DOCSLIB.ORG

Sexually Transmitted Infections and Reproductive Tract Infections

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Sexually Transmitted Infections and Reproductive Tract Infections 17 Sexually Transmitted Infections and Reproductive Tract Infections Claudia Hanson and Thérèse Delvaux INTRODUCTION syphilis, genital herpes, chancroids, lymphogranu- loma venereum, granuloma venereum, condylo- Importance of the problem mata acuminata and septic abortion. This chapter Sexually transmitted infections (STIs) are defined as will not include human papilloma virus (HPV) and infections that spread primarily through person-to- cervical cancer (Chapter 26), or HIV (Chapter 18). person sexual contact. However, several of these Other STIs such as hepatitis B which do not cause infections, in particular HIV, syphilis and hepatitis infections of the sexual organs, or post-partum B, can also be transmitted via mother-to-child- infections which are discussed in textbooks of transmission during pregnancy and childbirth, obstetrics, are not included in this chapter. blood products or tissue transfer. There are more than 30 different sexually transmissible bacteria, Epidemiology viruses and parasites1. STIs should be distinguished STIs are a major public health problem in all re- from reproductive tract infections (RTIs). RTIs gions of the world. WHO estimated in 2005 that are defined as infections of the genital organs and about 448 million curable infections occur every include endogenous infections such as bacterial year worldwide in adult men and women7. The vaginosis and vulvovaginitis candidiasis. These two burden of STIs falls primarily on low- and middle- infections are mostly not sexually transmitted and income countries with 110 million in Africa, 71 they can occur in women who have never had a million in South and South-East Asia and 109 mil- sexual relationship. RTIs also include exogenous lion in the Western Pacific regions. In addition infections, such as septic abortion due to unsafe many people are infected with non-curable STIs, procedures and post-partum infections. Thus the mainly viral diseases such as HIV/AIDS, hepatitis B term STIs and RTIs only partly overlap. The con- or genital herpes. About 536 million people aged cept of STI refers to the way of transmission, and 15–49 years were estimated to be living with herpes the concept RTI to the site where the infection simplex virus type 2 worldwide in 20038 (Tables 1 develops. and 2). The following chapter includes selected curable STIs and RTIs based on a synthesis of what is generally discussed in textbooks of gynecology and Table 1 Common curable STIs (2005 WHO estimation) obstetrics and World Health Organization (WHO) publications on STIs as well as treatment guide- Million cases lines. Treatment advice is based on WHO treat- per year 2,3 4,5 ment guidelines and Cochrane reviews , and is Gonorrhea (Neisseria gonorrhoeae) 88 restricted to drugs listed in the Interagency List of Chlamydia infection (Chlamydia trachomatis) 101 Essential Medicines for Reproductive Health6. Syphilis infection (Treponema pallidum) 11 The STIs discussed in this chapter include bacte- Trichomoniasis (Trichomonas vaginalis) 204 rial vaginosis, trichomoniasis, candidiasis, chlamy- Chancroid (Haemophilus ducreyi) 6 dia, gonorrhea, pelvic inflammatory disease (PID), 183 GYNECOLOGY FOR LESS-RESOURCED LOCATIONS Table 2 Common viral infections of interest in who have had PID are six to ten times more likely gynecology and obstetrics to have an ectopic (tubal) pregnancy than those HIV/AIDS (human immuno- 2.6 million new who have not had one. deficiency virus) infections in 2009 Moreover, untreated STIs are associated with congenital and perinatal infections in neonates. Genital herpes (herpes simplex 23.6 million new Particularly, early untreated maternal syphilis infec- virus type 2) infections in 2003 tion causes stillbirth and neonatal deaths resulting Genital warts (HPV in an overall perinatal mortality of 40%. predominantly types 6 and 11) Up to 35% of pregnancies among women with HPV types 16 and 18 Prevalence of 12% in untreated gonococcal infection result in spontane- women aged >15 years; ous abortions and premature deliveries, and up to 530,000 cases of cervical 10% in perinatal deaths. Up to 50% of children cancer every year born to mothers with untreated gonorrhea and 30% of children born to mothers with untreated HPV, human papillomavirus chlamydial infection will develop a serious eye in- fection or conjunctivitis (ophthalmia neonatorum). This is, however, easily preventable1. Untreated STIs, excluding HIV, are estimated to account for 17% of the economic loss due to MANAGEMENT AND TREATMENT disease. Most importantly, for both men and OF SYMPTOMATIC SEXUALLY women, STIs are associated with an increased risk TRANSMITTED INFECTIONS AND of both acquisition and transmission of HIV. The REPRODUCTIVE TRACT INFECTIONS risk of HIV transmission is about two to five times higher in people with an STI, highest in people Sexually transmitted infection syndromes with an ulcerative STI9,10 (level 1 evidence). Re- and the syndromic approach to patient cent evidence suggests that genital herpes (herpes management simplex 2) may be responsible for fuelling a large Although many different pathogens cause STIs or part of HIV infection11 (level 1 evidence). RTIs, many have a similar or overlapping clinical STIs are more frequent in young women than appearance, known as signs (what the individual or men and more frequent in low-income countries the healthcare provider sees on examination) and where diagnostics and treatment are limited. symptoms (what the patient feels, such as pain or Reasons discussed for the high prevalence of STIs itching). Signs and symptoms can help health pro- in low-income countries are demographic factors viders make a diagnosis. For example, profuse, (more young people), urbanization, migrant labor, purulent, malodorous vaginal discharge is seen in prostitution, concurrent partnerships, lack of access trichomoniasis. But vaginal discharge is also seen in to quality care for STIs, and for prevention efforts, infections other than STIs, such as bacterial vagino- including screening programs12. sis and vulvovaginal candidiasis. Often more than Another important factor is that a number of one etiological cause/microbe is involved in the in- STIs are asymptomatic which hampers control fection. Gonorrhea and Trichomonas alter the dis- efforts. For example, up to 70% of women and a charge. Thus the signs and symptoms are often not significant proportion of men with gonococcal specific enough to make an etiological diagnosis. and/or chlamydial infections may experience no The traditional method (and gold standard) for symptoms at all (see also section on ‘Management diagnosing a specific STI/RTI is by laboratory of asymptomatic STIs/RTIs: screening’). tests. But, tests for STIs are mostly not available at first-line health facilities and often not at district Common complications of sexually hospital level in low-resource settings. Some transmitted infections laboratory investigations for diagnosing STIs are Besides the higher risk of HIV infection, STIs cause expensive or demand advanced techniques. That many serious complications. Particularly, untreated is why WHO has recommended a syndromic chlamydial infection is estimated to be the cause of approach to diagnosis and management of STIs in at least a third of female infertility. Also, women low- and middle-income countries since the 1990s 184 Sexually Transmitted Infections and Reproductive Tract Infections and it has been the approach of choice since then in charts are promoted to assist health workers to most settings. The approach is based on a group of decide on the best treatment (Figures 1 and 2). symptoms and easily recognizable signs associated Training modules prepared by WHO are available with a number of well-defined etiologies. There in different languages3 and many countries have is much evidence, that syndromic management is adapted them to the locally observed resistance effective for treating STIs and has an impact on the patterns of STIs. STI epidemic. Dramatic declines in STI rates have The advantage of using this signs and symptom- been observed following the introduction of con- based approach is that the management of STIs is trol measures based on the syndromic approach13. not dependent on laboratory investigations, which Common symptoms and signs (syndromes) are: are not available in many first-line health facilities. Moreover not only specialists but also clinicians • Urethral discharge in men and nurses can treat patients effectively. However, • Genital ulcer syndromic management is not unanimously • Inguinal bulbo supported. Syndromic management of STIs has • Scrotal swelling been reviewed as being generally effective in treat- • Vaginal discharge ing urethral discharge and genital ulcer disease STIs • Lower abdominal pain in women in men14 (level 1 evidence). The main challenges • Neonatal conjunctivitis. are vaginal discharge and PID in women, as the The syndromic approach is a scientifically derived syndromes and signs are less specific13. approach. The antimicrobial regimens are chosen Another big challenge for the control of STIs is to cover major pathogens responsible for the syn- that infections are often asymptomatic. Syndromic dromes in a specific geographical area. Thus guide- management is not suitable for treating asympto- lines differ from country to country in accordance matic infections that require a screening approach. with epidemiological pattern of STIs and resistance Unfortunately, screening is not available at most to antibiotic therapy; this is why there is not
Load more

Recommended publications
  • Pattern of Microbial Flora in Septic Incomplete Abortion in Port Harcourt, Nigeria. Type of Article: Original
    Pattern of Microbial Flora in Septic Incomplete Abortion in Port Harcourt, Nigeria. Type of Article: Original Vaduneme .K. Oriji*, John .D. Ojule*, Roseline Iwoama** Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt* and Braithwaite Memorial Specialist Hospital**, Port Harcourt. Port Harcourt is an urban city in Nigeria. Current Nigeria ABSTRACT Demographic and Health Survey (NDHS)8 estimates that Background: Septic abortion occurs when there is 47% of the females in the reproductive age resides in the colonization of the upper genital tract by micro organisms urban areas and only 10% of women in this age group are following termination of pregnancy usually before the age currently using modern contraceptive method. The of viability. This can result from ascending infections from incidence of unwanted pregnancy amongst women in Port the lower genital tract or direct inoculation of micro Harcourt is therefore anticipated to be high. Induced organisms from contaminated and poorly sterilized abortions are still illegal in Nigeria and are largely procured instruments at the evacuation of the uterus in incomplete in clandestine manner9, in unhygienic places making it abortion or during unsafe abortion. Septic abortion is unsafe. The microbial flora commonly implicated in septic accompanied by significant morbidity, cost and maternal abortion, are micro-organisms that colonized the cervix death in Nigeria. Knowledge of the microbial flora causing and vagina prior to or during the abortive process. The septic abortion is important in the prevention and micro-organisms introduced into the uterus from the use of treatment of this condition. The aim of this study is to poorly sterilized instruments, during the process of identify the common micro organisms present in the evacuating the uterus as treatment for incomplete abortion endocervix and posterior vaginal fornix in patients with or at induced abortion, are also implicated.
    [Show full text]
  • Post-Abortion Care Curriculum Was Developed After Wide Consultation with Individuals and Organisations Involved in Reproductive Healthcare Globally
    CLINICAL TRAINING for Post-Abortion REPRODUCTIVE HEALTH in EMERGENCIES Care PARTICIPANT GUIDE ACKNOWLEDGEMENTS This Post-abortion Care Curriculum was developed after wide consultation with individuals and organisations involved in reproductive healthcare globally. RAISE would like to thank the following people for their contribution, during the development of this curriculum: 1. Ms. Miriam Wagoro, University of Nairobi, School of Nursing Sciences 2. Dr. Gathari Ndirangu, Kenyatta National Hospital 3. Ms. Jemimah Khamadi, Shekhinah Consultancy & Consulting Services 4. Dr. Solomon Orero, Reproductive Health Expert 5. Dr. B. Omuga, University of Nairobi, School of Nursing Sciences 6. Dr. Musili, Consultant Obstetrics/Gynaecology Pumuani Hospital 7. Mr. Richard Maweu, Ministry of Health, Kenya 8. Dr. Emily Rogena, University of Nairobi, Department of Pathology 9. Mr. Hadley Muchela, Liverpool VCT Care & Treatment, Kenya 10. Dr. Boaz Otieno Nyunya, Moi University, Department of Reproductive Health 11. Dr. Fred Akonde, RAISE, Nairobi 12. Ms. Pamela Ochieng, RAISE, Nairobi 13. Ms. Lilian Mumbi, RAISE, Nairobi RAISE Initiative. Post-Abortion Care: Participant Guide. Clinical Training for Reproductive Health in Emergencies. Reproductive Health Access Information and Services in Emergencies Initiative. London, Nairobi and New York, 2009. Design and production: Green Communication Design inc. www.greencom.ca TABLE OF CONTENTS ACRONYMS 3 INTRODUCTION 4 INTRODUCTIONTOTHISTRAININGCOURSE 5 OVERVIEW���������������������������������������������������������������������������������������������������
    [Show full text]
  • 6. Aftercare and Contraception
    6. AFTERCARE AND CONTRACEPTION This chapter will help you to provide routine aftercare and contraception following first trimester uterine aspiration. CHAPTER LEARNING OBJECTIVES Following completion of this chapter, you should be better able to: □ Appropriately prescribe post-procedure medications. □ Provide post-procedure counseling, including instructions about home care, warning signs for complications, and emergency contact information. □ Describe post-aspiration contraceptive options and contraindications to specific methods. READINGS / RESOURCES □ National Abortion Federation (NAF). Management of Unintended and Abnormal Pregnancy (Paul M. et al, Wiley-Blackwell, 2009) • Chapter 14: Contraception and surgical abortion aftercare □ Useful handouts for physicians and patients: • Reproductive Health Access Project: www.reproductiveaccess.org • RHEDI: http://rhedi.org/patients.php □ Related Chapter Content: • Chapter 5: Delayed post-procedure complications • Chapter 7: Medication abortion follow-up visit • Chapter 8: Early pregnancy loss follow-up visit SUMMARY POINTS SKILL • Providing women with instructions for home care, medications, contraception, warning signs for complications, and emergency contact information may help minimize patient stress, phone calls, and the need for a routine follow-up appointment following aspiration. • A critical component of abortion care involves contraceptive counseling, method selection, and timing of initiation. SAFETY • Be familiar with the medical eligibility criteria for safely initiating contraceptive methods for women with medical conditions. ROLE • Women with a history of abortion remain at risk for unintended pregnancy; 47% of procedures are repeat procedures. • Starting contraception on the day of uterine aspiration increases initiation and adherence to the method. • Most women are candidates for long acting reversible contraceptives (LARC, including IUDs and implants), which are highly effective, can be placed the day of aspiration, have no estrogen, and users have lower rates of repeat abortion.
    [Show full text]
  • Septic Abortion and Maternal Mortality: Report of a Case
    Septic abortion and maternal mortality: A bortion, septic Report of a case NORMAN F. C. BAKER, D.O. Union, New Jersey Septic abortion is a major cause cause of abortion and present a case illustrat- of maternal mortality. In the case ing some of the classic findings. reported here the patient Report of a case died in spite of antibiotic therapy. The A 36-year-old white woman, gravida VI, para 36-year-old woman presented 3-0-2-3, was admitted to the emergency room with heavy vaginal bleeding. The of Riverside Osteopathic Hospital at 8: 00 a.m. gestational age was estimated on April 26, 1967. She complained of vaginal to be 12 weeks. Dilatation and curettage bleeding associated with backache, uterine increased the suspicion of cramping, and dyspnea. She considered the bleeding to be heavy and stated that it had discrepancy between the reported begun spontaneously approximately 4 hours gestational age and actual fetal prior to admission; cramping had ensued short- size. Blood cultures were reported as ly after the onset of bleeding. Dyspnea began growing Aerobacter aerogenes at the time of admission. The first day of the and anaerobic beta Streptococcus, and last menstrual period was estimated as Febru- antibiotic therapy was adjusted ary 2, 1967, the estimated gestational age be- ing 12 weeks. The pregnancy had been un- accordingly. In spite of intensive eventful until this date; we were unable to therapy, oliguria and cardiac elicit any history of criminal intervention. failure developed and the patient died. However, there was some language barrier making interrogation difficult; further, the patient was somewhat disoriented.
    [Show full text]
  • Chlamydophila Abortus Pelvic Inflammatory Disease
    DISPATCHES chronic abdominal pain, increased vaginal discharge, and Chlamydophila unusually heavy menses. Her medical record showed two uncomplicated pregnancies, followed by an aseptic abor- abortus Pelvic tion in the second trimester, a further uncomplicated preg- nancy, and two first-trimester miscarriages. Since adoles- Inflammatory cence, the patient had experienced lower abdominal com- plaints, including menstrual irregularities, urinary symp- Disease toms, and unspecific vaginal discharge. Repeated treat- ment of mycosis and infections of the urinary tract did not Gernot Walder,* Herwig Meusburger,† lead to substantial clinical improvement nor did sympto- Helmut Hotzel,‡ Albrecht Oehme,§ matic treatment with corticosteroids or with Lactobacillus Walter Neunteufel,† Manfred P. Dierich,* acidophilus. Her condition was exacerbated after a copper- and Reinhard Würzner* containing intrauterine device was inserted in 1999. We report the first documented case of an extragesta- Episodes of lower abdominal pain became more frequent tional infection with Chlamydophila abortus in humans. The and more severe. They were accompanied by fatigue, gen- pathogen was identified in a patient with severe pelvic eral malaise, and sometimes by elevated temperature. Her inflammatory disease (PID) by sequence analysis of the menses became increasingly heavy, finally resulting in 10 ompA gene. Our findings raise the possibility that days of heavy bleeding. Clinical investigation on admis- Chlamydiaceae other than Chlamydia trachomatis are sion showed lower abdominal tenderness, cervical motion involved in PID. tenderness, and bilateral adnexal tenderness, more promi- nent on the right. The patient had signs of compensatory hlamydophila (Cp.) abortus, whose strains are nearly hypochromic anemia, which was attributable to menorrha- C100% conserved in ribosomal and ompA genes, has gia.
    [Show full text]
  • Dilatation and Curettage Versus Manual Vacuum Aspiration for First Trimester Clandestine Abortions
    International Journal of Reproduction, Contraception, Obstetrics and Gynecology Nkwabong E et al. Int J Reprod Contracept Obstet Gynecol. 2015 Jun;4(3):716-720 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 DOI: 10.18203/2320-1770.ijrcog20150079 Research Article Dilatation and curettage versus manual vacuum aspiration for first trimester clandestine abortions Elie Nkwabong*, Joseph Nelson Fomulu Department ofof Obstetrics & Gynecology, Faculty of Medicine and Biomedical Sciences/University Teaching Hospital, Yaoundé, Cameroon Received: 20 March 2015 Revised: 31 March 2015 Accepted: 09 May 2015 *Correspondence: Dr. Elie Nkwabong, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Unintended pregnancy rate is rising worldwide and most of these pregnancies end by clandestine abortion. This study aimed at comparing complications of clandestine abortions done with Manual Vacuum Aspiration (MVA) to those of clandestine abortions done with Dilatation and Curettage (D&C). Methods: This retrospective descriptive study was carried out in the Yaoundé University Teaching Hospital (Cameroon) from March 1st to August 31st, 2012. Abortions carried out with MVA or D&C were recruited. Main variables studied were abortionist, method used, complications presented and hospital stay. Data were analyzed using SPSS 18.0. Analyses included the t test and the Fisher exact test. The level of significance was P <0.05. Results: Main abortionists were nurses and general practitioners.
    [Show full text]
  • Clinical Information
    NAME OF MEDICINAL PRODUCT Augmentin 250mg/31.25mg QUALITATIVE AND QUANTITATIVE COMPOSITION Strength1 Strength (co-amoxiclav) Ratio (amoxicillin/clavulanate) (amoxicillin:clavulanate) Powder for oral suspension (in sachets) 250/31.25 mg 281.25 mg 8:1 1 Amoxicillin is present as amoxicillin trihydrate. Clavulanate is present as potassium clavulanate. Excipients • Silicon Dioxide, Crospovidone, Lemon-Peach-Strawberry Dry Flavour, Aspartame. CLINICAL INFORMATION • General description Amoxicillin-clavulanate (beta-lactam antibacterial penicillin coformulated with a beta- lactamase inhibitor) is an antibiotic agent with a notably broad spectrum of activity against the commonly occurring bacterial pathogens in general practice and hospital. The beta-lactamase inhibitory action of clavulanate extends the spectrum of amoxycillin to embrace a wider range of organisms, including many resistant to other beta-lactam antibiotics. Indications Amoxicillin-clavulanate should be used in accordance with local official antibiotic- prescribing guidelines and local susceptibility data. • Adult formulations Amoxicillin-clavulanate is indicated for short term treatment of bacterial infections at the following sites when caused by amoxicillin-clavulanate-susceptible organisms: Page 1 of 17 - Upper respiratory tract infections (including ENT) e.g. recurrent tonsillitis, sinusitis, otitis media, typically caused by Streptococcus pneumoniae, Haemophilus influenzae#, Moraxella catarrhalis# and Streptococcus pyogenes. - Lower respiratory tract infections e.g. acute
    [Show full text]
  • THE MANAGEMENT of SEPTIC ABORTIO at GROOTE SCHUUR HOSPITAL* ERIC It
    22 November 1969 S.A. TVDSKRIF VIR OBSTETRIE E GINEKOLOGIE 7 THE MANAGEMENT OF SEPTIC ABORTIO AT GROOTE SCHUUR HOSPITAL* ERIC It. STRASBURG. M.B., B.CH. (RAND), M.R.C.O.G. A 0 DE MS A. DAVEY, PH.D.. F.R.C.O.G., Department of Obstetrics and Gynaecology, Groote Sch/l/lr Hospital and University of Cape Town 'Sooner or later, i,nsensibly, unconsciously, the iron yoke and septic abortion with septic shock and/ or renal of conformity is upon our necks; and in our minds. as failure as manifest at Groote Schuur Hospital (ee in our bodies, the force of habit becomes irresistible.' Appendix).' Its basic theme is to stimulate an awarene WiLliam OsIer, Harveian Oration 1906 of the potential dangers in these patients and by 0 doing Septic abortion is one of the commonest of gynaecological to obviate them. diseases and is one of the commonest causes of maternal death. Septic incomplete abortion, often complicated by TABLE 11. MORTALITY RATES FOLLOWING ABORTION REPORTED EL [- septic shock and/or renal failure, accounted for approxi­ WHERE mately one-third of the admissions to Groote Schuur No. of No. of Mortality Hospital in the years 1960 - 1967. There were on an Author Years abortions Type deaths rate % average 4 - 5 deaths per year. The number of abortions Studdiford 1940-49 4,129 Combined I 1·08 treated, together with the incidence of deaths per total Burnetl 1946-50 2,322 Combined 4 0·09 Burnett 1946--50 267 Septic 2 0·75 number of abortions within this period, was as set out in Ramsay 195&--55 995 Septic 4 0·40 Table I.
    [Show full text]
  • Management of Miscarriage and Early 2Nd Trimester Intrauterine Fetal Demise
    1/31/19 SJH Management of Miscarriage and Early 2nd Trimester Intrauterine Fetal Demise Summary & Recommended Management: Overview SAB = approx. 25% of pregnancies Most common 1st tri complication 50% chromosomal Unlikely to be recurrent Usually unexplained and not preventable Modifiable RF: tobacco and substance cessation, folate supplementation, optimization of chronic medical conditions (e.g. improved BG control in DM) Options Expectant, medical, and surgical Hemorrhage and infection rates low for all groups No difference in future birth rates Expectant >80% will complete w expectant management alone May require follow up for 4wks or more to complete Antibiotics not needed Success with completion likely decreasing with increasing GA, especially beyond 8wks Medical Up to 90% success w medical management Ideal dose not known, misoprostol 800mcg PV or buccal may be the most efficient Mifepristone 200mg PO 24hrs before misoprostol administration should be considered if available An additional 800mcg misoprostol dose may be repeated 3hrs to 7days after initial misoprostol Increased success with higher misoprostol doses, more time, and lower GA Antibiotics not needed Confirmation of complete SAB may be a clinical diagnosis, no clear US criteria exist Surgical Successful >99%, immediate resolution D+C <14wks, D+E >/=14wks GA US assist intraoperatively may help if: anomalies, challenging dilation, perforation suspected, concern about incomplete procedure, later GA US recommended at D+E, especially for less-experienced
    [Show full text]
  • Prevention of Infection After Induced Abortion Release Date October 2010 SFP Guideline 20102
    Contraception xx (2011) xxx–xxx Clinical Guidelines Prevention of infection after induced abortion Release date October 2010 SFP Guideline 20102 Abstract One known complication of induced abortion is upper genital tract infection, which is relatively uncommon in the current era of safe, legal abortion. Currently, rates of upper genital tract infection in the setting of legal induced abortion in the United States are generally less than 1%. Randomized controlled trials support the use of prophylactic antibiotics for surgical abortion in the first trimester. For medical abortion, treatment-dose antibiotics may lower the risk of serious infection. However, the number-needed-to-treat is high. Consequently, the balance of risk and benefits warrants further investigation. Perioperative oral doxycycline given up to 12 h before a surgical abortion appears to effectively reduce infectious risk. Antibiotics that are continued after the procedure for extended durations meet the definition for a treatment regimen rather than a prophylactic regimen. Prophylactic efficacy of antibiotics begun after abortion has not been demonstrated in controlled trials. Thus, the current evidence supports pre-procedure but not post-procedure antibiotics for the purpose of prophylaxis. No controlled studies have examined the efficacy of antibiotic prophylaxis for induced surgical abortion beyond 15 weeks of gestation. The risk of infection is not altered when an intrauterine device is inserted immediately post-procedure. The presence of Chlamydia trachomatis, Neisseria gonorrhoeae or acute cervicitis carries a significant risk of upper genital tract infection; this risk is significantly reduced with antibiotic prophylaxis. Women with bacterial vaginosis (BV) also have an elevated risk of post-procedural infection as compared with women without BV; however, additional prophylactic antibiotics for women with known BV has not been shown to reduce their risk further than with use of typical pre-procedure antibiotic prophylaxis.
    [Show full text]
  • The Global Burden of Unsafe Abortion in the Year 2000
    The global burden of unsafe abortion in the year 2000 Elisabeth Åhman1, Carmen Dolea2, Iqbal Shah1 1. Introduction The term “abortion” covers a variety of conditions arising during early pregnancy, from ectopic pregnancy and hydatidiform mole, through to spontaneous and induced abortion. There are important differences in the dimensions and nature of deaths and disabilities resulting from different kinds of abortion1. Ectopic pregnancy is defined as the implantation of the fertilised ovum outside the uterine cavity, usually in the fallopian tubes. Risk factors associated with ectopic pregnancy are: pelvic inflammatory disease, sexually transmitted disease, history of ectopic pregnancy, in vitro fertilisation, and elderly parity. Epidemiological data on ectopic pregnancy are scarce, and the way the results are presented render the comparability of studies difficult (the denominator varies from live births, to pregnancies, or deliveries, or still and live births etc.).1 However, some countries have reported an increased trend in the incidence of ectopic pregnancy (US, UK), which may not entirely be attributed to improved methods to diagnose early pregnancy.2,3 Studies in Sweden have demonstrated that the epidemiology of ectopic pregnancy mirrors the epidemiological trends of pelvic inflammatory disease and of some sexually transmitted diseases.4,5 Other small-scale studies also showed that women with ectopic pregnancy have evidence of previous or current genital Chlamydia trachomatis infection, underlining the importance of this microorganism
    [Show full text]
  • Septic Abortion Felicity Ashworth
    8. Septic Abortion Felicity Ashworth The term septic abortion describes the occurrence of infection developing in or around the uterus during or after an abortion. The genital tract is particularly susceptible to infection at this time and sepsis is often, but not always, consequent to attempts to cause abortion by untrained persons using non-sterilised instru­ ments. The incidence of sepsis complicating an incomplete abortion varies between countries and reported series are given in Table 8.1. Munday et al. (1989) report that there were 3050 women discharged from hospitals in the UK with the diagnosis of septic abortion in 1965 compared to only 390 in 1982. Figures from New Zealand (Shepherd and Benny 1984) show a reduction from 6% of all abortions being septic in 1962 to less than 1% in 1979. The incidence of septic abortion has declined in countries where the operation of termination of pregnancy has been legalised and women have more ready access to these services. Table 8.1. Incidence of incomplete abortion complicated by sepsis Author Country Incidence (%) Adetoro (1986) Nigeria 12 Aggarwal and Mati (1980) Kenya 16 Barnes and Ulfelder (1964) USA 14 Botes (1973) South Africa 5.8-34 Munday et al. (1989) UK below 1 Shepherd and Benny (1984) New Zealand below 1 Relevance of Septic Abortion to Maternal Mortality Statistics Deaths from abortion, and particularly septic abortion, contribute significantly to a country's maternal mortality. In England and Wales the most dramatic decline I. Stabile et al. (eds.), Spontaneous Abortion © Springer-Verlag London Limited 1992 120 Septic Abortion in maternal mortality followed the introduction of the Abortion Act in 1967.
    [Show full text]