Hospitalisations for pelvic inflammatory disease in young Aboriginal women living in remote Australia: the role of chlamydia and gonorrhoea

2021 ◽  
pp. sextrans-2021-055242
Author(s):  
Louise Causer ◽  
Bette Liu ◽  
Caroline Watts ◽  
Hamish McManus ◽  
Basil Donovan ◽  
...  
Keyword(s):  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Dual Infection ◽  
Chlamydia Infection ◽  
Local Context ◽  
Published Data ◽  
Aboriginal Women ◽  
Population Attributable Fractions ◽  
Attributable Fractions ◽  
Rate Ratios

ObjectiveAboriginal women living in remote Australia experience a high burden of both chlamydia and gonorrhoea infections and disproportionately high rates of pelvic inflammatory disease (PID). We estimated for the first time the fraction of PID attributable to these infections in young Aboriginal women living in these settings.MethodsUsing published data from two large Australian studies (2002–2013; 2010–2014), we calculated the fraction of emergency department presentations and hospitalisations for PID attributable to chlamydia and/or gonorrhoea infection in Aboriginal women aged 16–29 years living in remote Australia. We used a Monte Carlo simulation to estimate the mean and 95% CIs for the assumed prevalence and population attributable fractions for PID for infection stratifications (chlamydia only, gonorrhoea only and dual infection) as well as for any infection (chlamydia and/or gonorrhoea). Additional outputs were calculated for chlamydia infection with/without gonorrhoea coinfection, and vice versa.ResultsThe prevalence of chlamydia only was 12.9% (95% CI: 11.6% to 14.2%), gonorrhoea only was 7.8% (95% CI: 6.6% to 8.9%) and dual infection was 6.5% (95% CI: 5.8% to 7.2%); rate ratios of PID were 1.9 (95% CI: 1.5 to 2.3), 5.2 (95% CI: 4.3 to 6.4) and 4.6 (95% CI: 3.8 to 5.5), respectively. The overall fraction of PID attributable to chlamydia and/or gonorrhoea was 40.2% (95% CI: 36.0% to 44.4%); any gonorrhoea was 33.4% (95% CI: 29.2% to 37.8%) and any chlamydia was 20.6% (95% CI: 16.9% to 24.6%).ConclusionOur study demonstrates the importance of calculating the fraction of PID related to chlamydia and gonorrhoea in the local context, demonstrating the major contribution gonorrhoea makes to PID hospitalisations among Australian Aboriginal women living in remote settings. To significantly and sustainably reduce the unacceptable rate of PID in this population, strategies are urgently needed to improve timely testing and treatment and recognition and management of PID in primary care.

scholarly journals Cost Effectiveness Analysis of Azithromycin and Doxycycline forChlamydia TrachomatisInfection in Women: A Canadian Perspective

1997 ◽  
Vol 8 (4) ◽  
pp. 202-208 ◽  
Author(s):  
Fawziah Marra ◽  
Carlo A Marra ◽  
David M Patrick
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Hypothetical Cohort ◽  
Chlamydia Infection ◽  
Economic Evaluations ◽  
Base Case ◽  
Diagnostic Strategies ◽  
The Cost

OBJECTIVE: To assess the cost effectiveness of azithromycin versus doxycycline therapy for cervicalChlamydia trachomatisinfections in Canada.DESIGN: A predictive decision analytic model using previously published clinical and economic evaluations, expert opinion and costs of medical care in Canada.POPULATION: A hypothetical cohort of 5000 women followed over 10 years.INTERVENTIONS: Two diagnostic strategies were compared, laboratory confirmed diagnosis (LCD) and presumptive diagnosis (PD) ofC trachomatisinfection. Under each strategy, two treatment alternatives were analyzed, a single 1 g dose of azithromycin and a seven-day course of doxycycline as 100 mg twice daily.RESULTS: Despite a fourfold higher acquisition cost, under base case conditions, for both diagnostic strategies, the azithromycin treatment alternative was more cost effective than the doxycycline alternative. For the LCD model, the cost per cure for patients receiving azithromycin was $184.76 compared with $240.59 for patients receiving doxycycline, resulting in an incremental cost of $55.83. For the PD model, the cost per cure for patients treated with azithromycin was $51.48 compared with $51.82, resulting in an incremental cost of $0.34. For the hypothetical cohort of 5000 women, the use of azithromycin translates into a projected annual cost savings of $279,150 and $1,700 for the LCD and PD models, respectively. In one-way sensitivity analyses for the LCD model, no clinically plausible changes in the base case estimates changed the results of the cost effectiveness outcome. In the PD model, clinically plausible changes in the probabilities of doxycycline cure, pelvic inflammatory disease, sequelae and chlamydia infection were found to alter the cost effectiveness outcome.CONCLUSIONS: Based on the results from our model, the azithromycin strategy should be employed for the treatment of laboratory confirmed cases. However, for presumptive cases, azithromycin should be used only if the probabilities ofC trachomatisand pelvic inflammatory disease are more than 19%, doxycycline effectiveness is less than 78%, or the cost of azithromycin is less than $19.00.

scholarly journals Erroneously Suspected Ovarian Cancer in a 38-Year-Old Woman with Pelvic Inflammatory Disease and Chlamydia

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Romana Brun ◽  
Juliane Hutmacher ◽  
Daniel Fink ◽  
Patrick Imesch
Keyword(s):  
Ovarian Cancer ◽  
Ct Scan ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Transmitted Disease ◽  
Young Patients ◽  
Chlamydia Infection ◽  
Ca 125 ◽  
Abdominal Sonography ◽  
Sexually Transmitted

Chlamydia trachomatis is the most common bacterial cause of sexually transmitted disease and can cause pelvic inflammatory disease (PID), leading to severe outcomes such as ectopic pregnancy, infertility, or pelvic pain. We report a case of a 38-year-old patient with abdominal pain and dyspareunia. Clinical examination revealed diffuse abdominal tenderness. Vaginal and abdominal sonography showed substantial ascites and CA-125 level was elevated. Therefore, the attendant physician performed an abdominal CT scan for further diagnosis. Radiographically diffuse peritoneal enhancement, consistent with peritoneal carcinomatosis, 4-quadrant ascites, and slightly enlarged ovaries with solid and cystic structures were diagnosed, leading to the suspicion of ovarian cancer. In addition, the results of the cervical smear PCR for chlamydia were positive. Due to the positive chlamydia result, the suspicious CT scan, and the young age, we decided to perform a diagnostic laparoscopy as a first step. Intraoperatively, the ovaries were of normal aspect without any cancerous lesions. However, the ascites and the yellow-reddish jelly-like deposits were consistent with acute PID. Thus, chlamydia infection may simulate the presentation of ovarian cancer. Therefore, especially in young patients, we recommend careful scrutiny of every diagnosis of ovarian cancer even if its presentation seems to be typical.

Chlamydia infection, pelvic inflammatory disease, ectopic pregnancy and infertility: cross-national study

2011 ◽  
Vol 87 (7) ◽  
pp. 601-608 ◽  
Author(s):  
N. Bender ◽  
B. Herrmann ◽  
B. Andersen ◽  
J. S. Hocking ◽  
J. van Bergen ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Chlamydia Infection ◽  
National Study ◽  
Cross National Study ◽  
Cross National

Pelvic examination leads to changed clinical management in very few women diagnosed with asymptomatic chlamydia infection

Sexual Health ◽  
2010 ◽  
Vol 7 (4) ◽  
pp. 498 ◽  
Author(s):  
Yi Man Lee ◽  
Anil Samaranayake ◽  
Christopher K. Fairley ◽  
Marcus Y. Chen ◽  
Fiona MacFarlane ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Sexual Health ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Clinical Management ◽  
Chlamydia Infection ◽  
Health Clinic ◽  
Pelvic Examination ◽  
Pelvic Examinations

The present study aimed to determine whether pelvic examinations change clinical management of women with asymptomatic chlamydia infection. Records for women with asymptomatic chlamydia who underwent a pelvic examination at a sexual health clinic in Melbourne, Australia (January 2006 to June 2007) were analysed retrospectively. Of 91 cases, 31 (34%) warranted examination; one woman (1%; 95% confidence interval: 0.5%, 6.4%) had muco-purulent cervicitis and mild tenderness, and was treated for possible pelvic inflammatory disease. These data suggest that a pelvic examination will lead to changes in treatment for very few women diagnosed with asymptomatic chlamydia infection.

scholarly journals Clinical characteristics of genital chlamydia infection in pelvic inflammatory disease

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Sung Taek Park ◽  
Suk Woo Lee ◽  
Min Jeong Kim ◽  
Young Mo Kang ◽  
Hye Min Moon ◽  
...  
Keyword(s):  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Clinical Characteristics ◽  
Chlamydia Infection

scholarly journals Chlamydia infection as a risk factor in ectopic pregnancy: a case control study

2018 ◽  
Vol 7 (10) ◽  
pp. 4254
Author(s):  
Angela George ◽  
Shaila S.
Keyword(s):  
Ectopic Pregnancy ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Case Control Study ◽  
Case Control ◽  
Chlamydia Infection ◽  
Increased Risk ◽  
History Of ◽  
Ectopic Pregnancies ◽  
Control Study

Background: Chlamydia trachomatis has been linked to 30-50% of all ectopic pregnancies, due to irreversible tissue damage.  Hence it is pertinent to explore the risk factors pertaining to Chlamydia infection and ectopic pregnancies. The aim is to study whether Chlamydia infection is a risk factor for ectopic pregnancy in comparison with early intrauterine pregnancy, and study other risk factors in ectopic pregnancyMethods: Case-control study conducted at Sree Avittom Thirunal Hospital, Thiruvananthapuram over a period of six months taking 43 subjects in each group, i.e., cases and controls. An interview followed by collection of venous blood sample was done, which was subjected to Enzyme linked immunoassay test to detect Immunoglobulin G antibodies to Chlamydia. Comparison of qualitative variables such as age, socioeconomic status, history of infertility, history of pelvic inflammatory disease, previous history of ectopic pregnancy, use of IUCD, history of IVF, use of OCP or progesterone only pills and presence of Chlamydia IgG antibodies - between two groups was analyzed by chi-square test and the strength of association expressed in terms of Odds Rati. A p-value <0.05 was considered statistically significant.Results: Out of 86 samples 54 were positive for Chlamydia infection. Subjects with Chlamydia infection had an increased risk of developing ectopic pregnancy. Among the other risk factorshistory of pelvic inflammatory disease and history of infertility were the most significant with Odds of 3.46 and 3.98 respectively. History of oral contraceptive use also had a significant risk associated with developing ectopic pregnancy. Other factors with significant association included, age more than 25 years, Upper Socioeconomic Class, previous ectopic pregnancy and history of IUCD use for more than 5 years.Conclusions: The increased number of Chlamydia infection and its increased risk for developing irreversible sequels such as ectopic pregnancy, it is pertinent to vigilantly diagnose, treat and prevent vaginal infection and pelvic inflammatory disease.

Diagnostik und Therapie der Adnexitis (Pelvic Inflammatory Disease)

2020 ◽  
Vol 77 (4) ◽  
pp. 164-170
Author(s):  
Franziska Siegenthaler ◽  
Elke Krause ◽  
Michael D. Mueller
Keyword(s):  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Diagnostik Und Therapie ◽  
Operative Exploration

Zusammenfassung. Die Adnexitis, im anglo-amerikanischen Sprachgebrauch hat sich der Sammelbegriff Pelvic Inflammatory Disease (PID) durchgesetzt, stellt ein häufiges medizinisches Problem dar. Die Diagnose einer PID kann schwierig sein, da die klinischen Manifestationen unspezifisch sind und sie andere Becken- und Bauchprozesse imitieren können. Infektionen im Bereich der Adnexen können schwerwiegend sein und Langzeitkomplikationen (chronische Unterbauchschmerzen, Infertilität) verursachen, weshalb eine rasche Diagnosestellung und der frühzeitige Beginn einer adäquaten Antibiotika Therapie von grosser Wichtigkeit sind. Unkomplizierte PID haben meistens einen günstigen Verlauf, bei komplizierten Formen mit Tuboovarialabzess ist meist eine operative Exploration notwendig.

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