in the PID Evaluation and Clinical Health study. Risk ratios and 95% CIs were constructed to determine associations between bacteria, histologically confirmed endometritis, recurrent PID and infertility, adjusting for age, race, gonorrhoea and chlamydia. Infertility models were additionally adjusted for baseline infertility. Results Persistent detection of BV-associated bacteria was common (range 58% for A. vaginae to 82% for BVAB1) and elevated the risk for persistent endometritis (RR adj 8.5, 95% CI 1.6 to 44.6) 30 days post-cefoxitin/doxycycline treatment, independent of gonorrhoea and chlamydia. In models adjusted for gonorrhoea and chlamydia, endometrial BV-associated bacteria were associated with recurrent PID (RR adj 4.7, 95% CI 1.7 to 12.8), and women who tested positive in the cervix and/or endometrium were more likely to develop infertility (RR adj 3.4, 95% CI 1.1 to 10.4). Associations between ureaplasmas and PID sequelae were modest. Conclusions To our knowledge, this is the first prospective study to demonstrate that S. sanguinegens , S. amnionii , BVAB1 and A. vaginae are associated with PID, failure of the Centers for Disease Control and Prevention-recommended treatment to eliminate short-term endometritis, recurrent PID and infertility. Optimal antibiotic regimens for PID may require coverage of novel BV-associated microbes.
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does bacterial vaginosis cause Pelvic Inflammatory Disease
Sexually Transmitted Diseases, 2013Co-Authors: Brandie D Taylor, Toni Darville, Catherine L HaggertyAbstract:Pelvic Inflammatory Disease (PID), the infection and inflammation of the female genital tract, results in serious reproductive morbidity including infertility and ectopic pregnancy. Bacterial vaginosis (BV) is a complex alteration of the vaginal flora that has been implicated in PID. The role of BV in the etiology and pathogenesis of PID has not been studied extensively. Our objective was to extensively review data related to the relationship between BV and PID (n = 19 studies). Several studies found a link between BV and cervicitis, endometritis, and salpingitis. Furthermore, it seems that some BV-associated organisms are associated with PID, whereas others are not. However, studies demonstrating an independent association between BV-associated organisms and PID are sparse. In addition, a causal association between BV and PID has not been established. Prospective studies are needed to further delineate the role of BV in PID, with particular focus on individual BV-associated organisms.
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mycoplasma genitalium an emerging cause of Pelvic Inflammatory Disease
Infectious Diseases in Obstetrics & Gynecology, 2011Co-Authors: Catherine L Haggerty, Brandie D TaylorAbstract:Mycoplasma genitalium is a sexually transmitted pathogen that is increasingly identified among women with Pelvic Inflammatory Disease (PID). Although Chlamydia trachomatis and Neisseria gonorrhoeae frequently cause PID, up to 70% of cases have an unidentified etiology. This paper summarizes evidence linking M. genitalium to PID and its long-term reproductive sequelae. Several PCR studies have demonstrated that M. genitalium is associated with PID, independent of gonococcal and chlamydial infection. Most have been cross-sectional, although one prospective investigation suggested that M. genitalium was associated with over a thirteenfold risk of endometritis. Further, a nested case-control posttermination study demonstrated a sixfold increased risk of PID among M. genitalium positive patients. Whether or not M. genitalium upper genital tract infection results in long-term reproductive morbidity is unclear, although tubal factor infertility patients have been found to have elevated M. genitalium antibodies. Several lines of evidence suggest that M. genitalium is likely resistant to many frequently used PID treatment regimens. Correspondingly, M. genitalium has been associated with treatment failure following cefoxitin and doxycycline treatment for clinically suspected PID. Collectively, strong evidence suggests that M. genitalium is associated with PID. Further study of M. genitalium upper genital tract infection diagnosis, treatment and long-term sequelae is warranted.
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adverse adolescent reproductive health outcomes after Pelvic Inflammatory Disease
JAMA Pediatrics, 2011Co-Authors: Maria Trent, Catherine L Haggerty, Jacky M Jennings, Sunghee Lee, Debra C Bass, Roberta B NessAbstract:Objective To compare longitudinal adolescent and adult reproductive outcomes after Pelvic Inflammatory Disease (PID). Design Secondary analysis of longitudinal data from the Pelvic Inflammatory Disease Evaluation and Clinical Health study. Setting A large multicenter randomized clinical trial assessing PID treatment strategies in the United States. Participants Eight hundred thirty-one female patients aged 14 to 38 years with a diagnosis of PID. Main Exposure Adverse longitudinal outcomes were compared in adolescents (≤19 years) and adults (>19 years). Outcome Measures Primary outcome measures included recurrent sexually transmitted infection at 30 days, recurrent PID, chronic abdominal pain, infertility, pregnancy, and times to recurrent PID and pregnancy. Cox proportional hazards modeling was used to examine the effect of young age on times to pregnancy and recurrent PID. Results Adolescents were more likely than adults to have positive results of sexually transmitted infection testing at baseline and at 30 days. There were no significant group differences in chronic abdominal pain, infertility, and recurrent PID at 35 or 84 months, but adolescents were more likely to have a pregnancy at both time points. Adjusted hazard ratios (95% confidence intervals) also demonstrated that adolescents had shorter times to pregnancy (1.48 [1.18-1.87]) and recurrent Pelvic Inflammatory Disease (1.54 [1.03-2.30]). Conclusion Adolescents may require a different approach to clinical care and follow-up after PID to prevent recurrent sexually transmitted infections, recurrent PID, and unwanted pregnancies.
Sharon L Hillier - One of the best experts on this subject based on the ideXlab platform.
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subclinical Pelvic Inflammatory Disease and infertility
Obstetrics & Gynecology, 2012Co-Authors: Harold C. Wiesenfeld, Antonio J Amortegui, Sharon L Hillier, Leslie A Meyn, Richard L. SweetAbstract: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 cervic
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the associations between Pelvic Inflammatory Disease trichomonas vaginalis infection and positive herpes simplex virus type 2 serology
Sexually Transmitted Diseases, 2006Co-Authors: Thomas L Cherpes, Harold C. Wiesenfeld, Leslie A Meyn, Melissa A Melan, Jeffrey A Kant, Lisa A Cosentino, Sharon L HillierAbstract:Objective: Roles for Chlamydia trachomatis and Neisseria gonorrhoeae infections in Pelvic Inflammatory Disease pathogenesis are well delineated; however, the etiologic contributions of herpes simplex virus type 2 (HSV-2) and Trichomonas vaginalis have been underexplored. Goal: The goal of this study was to investigate the association between acute and plasma cell endometritis, fallopian tube obstruction, HSV-2 serology, and T. vaginalis infection. Study Design: The authors conducted a cross-sectional secondary analysis of 736 women at risk for bacterial sexually transmitted Diseases that used endometrial biopsy data obtained at enrollment as well as hysterosalpingography results obtained 12 weeks after enrollment. Results: Women diagnosed with T. vaginalis at enrollment were more likely to have histologic evidence of acute endometritis. Both plasma cell and acute endometritis were significantly more common among women with positive serology HSV-2; furthermore, women coinfected with HSV-2 and C. trachomatis, N. gonorrhoeae, T. vaginalis, or bacterial vaginosis were much more likely to be diagnosed with acute endometritis than were women infected with HSV-2 or one of these pathogens alone. Among women with available HSV-2 serology and hysterosalpingogram results, HSV-2 was the only genital tract pathogen infection associated with fallopian tube obstruction. Conclusions: Our analyses demonstrate that T. vaginalis infection and positive HSV-2 serology are associated with endometritis. Further work will be needed to determine the specific roles these pathogens may play in Pelvic Inflammatory Disease pathogenesis. Pelvic Inflammatory Disease (PID) IS defined as an Inflammatory disorder of the female upper genital tract that includes variable combinations of endometritis, salpingitis, Pelvic peritonitis, and tuboovarian abscess. 1 Long-term sequelae of PID include tubal infertility, ectopic pregnancy, and chronic Pelvic pain. Neisseria gonorrhoeae, Chlamydia trachomatis, and endogenous facultative and anaerobic bacteria are frequently isolated from the upper genital tract of women with acute PID, but often times no putative etiologic agent is recovered. 2
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a cluster analysis of bacterial vaginosis associated microflora and Pelvic Inflammatory Disease
American Journal of Epidemiology, 2005Co-Authors: Roberta B Ness, Richard L. Sweet, David E. Soper, Sharon L Hillier, Carol A Stamm, Peter A Rice, Holly E RichterAbstract:: 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. PID was defined as 1) histologic endometritis or 2) Pelvic pain and tenderness plus oral temperature >38.8 degrees C, leukorrhea or mucopus, erythrocyte sedimentation rate >15 mm/hour, white blood cell count >10,000, or gonococcal/chlamydial lower genital infection. Exploratory factor analysis identified two discrete clusters of genital microorganisms. The first correlated with BV by Gram's stain and consisted of the absence of hydrogen peroxide-producing lactobacillus, Gardnerella vaginalis, Mycoplasma hominis, anaerobic gram-negative rods, and, to a lesser degree, Ureaplasma urealyticum. The second, unrelated to BV by Gram's stain, consisted of Enterococcus species and Escherichia coli. Being in the highest tertile in terms of growth of BV-associated microorganisms increased PID risk (adjusted rate ratio = 2.03, 95% confidence interval: 1.16, 3.53). Carriage of non-BV-associated microorganisms did not increase PID risk. Women with heavy growth of BV-associated microorganisms and a new sexual partner appeared to be at particularly high risk (adjusted rate ratio = 8.77, 95% confidence interval: 1.11, 69.2). When identified by microbial culture, a combination of BV-related microorganisms significantly elevated the risk of acquiring PID.
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comparison of acute and subclinical Pelvic Inflammatory Disease
Sexually Transmitted Diseases, 2005Co-Authors: Harold C. Wiesenfeld, Antonio J Amortegui, Richard L. Sweet, Roberta B Ness, Marijane A Krohn, Sharon L HillierAbstract: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
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lower genital tract infection and endometritis insight into subclinical Pelvic Inflammatory Disease
Obstetrics & Gynecology, 2002Co-Authors: Harold C. Wiesenfeld, Antonio J Amortegui, Sharon L Hillier, Marijane A Krohn, Phillips R Heine, 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.
