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Difficulties experienced in defining the microbial cause of pelvic inflammatory disease

Clinical assessment of women with pelvic pain was a poor indicator of disease seen at laparoscopy. Thus, of 109 women, 22 at laparoscopy had salpingitis, 19 had adhesions without salpingitis, 20 had endometriosis or ovarian pathology and 48 no observable abnormality. In all laparoscopic categories,...

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Published in:International journal of STD & AIDS 2012-01, Vol.23 (1), p.18-24
Main Authors: Taylor-Robinson, D, Jensen, J S, Svenstrup, H, Stacey, C M
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description Clinical assessment of women with pelvic pain was a poor indicator of disease seen at laparoscopy. Thus, of 109 women, 22 at laparoscopy had salpingitis, 19 had adhesions without salpingitis, 20 had endometriosis or ovarian pathology and 48 no observable abnormality. In all laparoscopic categories, Ureaplasma spp. and Mycoplasma hominis, but not Mycoplasma genitalium, were at least as common in the cervix/vagina as Chlamydia trachomatis and equally frequent in the endometrium. However, C. trachomatis had the greatest propensity for spread to the Fallopian tubes. Thus, of 28 women who had C. trachomatis organisms in the vagina/cervix, 13 had them in a Fallopian tube (ratio 2.2:1); the ratio was 6:1 for Neisseria gonorrhoeae, 8:1 for M. genitalium, 21:1 for M. hominis and 31:1 for Ureaplasma spp. M. hominis organisms in a large number were detected most often in women with salpingitis. The likelihood of spread of Ureaplasma urealyticum and U. parvum from the lower to the upper genital tract was about the same and they were detected only once each in a tube, which was not inflamed in either case. Multiple bacteria were often detected at a single site, making it difficult to establish the exact cause of disease. However N. gonorrhoeae was considered to be the sole cause of salpingitis in one woman and the primary or equal primary contributor in four others; C. trachomatis was involved in at least 11 women, mostly as the sole cause or as the primary contributor; M. genitalium was considered the cause in one woman and had possible involvement in three others; and M. hominis was a questionable sole cause in one woman and the primary or equal primary contributor in three. Serologically, C. trachomatis was related to adhesions, without salpingitis, more often (63%) than any other micro-organism. M. genitalium may have been implicated in one case. Serologically, a previous C. trachomatis infection was indicated in 40% of women without an observable laparoscopic abnormality. C. trachomatis in the endometrium and tubes of women without any laparoscopic abnormality suggests subclinical disease, endometritis or endosalpingitis. There was evidence for a smaller proportion (19%) of women without an abnormality having been infected previously with M. genitalium. To some extent this is consistent with the infrequency of acute M. genitalium infections in this cohort of women.
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Serologically, a previous C. trachomatis infection was indicated in 40% of women without an observable laparoscopic abnormality. C. trachomatis in the endometrium and tubes of women without any laparoscopic abnormality suggests subclinical disease, endometritis or endosalpingitis. There was evidence for a smaller proportion (19%) of women without an abnormality having been infected previously with M. genitalium. To some extent this is consistent with the infrequency of acute M. genitalium infections in this cohort of women.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>22362682</pmid><doi>10.1258/ijsa.2011.011066</doi><tpages>7</tpages></addata></record>
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subjects AIDS/HIV
Antibodies, Bacterial - blood
Bacterial diseases
Bacterial diseases of the genital system
Biological and medical sciences
Cervix Uteri - microbiology
Chlamydia trachomatis
Chlamydia trachomatis - immunology
Chlamydia trachomatis - isolation & purification
Epidemiology. Vaccinations
Fallopian Tubes - microbiology
Female
General aspects
Human bacterial diseases
Humans
Infectious diseases
Laparoscopes
Medical sciences
Mycoplasma genitalium
Mycoplasma genitalium - immunology
Mycoplasma genitalium - isolation & purification
Mycoplasma hominis
Mycoplasma hominis - immunology
Mycoplasma hominis - isolation & purification
Neisseria gonorrhoeae
Neisseria gonorrhoeae - immunology
Neisseria gonorrhoeae - isolation & purification
Pelvic Inflammatory Disease - complications
Pelvic Inflammatory Disease - microbiology
Pelvic Inflammatory Disease - surgery
Pelvic Pain - etiology
Salpingitis - complications
Salpingitis - microbiology
Serologic Tests
Tissue Adhesions - complications
Ureaplasma
Ureaplasma urealyticum
Ureaplasma urealyticum - immunology
Ureaplasma urealyticum - isolation & purification
Vagina - microbiology
title Difficulties experienced in defining the microbial cause of pelvic inflammatory disease
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