SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
In a three-year prospective clinical study, 42 children aged between 1 and 12 years were found to have gonococcal vulvovaginitis. Epidemiological investigations showed that contaminated fomites--particularly bedclothing, underclothing, and towels--and precocious sexual intercourse were the important vehicles of transmission of gonococci to the genital tract of these children.
Chlamydia trachomatis is found worldwide and is probably the most common sexually transmitted disease, infecting both females and males, adults as well as children. The organism is responsible for a variety of infections in women--urethral syndrome, cervicitis, endometritis and salpingitis. C. trachomatis may colonize the lower genital tract and result in asymptomatic infection, ultimately resulting in sterility. In addition, infection of the female genital tract during pregnancy may result in spontaneous abortion, premature labor, postpartum endometritis, neonatal conjunctivitis or pneumonia.
Sexually transmitted diseases (STDs) are a major cause of ill health in women and their sexual partners and children. Contraceptive methods alter in various ways the risk of acquiring STD but assessment of the odds ratio is difficult due to the many confounding factors. Spermicides have been reported to kill a wide range of bacteria and viruses including HIV in vitro and to protect in vivo from infection by gonorrhoea, chlamydia and pelvic inflammatory disease (organisms unspecified). Spermicides will not cure pre-existing infections. Condoms and diaphragms will give some protection from bacterial and viral infections in all parts of the genital tract. Hormonal contraception and tubal ligation give protection to the upper genital tract but not the cervix. Carcinoma of the cervix follows the same pattern as STDs. The risk of pelvic infection in intrauterine device users is discussed in the chapter by Bromham (pp 100-123, this issue).
The purpose of this study was to find a barrier contraceptive agent capable of controlling infections and sexual transmission of Ureaplasma urealyticum from the female genital tract, especially to help reduce nongonococcal urethritis in males caused by this organism. Therefore, the in vitro antimicrobial activity of six intravaginal contraceptives and BetadineR against the eight serotypes of the organism was investigated. The results indicate that some of these contraceptives produce partial inhibition of the Ureaplasma at low dilutions, while BetadineR produces a ureaplasmacidal effect up to dilutions of 1:64. These effects appear not to be due primarily to the pH of these agents. Thus, some of these agents may have a potential role in controlling transmission of Ureaplasma urealyticum.
Coincident with the epidemic of sexually transmitted diseases, the incidence of pelvic inflammatory disease has risen sharply in recent years. Pelvic inflammatory disease is a major direct cause of infertility; in addition, it leads to ectopic pregnancies and chronic inflammatory residua requiring surgical intervention. This threat to the future fertility of women is rendered more serious by the difficulty of making a correct diagnosis and the likelihood that faulty diagnosis will result in inadequate treatment. Pelvic inflammatory disease is caused not only by Neisseria gonorrhoeae but also by Chlamydia trachomatis, genital tract mycoplasmas, and mixed bacteria from the endogenous vaginal and cervical flora, especially anaerobes. Diagnostic criteria include (1) lower abdominal and pelvic pain, (2) lower abdominal tenderness, (3) elevation of erythrocyte sedimentation rate, (4) adnexal inflammatory mass, and (5) presence of leukocytes and bacteria in the peritoneal fluid. Early diagnosis and prompt treatment appear to be crucial in preventing infertility. No studies have evaluated prospectively the relative advantages of inpatient vs. outpatient management of acute pelvic inflammatory disease. The recommendations of the Centers for Disease Control (CDC; Atlanta, Ga.) for outpatient treatment and the results of a multi-hospital collaborative study using the CDC regimens are discussed. Criteria for hospitalization and parenteral antibiotic therapy are presented.
As a corollary to a case-control study evaluating the risk of pelvic inflammatory disease (PID) among users of an intrauterine contraceptive device (IUD), Papanicolaou smears were studied to detect the presence of actinomycetes. Forty-six PID case patients and 108 control patients were included in the corollary study. The presence of actinomycetes was noted only among current or past wearers of an IUD. Women with actinomycetes present on Papanicolaou smear had a 3.6-fold risk of hospitalization for PID, as compared to women without actinomycetes. This trend persisted when only IUD users were evaluated. Of patients with PID who had actinomycetes noted on the Papanicolaou smear, 87 1/2% had a tuboovarian abscess, compared to 28.9% of patients without actinomycetes. In addition, patients with actinomycetes present had PID treated surgically more frequently.
In a study of 3794 consecutive women attending a gynaecological outpatient clinic with symptoms of lower genital tract infection (LGTI) 350 (9.2%) harboured Chlamydia trachomatis and 83 (2.2%) Neisseria gonorrhoeae. One hundred and ninety-five patients who were later found to have acute salpingitis and 109 other women in whom the chlamydial cultures were spoiled were excluded from the series. Of the remaining 3490 women, 281 were infected with C trachomatis, 42 with N gonorrhoeae, and 17 with both. Of the 3150 women who were infected with neither organism, 146 were randomly selected as controls. The chlamydia-positive patients were younger (P less than 0.001), did not complain of pelvic discomfort or pain (P less than 0.01), and used oral contraceptives (P less than 0.001) more frequently than did the controls; intrauterine devices were used more often (P less than 0.01) by the controls. Increased vaginal discharge was reported significantly more often in chlamydia-positive patients than in the controls (P less than 0.05). Of 266 women harbouring C trachomatis the organism was still present in 22 (8.3%) when they were followed up from two to more than eight weeks after finishing treatment with doxycycline. Of 91 male consorts of chlamydia-positive women, 53 (58.2%) were infected with C trachomatis.
Pelvic inflammatory disease is not a reportable condition in the United States. Based on data extracted from the Hospital Discharge Survey conducted by the National Center for Health Statistics, this article presents estimates of the frequency and distribution of PID in short-stay hospitals from 1970 through 1975.
We reviewed Cook County Hospital records of 134 consecutive patients hospitalized for acute pelvic inflammatory disease unrelated to intrauterine devices, delivery, or pelvic surgery. Nearly half our patients had peritonitis or a pelvic mass and most were young or nulliparous. Neisseria gonorrhoeae was recovered from the endocervices of 41 (34%) of 120 patients and was more common among younger patients. Most patients responded to antibiotic therapy; consequently, we recommend antibiotic treatment for acute PID unless surgical emergencies cannot be excluded or patients do not improve with antibiotic therapy alone.
We studied the relationships of selected microbial, clinical, demographic, and behavioral variables to mucopurulent cervicitis in two clinical settings, a sexually transmitted disease clinic and a student health clinic. From each clinic, we studied a group of women referred for suspected mucopurulent cervicitis and a representative sample of other women attending the clinic. After the women were stratified by patient group and summary odds ratios for all groups were obtained, mucopurulent cervicitis was most strongly associated with the isolation of Chlamydia trachomatis; other variables associated with mucopurulent cervicitis included the isolation of Ureaplasma urealyticum, Gardnerella vaginalis, and Trichomonas vaginalis, the presence of serum antibody to C. trachomatis, the clinical diagnosis of bacterial vaginosis, and oral contraceptive use (positive associations) or isolation of yeast (negative association). After adjustment for cervical culture results for C. trachomatis, mucopurulent cervicitis was positively associated with oral contraceptive use (p = 0.02) and isolation of U. urealyticum (p = 0.02) and negatively associated with isolation of yeast (p = 0.03). Among women with a positive cervical culture for C. trachomatis, isolation of U. urealyticum was significantly associated with mucopurulent cervicitis, while among the subgroup of women with a negative cervical culture for C. trachomatis and positive serum antibody to C. trachomatis, oral contraceptive use was strongly associated with mucopurulent cervicitis. These results confirm that in both clinical settings C. trachomatis is the major cause of mucopurulent cervicitis. The roles of U. urealyticum, T. vaginalis, G. vaginalis, bacterial vaginosis, and oral contraceptive use in the etiology of mucopurulent cervicitis deserve further study.
The incidence of gonorrhea was investigated in an abortion population. A total of 1021 women participated in this study. Three asymptomatic cases of gonorrhea were detected. None of these women had had gonorrhea before or had a previous abortion. No relation was found between the incidence of gonorrhea and age. The abortion population in our community cannot be considered to be a high-risk group for gonorrhea. In our opinion, this low incidence neither justifies routine gonococcal culture nor the prophylactic use of antibiotics in the abortion population.
During the period June 1989 to March 1991, laboratory evidence of sexually transmitted diseases (STDs) was found in 107 patients at the Red Cross War Memorial Children's Hospital in Cape Town. Data was available on 96 patients aged 23 months to 14 years (mean 75.9 months). Vaginal discharge was the most frequent presenting symptom (76%), particularly in those less than 5 years of age (90%). Although a history of abuse was not given on presentation in 62%, evidence of abuse was subsequently elicited in 67% of patients. Neisseria gonorrhoeae was the most common sexual pathogen (61 isolates, 8 penicillin resistant), followed by G vaginalis (17 isolates), Trichomonas vaginalis (7 infections), and T pallidum (9 TPHA positive, 5 with VDRL 1:4 or higher). Chlamydia trachomatis was demonstrated by immunofluorescence in 14 children. Multiple STDs were demonstrated in 10 patients. Although evidence of CSA was not found in all patients with STDs it was likely that the vast majority of patients had acquired these infections by CSA. Symptomatic prepubertal children with G vaginalis isolates should be investigated for CSA. Chlamydial immunofluorescence tests did not assist the diagnosis of CSA in children and should not be used, as they have no medicolegal significance.
Perihepatic adhesions are often considered to be associated with pelvic inflammatory disease and subsequent infertility. Seventeen patients out of 100 undergoing elective laparoscopic sterilization had evidence of perihepatic adhesions. Four of the 17 showed evidence of old pelvic inflammatory disease, but only two gave a history of sexually transmitted disease. All patients had a negative gonorrhea culture and 50 also had a negative chlamydia culture before the procedure. These data suggest that perihepatic adhesions may be observed in otherwise normal fertile women, and its presence does not necessarily imply pelvic inflammatory disease or poor fertility.
The objective of this study was to compare sexually transmitted disease (STD) occurrence and STD complaints in women using intrauterine device (IUD) with women who are not using any modern contraceptive method in a family planning setting in Trabzon, Turkey. A great majority of all women in both groups were housewives and all indicated their husbands as the first and only lifetime sexual partner. The IUD user group (n = 211) did not differ significantly from the nonuser group (n = 155) in terms of mean age, years of schooling, first age at intercourse, frequency of sexual intercourse or practice of vaginal douching (p >0.05). STD signs and symptoms were not found to be significantly different among both groups, with the exception of vaginal discharge. IUD users complained more of abnormal vaginal discharge than nonusers (RR = 2.09, CI = 1.17-3.75, p = 0.007). Bacterial vaginosis was diagnosed with the Gram-staining of the vaginal smear and current IUD users were found to be 2.78 times more likely to be diagnosed with bacterial vaginosis as compared to nonusers (p <0.00). The diagnosis of trichomoniasis, N. gonorrhea, vulvovaginal candidiasis, and Chlamydia was not found to be associated with IUD use.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.