DOCSLIB.ORG

What Is Endometritis and Does It Require Treatment?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
What Is Endometritis and Does It Require Treatment? 252 EDITORIAL Sex Transm Infect: first published as 10.1136/sti.2004.009548 on 4 August 2004. Downloaded from ENDOMETRITIS does appear to increase the risk of ....................................................................................... endometritis being asymptomatic.7 One of the few features that has been linked to endometritis is the phase of What is endometritis and does it the menstrual cycle.68 In women pre- senting with lower abdominal pain, in require treatment? whom a diagnosis of PID is being queried, almost 80% have endometritis J D C Ross when they present in the first 3 weeks of the menstrual cycle, compared to ................................................................................... around 20% if they present in the final week of their cycle, just before men- The answer is not straightforward struation.8 This suggests that women are at highest risk of infection ascending he concept of lower genital tract serious effects on future fertility. This and causing endometrial inflammation infection with chlamydia or gonor- limits the clinical applicability of this just following their period, possibly Trhoea causing cervicitis and vaginal approach for making a diagnosis, as because of loss of the cervical mucous discharge is familiar to most sexual does the theoretical risk of introducing plug or hormonal changes affecting health physicians. Likewise, upper geni- infection into the upper genital tract local immune function. It also raises tal tract infection with inflammation of when taking the endometrial biopsy.2 the possibility that endometritis may, at the fallopian tubes and adnexae in the A more rapid assessment of endome- least in a subgroup of women, be a form of pelvic inflammatory disease trial inflammation can be obtained by transient phenomenon with sponta- (PID) is also a common clinical syn- looking at a Gram stained smear or wet neous clearance occurring within a few drome with well recognised implications mount of vaginal discharge. Increasing weeks. for future fertility. It is assumed that numbers of polymorphs in the discharge Vaginal douching has been linked most PID develops secondary to the are associated with endometritis, with a higher incidence of endometritis, spread of infection from the lower although the correlation is not particu- but only in those women who have genital tract, through the uterine cavity larly strong.3 The main purpose of douched recently or give a history of into the upper genital tract. What is less looking for pus cells in vaginal secre- frequent douching.9 It has been postu- certain, and where no clear guidance is tions lies more in excluding PID than lated that douching ‘‘washes away’’ the currently available, is whether this diagnosing it—the negative predictive normal vaginal flora, increasing the intermediate step of endometritis is a value of such an approach is around risk of bacterial vaginosis, which in distinct clinical condition in its own 95%, compared to positive predictive turn predisposes to endometritis. right and, if so, how it should be value of only around 20%. In other Interestingly, the association between diagnosed and treated. words the absence of pus cells makes douching and endometritis is only seen Endometritis is a pathological diag- endometritis (and PID) very unlikely, in those who do not have bacterial nosis with infiltration of the normal but their presence lacks specificity. vaginosis, which is somewhat against vascular architecture by inflammatory Other features on the vaginal smear this theory.9 This highlights the difficul- cells. Agreeing a precise histological such as reduced numbers of lactobacilli, ties of interpreting the relation between definition of endometritis is difficult may also support the diagnosis of upper genital tract infection and douch- http://sti.bmj.com/ since a variety of different features are endometritis but have not been rigor- ing since, until recently, the studies seen—the inflammatory infiltrate may ously assessed. have all been retrospective and therefore be confined to the surface epithelium or unable to attribute cause and effect. spread more deeply into the stroma; More recently, prospective data have One of the central questions in the inflammatory cells may comprise neu- been presented suggesting that women management of endometritis is trophils and/or plasma cells; and who douche are at no higher risk of whether endometritis and PID are lymphoid aggregates or subepithelial upper genital tract infection than those on September 26, 2021 by guest. Protected copyright. haemorrhages have also been reported. different aspects of the same dis- who do not (ISSTDR Meeting Ottawa, The features which correlate most ease, or separate clinical entities 2003, oral presentation 0052). It there- closely to ‘‘true’’ PID are the presence requiring different treatment and fore seems possible that PID itself may of both neutrophils and plasma cells, having a different prognosis make women more likely to douche leading to the most commonly accepted (rather than vice versa), with women definition of endometritis which is five Endometritis is commonly found in using douching to try to reduce the or more neutrophils per 400 power field women who have otherwise uncompli- symptoms (vaginal odour, discharge) in the superficial endometrium, in addi- cated lower genital tract infection. associated with their PID.10 tion to one or more plasma cells per 120 Around a quarter of women with One of the central questions that power field in the endometrial stroma.1 cervical gonorrhoea or chlamydia will needs to be addressed in determining Sampling of the endometrium is also have endometritis on endometrial the correct management of endometritis usually performed using a endometrial biopsy, as do 15% of women with is whether endometritis and PID are suction biopsy device, which is inserted bacterial vaginosis.4 Predicting which different aspects of the same disease, or through the cervix to obtain a small women will have endometritis as separate clinical entities requiring dif- piece of endometrial tissue. This is opposed to infection limited to the lower ferent treatment and having a different generally a simple, well tolerated proce- genital tract is difficult. The presence of prognosis. Endometritis is associated dure performed in an outpatient setting. endometritis is not associated with with abdominal pain6 and also with Unfortunately the fixing, staining, and behavioural or demographic features vaginal discharge, cervical tenderness, reporting of the endometrial sample such as age, ethnicity, condom use, or and pyrexia, albeit at a lower rate than takes several days and even small delays sex during menstruation.5 The use of the is seen with salpingitis.8 Endometritis in confirming the diagnosis and starting oral contraceptive pill does not itself also leads to elevations in the peripheral therapy for pelvic infection can have increase the risk of endometritis,6 but it white blood count and erythrocyte www.stijournal.com EDITORIAL 253 Sex Transm Infect: first published as 10.1136/sti.2004.009548 on 4 August 2004. Downloaded from sedimentation rate, which suggests that women with asymptomatic lower geni- 3 Yudin MH, Hillier SL, Wiesenfeld HC, et al. Vaginal polymorphonuclear leukocytes it is of clinical relevance. The presence of tal tract infections. It is often associated and bacterial vaginosis as markers for endometritis on endometrial biopsy cor- with salpingitis but can cause abdom- histologic endometritis among women relates well, although not completely, inal pain and systemic signs of infection without symptoms of pelvic inflammatory disease. Am J Obstet Gynecol with salpingitis—its positive and nega- even in the absence of classic PID. Some 2003;188:318–23. tive predictive values are around 90%.1 reassurance regarding the long term 4 Wiesenfeld HC, Hillier SL, Krohn MA, et al. Lower Thus, endometritis is commonly asso- sequelae of symptomatic endometritis genital tract infection and endometritis: insight is provided by the PEACH study which into subclinical pelvic inflammatory disease. ciated with salpingitis but either can Obstet Gynecol 2002;100:456–63. occur in isolation. suggests that failure to clear endome- 5 Korn AP, Hessol NA, Padian NS, et al. Risk Does endometritis require treatment? tritis following antibiotic therapy is not factors for plasma cell endometritis among associated with an increased risk of long women with cervical Neisseria gonorrhoeae, Antimicrobial therapy of endometritis cervical Chlamydia trachomatis, or bacterial has been assessed most thoroughly in term sequelae. Endometritis can be a vaginosis. Am J Obstet Gynecol the PEACH study.11 This large rando- distinct clinical syndrome requiring 1998;178:987–90. treatment in those women who are 6 Nelson DB, Ness RB, Peipert JF, et al. mised controlled trial primarily com- Factors predicting upper genital tract pared the efficacy of PID treatment in symptomatic, but evidence for or inflammation among women with lower symptomatic inpatients and outpatients, against active screening and treatment genital tract infection. J Women’s Health of asymptomatic women in the absence 1998;7:1033–40. but also includes data from endometrial 7 Ness RB, Keder LM, Soper DE, et al. Oral biopsies taken at baseline and after of lower genital tract infection is cur- contraception and the recognition of endometritis. 30 days in a subset of patients. Almost rently lacking. Am J Obstet Gynecol 1997;176:580–5. 8 Eckert LO, Hawes SE, Wolner-Hanssen
Load more

Recommended publications
  • The Relations Between Anemia and Female Adolescent's Dysmenorrhea
    Universitas Ahmad Dahlan International Conference on Public Health The Relations Between Anemia and Female Adolescent’s Dysmenorrhea Paramitha Amelia Kusumawardani, Cholifah Diploma Program of Midwifery, Health Science Faculty , University of Muhammadiyah Sidoarjo Article Info ABSTRACT Keyword: Dysmenorrhea described as painful cramps in the lower abdomen that Anemia, occur during menstruation and the infection indications, pelvic disease Dysmenorrhea, moreover in the severe cases it caused fainted. The women who Female adolescents. complained dysmenorrhea problems mostly are who experience menstruation at any age. That means there is no limits age and usually dysmenorrhea often occur with dizziness, cold sweating, even fainted. In some countries the dysmenorrhea problem happens quite high as happened in the United States found 60-91% while in Indonesia amounted to 64.25%. as many as 45-75% of female adolescent experienced dysmenorrhea with the chronic or severe pain that effected to their everyday activities The number of teenagers who experience dysmenorrhea is due to high cases of anemia, irregular exercise, and lack of knowledge of nutritional status. In the previous study there are 85% of female adolescent experience dysmenorrhea. The method of this study is a correlational method with cross sectional approach. The data collecting method examining Hb levels. The population and sample of this study was 40 female adolescent The result showed that the female adolescent who had dysmenorrhea with anemia was 26 (92.4%). From the calculation by Exact Fisher the correlation between anemia and dysmenorrhea cases among female adolescent P <0.05 and p = 0.003, there was significant correlation between adolescent’s dysmenorrhea. Based on the result of statistic analysis, it can be concluded that the anemia can be categorized as one of dysmenorrhea causes.
    [Show full text]
  • Dysmenorrhoea
    [ Color index: Important | Notes| Extra | Video Case ] ​ ​ ​ ​ ​ ​ ​ ​ Editing file link ​ Dysmenorrhoea Objectives: ➢ Define dysmenorrhea and distinguish primary from secondary dysmenorrhea ➢ • Describe the pathophysiology and identify the etiology ➢ • Discuss the steps in the evaluation and management options References : Hacker and moore, Kaplan 2018, 428 boklet ,433 , video case ​ Done by: Omar Alqahtani ​ Revised by: Khaled Al Jedia ​ DYSMENORRHEA Definition: dysmenorrhea is a painful menstruation it could be primary or secondary ​ ​ Primary dysmenorrhea Definition: Primary dysmenorrhea refers to recurrent, crampy lower abdominal pain, along ​ ​ with nausea, vomiting, and diarrhea, that occurs during menstruation in the absence of pelvic pathology. It is the most common gynecologic complaint among adolescent girls. ​ ​ Characteristic: ​ The onset of pain generally does not occur until ovulatory menstrual cycles are established. ​ ​ Maturation of the hypothalamic-pituitary-gonadal axis leading to ovulation occurs in half of the teenagers within 2 years post-menarche, and the majority of the remainder by 5 years post-menarche. (so mostly it’s occur 2-5 years after first menstrual period) ​ • The symptoms typically begin several hours prior to the onset of menstruation and continue ​ ​ for 1 to 3 days. ​ ​ • The severity of the disorder can be categorized by a grading system based on the degree of menstrual pain, the presence of systemic symptoms, and impact on daily activities Pathophysiology Symptoms appear to be caused by excess production of endometrial prostaglandin F2α ​ ​ resulting from the spiral arteriolar constriction and necrosis that follow progesterone withdrawal as the corpus luteum involutes. The prostaglandins cause dysrhythmic uterine contractions, hypercontractility, and increased uterine muscle tone, leading to uterine ischemia.
    [Show full text]
  • Endometritis Caused by Chlamydia Trachomatis
    Br J Vener Dis 1981; 57:191-5 Endometritis caused by Chlamydia trachomatis P-A MARDH,* B R M0LLER,t H J INGERSELV,* E NUSSLER,* L WESTROM,§ AND P W0LNER-HANSSEN§ From the *Institute of Medical Microbiology, University of Lund, Sweden; the tlnstitute of Medical Microbiology, University of Aarhus, Denmark; the *Department of Obstetrics and Gynaecology, Municipal Hospital, Aarhus, Denmark; and the §Department of Obstetrics and Gynaecology, University Hospital, Lund, Sweden SUMMARY Chlamydia trachomatis was found to be the aetiological agent of endometritis in three women with concomitant signs of salpingitis. All patients developed a significant antibody response to the organism. Chlamydia were recovered from aspirated uterine contents of two patients and darkfield examination of histological sections showed chlamydial inclusions in endometrial cells in one patient. Thus, C trachomatis can be recovered from the endometrium of patients in whom the cervical culture result is negative. In one patient curettage showed endometritis with a characteristic plasma-cell infiltration. The occurrence of chlamydial endometritis may explain why irregular bleeding is a common finding in patients with salpingitis. It also suggests a canalicular spread of chlamydia from the cervix to the Fallopian tubes. Introduction hominis and Ureaplasma urealyticum by cotton- tipped wooden sticks. Specimens for the isolation of Chlamydia trachomatis has been associated with N gonorrhoeae from the cervix and rectum were cervicitis' and salpingitis,2 and perihepatitis may collected with cotton-tipped wooden swabs treated occur in women with chlamydial genital infection.3 with charcoal. Salpingitis caused by chlamydia4 and gonococci5 are histologically similar. Gonococcal salpingitis is an Endometrial contents endosalpingitis and the infection spreads to the For the collection of end6metrial contents, a plastic Fallopian tubes from the cervix via the tube (armoured with a mandrin) was introduced endometrium.5 Experimental salpingitis in monkeys through the cervical canal.
    [Show full text]
  • Sexually Transmitted Infections DST-1007 Mucopurulent Cervicitis (MPC)
    Certified Practice Area: Reproductive Health: Sexually Transmitted Infections DST-1007 Mucopurulent Cervicitis (MPC) DST-1007 Mucopurulent Cervicitis (MPC) DEFINITION Inflammation of the cervix with mucopurulent or purulent discharge from the cervical os. POTENTIAL CAUSES Bacterial: • Chlamydia trachomatis (CT) • Neisserria gonorrhoeae (GC) Viral: • herpes simplex virus (HSV) Protozoan: • Trichomonas vaginalis (TV) Non-STI: • chemical irritants • vaginal douching • persistent disruption of vaginal flora PREDISPOSING RISK FACTORS • sexual contact where there is transmission through the exchange of body fluids • sexual contact with at least one partner • sexual contact with someone with confirmed positive laboratory test for STI • incomplete STI medication treatment • previous STI TYPICAL FINDINGS Sexual Health History • may be asymptomatic • sexual contact with at least one partner • increased abnormal vaginal discharge • dyspareunia • bleeding after sex or between menstrual cycles • external or internal genital lesions may be present with HSV infection • sexual contact with someone with confirmed positive laboratory test for STI Physical Assessment Cardinal Signs • mucopurulent discharge from the cervical os (thick yellow or green pus) and /or friability of the cervix (sustained bleeding after swabbing gently) BCCNM-certified nurses (RN(C)s) are responsible for ensuring they reference the most current DSTs, exercise independent clinical judgment and use evidence to support competent, ethical care. NNPBC January 2021. For more information or to provide feedback on this or any other decision support tool, email mailto:[email protected] Certified Practice Area: Reproductive Health: Sexually Transmitted Infections DST-1007 Mucopurulent Cervicitis (MPC) The following may also be present: • abnormal change in vaginal discharge • cervical erythema/edema Other Signs • cervicitis associated with HSV infection: o cervical lesions usually present o may have external genital lesions with swollen inguinal nodes Notes: 1.
    [Show full text]
  • Cervical Erosion As Result of Infectious Vaginitis
    Available online a t www.pelagiaresearchlibrary.com Pelagia Research Library European Journal of Experimental Biology, 2012, 2 (5):1659-1663 ISSN: 2248 –9215 CODEN (USA): EJEBAU Cervical erosion as result of infectious vaginitis Sánchez A1, Rivera A 2* , Castillo F1 and Ortiz S1 1 Departamento de Biología Celular, Facultad de Medicina de la Benemérita Universidad Autónoma de Puebla, México. 2 Centro de Investigaciones en Ciencias Microbiológicas, Instituto de Ciencias de la Benemérita Universidad Autónoma de Puebla. _____________________________________________________________________________________________ ABSTRACT The vulvovaginitis can occur at any stage of life, being 90% of bacterial origin, parasitic and fungal agents such as Chlamydia trachomatis, Gardnerella vaginalis, Trichomonas vaginalis and Candida albicans causing erosion of cervical epithelium, so this study aims to demonstrate that vaginitis infectious agents cause erosion of the cervix of a total of 1033 patients who came to the Laboratorio de Biología Celular de la Facultad de Medicina de la Universidad Autónoma de Puebla, México in January 2001 to December 2009 the Cancer Screening Program which underwent Papanicolaou smears, the samples were stained by the modified Papanicolaou method and observed under a microscope. As for the results of 1033 patients, 378 showed vaginitis, of these, 301 were associated with infectious vaginitis and 77 without identified microorganisms but with signs of vaginitis (probably by irritation to some physical agent or vitamin A deficiency). The microorganisms found in 301 patients with vaginitis were as follows: 173 samples with abundant coccoid flora, 63 associated with flora coccoid and fungi, 37 fungi, 16 trichomonas, 3 coconuts associated with trichomonas, 3 fungi associated with Trichomonas, 2 with Trichomonas, fungi and coccoid, 2 with Gardnerella, 1 coccoid flora, and 1 Gardnerella associated with coconuts .
    [Show full text]
  • Sexually Transmitted Diseases Treatment Guidelines, 2015
    Morbidity and Mortality Weekly Report Recommendations and Reports / Vol. 64 / No. 3 June 5, 2015 Sexually Transmitted Diseases Treatment Guidelines, 2015 U.S. Department of Health and Human Services Centers for Disease Control and Prevention Recommendations and Reports CONTENTS CONTENTS (Continued) Introduction ............................................................................................................1 Gonococcal Infections ...................................................................................... 60 Methods ....................................................................................................................1 Diseases Characterized by Vaginal Discharge .......................................... 69 Clinical Prevention Guidance ............................................................................2 Bacterial Vaginosis .......................................................................................... 69 Special Populations ..............................................................................................9 Trichomoniasis ................................................................................................. 72 Emerging Issues .................................................................................................. 17 Vulvovaginal Candidiasis ............................................................................. 75 Hepatitis C ......................................................................................................... 17 Pelvic Inflammatory
    [Show full text]
  • Fitz-Hugh–Curtis Syndrome
    Gynecol Surg (2011) 8:129–134 DOI 10.1007/s10397-010-0642-8 REVIEW ARTICLE Fitz-Hugh–Curtis syndrome Ch. P. Theofanakis & A. V. Kyriakidis Received: 25 October 2010 /Accepted: 14 November 2010 /Published online: 7 December 2010 # Springer-Verlag 2010 Abstract Fitz-Hugh–Curtis syndrome is characterized by Background perihepatic inflammation appearing with pelvic inflamma- tory disease (PID), mostly in women of childbearing age. The Fitz-Hugh–Curtis syndrome, perihepatitis associated Acute pain and tenderness in the right upper abdomen is the with pelvic inflammatory disease (PID) [1], was first most common symptom that makes women visit the described by Carlos Stajano in 1920 to the Society of emergency rooms. It can also emerge with fever, nausea, Obstetricians and Gynecologists of Montevideo in Uruguay vomiting, and, in fewer cases, pain in the left upper [2]. Ten years later, in 1930, Thomas Fitz-Hugh and Arthur abdomen. It seems that the pathogens that are mostly Curtis took the description of the syndrome one step further responsible for this situation is Chlamydia trachomatis and by connecting the acute clinical syndrome of right upper Neisseria gonorrhoeae. Because of its characteristics, quadrant pain due to pelvic infection with the “violin- differential diagnosis for this syndrome is a constant, as it string” adhesions (Fig. 1) present in women with signs of mimics many known diseases, such as cholelithiasis, prior salpingitis [3, 4]. After having studied several cases of cholecystitis, and pulmonary embolism. The development patients with gonococcal disease, baring these adhesions of CT scanning provided diagnosticians with a very useful between the liver and the abdominal wall, Curtis demon- tool in the process of recognizing and analyzing the strated a couple of years later that these signs are absent in syndrome.
    [Show full text]
  • Non-Sporing Anaerobes
    NON-SPORING ANAEROBES Dr. R.K.Kalyan Professor Microbiology KGMU, Lko Beneficial Role of Commensal non-sporing Anaerobes Part of normal flora, modulate physiological functions Compete with pathogenic bacteria Modulate host’s intestinal innate immune response‰ Production of vitamins like biotin, vit-B12 and K ‰Polysaccharide A of Bacteroides fragilis influences the normal development and function of immune system and protects against inflammatory bowel disease. Lactobacilli maintain the vaginal acidic pH which prevents colonization of pathogens. Non-sporing Anaerobes Causing Disease ‰Anaerobic infections occur when the harmonious relationship between the host and the bacteria is disrupted ‰Disruption of anatomical barrier (skin and mucosal barrier) by surgery, trauma, tumour, ischemia, or necrosis (all of which can reduce local tissue redox potentials) allow the penetration of many anaerobes, resulting in mixed infection Classification of non-sporing anaerobes Gram-positive cocci Gram-negative cocci • Peptostreptococcus •Veillonella • Peptococcus Gram-positive bacilli Gram-negative bacilli •Bifidobacterium • Bacteroides • Eubacterium • Prevotella • Propionibacterium • Porphyromonas • Lactobacillus • Fusobacterium •Actinomyces • Leptotrichia • Mobiluncus Spirochete • Treponema, Borrelia Anaerobes as a part of normal flora Anatomic Total Anaerobic/Aero Common anaerobic al Site bacteria/ bic Ratio Normal flora gm or ml MOUTH Saliva 108–109 1:1 Anaerobic cocci Actinomyces 10 11 Tooth 10 –10 1:1 Fusobacterium surface Bifidobacterium
    [Show full text]
  • Dysmenorrhea
    Pediatric & Adolescent Gynecology & Obstetrics Dysmenorrhea (Painful Periods) Defining Dysmenorrhea Painful menstruation — dysmenorrhea — is the most common menstrual disorder, with up to 90 percent of adolescent women experiencing pain with menses. Dysmenorrhea can be both primary and secondary in cause, and both forms are amenable to treatment. Primary dysmenorrhea is defined as painful menstruation in the absence of specific organic pathology, while secondary dysmenorrhea is related to conditions of the pelvic organs and may become worse over time. When a patient has painful periods, she and her family may be worried that it is a sign of a serious problem, such as cancer, or a threat to their reproductive potential. The vast majority of adolescents presenting with painful menses have primary dysmenorrhea and respond well to medical interventions. Conditions Associated With Secondary Dysmenorrhea Condition Description Endometriosis Tissue that normally lines the inside of the uterus grows outside the uterus, most commonly around the ovaries, intestines or other pelvic organs Müllerian duct anomalies Congenital (developmental) anomalies of the reproductive tract in which menstrual egress may be blocked Adenomyosis Tissue that normally lines the inside of the uterine cavity grows into the muscular wall of the uterus Fibroids Noncancerous growths of the uterus Salpingitis Inflammation of the fallopian tubes Pelvic adhesions Bands of scar tissue that can cause internal organs to be stuck together when they are not supposed to be Determining a Cause Referral Note: For any tests, procedures or imaging that are outside the scope of your regular pediatric or general practice, please refer the patient to Pediatric and Adolescent Gynecology at Nationwide Children’s Hospital.
    [Show full text]
  • The Woman with Postmenopausal Bleeding
    THEME Gynaecological malignancies The woman with postmenopausal bleeding Alison H Brand MD, FRCS(C), FRANZCOG, CGO, BACKGROUND is a certified gynaecological Postmenopausal bleeding is a common complaint from women seen in general practice. oncologist, Westmead Hospital, New South Wales. OBJECTIVE [email protected]. This article outlines a general approach to such patients and discusses the diagnostic possibilities and their edu.au management. DISCUSSION The most common cause of postmenopausal bleeding is atrophic vaginitis or endometritis. However, as 10% of women with postmenopausal bleeding will be found to have endometrial cancer, all patients must be properly assessed to rule out the diagnosis of malignancy. Most women with endometrial cancer will be diagnosed with early stage disease when the prognosis is excellent as postmenopausal bleeding is an early warning sign that leads women to seek medical advice. Postmenopausal bleeding (PMB) is defined as bleeding • cancer of the uterus, cervix, or vagina (Table 1). that occurs after 1 year of amenorrhea in a woman Endometrial or vaginal atrophy is the most common cause who is not receiving hormone therapy (HT). Women of PMB but more sinister causes of the bleeding such on continuous progesterone and oestrogen hormone as carcinoma must first be ruled out. Patients at risk for therapy can expect to have irregular vaginal bleeding, endometrial cancer are those who are obese, diabetic and/ especially for the first 6 months. This bleeding should or hypertensive, nulliparous, on exogenous oestrogens cease after 1 year. Women on oestrogen and cyclical (including tamoxifen) or those who experience late progesterone should have a regular withdrawal bleeding menopause1 (Table 2).
    [Show full text]
  • Chlamydia Trachomatis: an Important Sexually Transmitted Disease in Adolescents and Young Adults
    Chlamydia Trachomatis: An Important Sexually Transmitted Disease in Adolescents and Young Adults Donald E. Greydanus, MD, and Elizabeth R. McAnarney, MD Rochester, New York Chlamydia trachomatis is being recognized as an important sexually transmitted disease in adolescents and young adults. This report reviews the recent literature regarding the many clinical entities encompassed by this organism; this includes urethritis and cervicitis as well as epididymitis, salpingitis, peritonitis, perihepatitis, urethral syndrome, Reiter syndrome, arthritis, endocarditis, and others. It is emphasized that many aspects of chlamydial infections parallel those of gonorrhea, including incidence, transmission, carrier state, reservoir, complications, (local and systemic), and others. A paragonococcal spectrum of sexual chlamydial disorders is discussed as well as effective antibiotic therapy. This micro­ biological agent must always be considered if venereal disease is suspected by the clinician in teenagers or adults. Mixed infections with Chlamydia trachomatis and Neisseria gonor- rhoeae are common in both males and females. It may be preferable to treat gonorrhea with tetracycline to cover for this possibility. Recent reviews1-3 have implicated Chlamydia ically distinct, causing “nonspecific” urethritis or trachomatis as a major cause of sexually transmit­ cervicitis, trachoma, and lymphogranuloma vene­ ted disease (STD) in young adult and presumably reum). adolescent populations in the Western world. The Chlamydia trachomatis infections have been
    [Show full text]
  • Prevention of Salpingitis by a Chlamydia Eradication Control Effort Background
    PREVENTION OF INFERTILITY SOURCE DOCUMENT PREVENTION OF SALPINGITIS BY A CHLAMYDIA ERADICATION CONTROL EFFORT BACKGROUND Chlamydia trachomatis causes about 4 to 5 million infections annually in the U.S.1 Since chlamydia became a reportable disease in the U.S. in 1986, the number of cases in both men and women have increased each year to current rates of 290/100,000 women and 52/100,000 men in 19951. The greater number of reported cases in women than men reflects more widespread screening for chlamydia in women than men and the increase in rates also probably reflect increased screening over this time. The prevalence of chlamydia infection is highest for sexually active women aged 15-21 and declines thereafter. However, based upon serum antibody to chlamydia, women continue to become infected until about age 30 at which time the prevalence of chlamydial antibody plateaus at about 50%. The prevalence of chlamydia infection has ranged widely from 3 to 5% in asymptomatic women to over 20% in women seen in sexually transmitted disease (STD) clinics2. Chlamydia causes well-defined symptomatic infections of the mucosal surfaces of the urethra, cervix, endometrium and fallopian tubes. However, most women with chlamydia have infections at these sites that produce non-specific symptoms or, commonly, no symptoms. It has been demonstrated repeatedly that sexually active populations where little diagnostic testing and specific treatment is being used, the prevalence of infection can reach very high levels because chlamydia is so often asymptomatic. DIAGNOSIS OF CHLAMYDIA Considerable advance has occurred in diagnostic tests for C. trachomatis in the past decade.
    [Show full text]